Has Routine Outcome Monitoring Implementation Caught Up with the Science?

There is compelling evidence from randomized clinical trials (RCT) that routine outcome monitoring (ROM) improves outcomes and reduces dropouts. In addition, benchmarking studies have suggested outcomes in the real world comparable to RCTs when ROM is implemented. Only two systems have RCT support, Lambert’s Outcome Questionnaire System and the Partners for Change Outcome Management System (PCOMS). Eight of the nine RCTs that support PCOMS have been conducted by the Better Outcomes Now (BON) team of Duncan, Reese, Chapman, and colleagues.

The Bad News

But has practice caught up with the science of ROM? Unfortunately, no. A recent study (Jensen-Doss et al., 2018) of social workers, counselors, and marriage and family therapists (n = 504) delivered the bad news.  Only 13.9% of participants reported the use of standardized progress measures (like the Outcome Rating Scale). When asked about how often they would like to administer these measures, nearly 25% of participants said they would like to gather frequent progress data. However, only 6.8% said they would prefer administering them every 1–2 sessions and 45% said they would prefer to not gather any progress data. Thus, consistent with prior studies of psychologists, these data indicate very low rates of ROM among social workers, mental health counselors, and marriage and family therapists.

But things are changing. First, all three behavioral health accreditation bodies, the Council on Accreditation (COA), the Commission on Accreditation of Rehabilitation Facilities (CARF), and the Joint Commission, now require some form of client-generated outcome management. In the public domain, accreditation is required for reimbursement so the upcoming cycles of accreditation visits will likely result in increased ROM implementation beyond that reported above. And second, graduate training programs are increasingly inclusive of ROM training.

Why So Few?

Why do so few clinicians currently practice ROM? Bottom line: Feasibility is critical to practitioner acceptance. Most studies of ROM implementation cite barriers related to the time of administration and the overall burden to front-line staff (Ionita et al., 2021). In tandem with utilizing brief measures and web-based technology, a recent study (Cooper et al., 2020) reported that intensive, long-term clinician training and support to be a critical factor affecting ROM implementation and adoption.

PCOMS And BON Deliver

PCOMS and BON deliver on both counts. PCOMS consists of the most feasible, psychometrically validated measures on the planet (just 4 items) and BON contains a full curriculum for training therapists and supervisors, including client videos. And the BON team is responsible for the scientific credibility of PCOMS. Find out how all this translates to superior outcome management software. Ask for a free trial today.