PhD/PsyD Tracking outcomes in private practice

[calimich]

Do any of y’all use tracking tools in pp? When I was at a counseling center each client was administered the CCAPS before each session and we quickly reviewed it before seeing them. I found it helpful.

Now in pp I often receive offers for similar online tools, like from myoutcomes.com. Anyone have experience with them, or other similar platforms for use in pp?

---

Members don't see this ad.

 

[LadyHalcyon]

I've used the ORS/SRS

FIT Software Tools – Measure Outcomes

The Therapeutic Outcome Management System (TOMS)

Do any of y’all use tracking tools in pp? When I was at a counseling center each client was administered the CCAPS before each session and we quickly reviewed it before seeing them. I found it helpful.

Now in pp I often receive offers for similar online tools, like from myoutcomes.com. Anyone have experience with them, or other similar platforms for use in pp?

 

[calimich]

In private practice? How do you administer it?

 

[LadyHalcyon]

There are a couple different ways it can be administered. I'm pretty sure it can be input straight into a computer or you can laminate this sheet and track the data manually. Attached is a laminated sheet I have in my office. Basically the pt marks a line on the scale and you use a ruler to measure it, then input the data and the program tracks it for you. I like this one because the SRS tracks the relationship between patient and therapist.

I have also used the OQ analyst in a private practice. We would bring pt's back to an assessment computer and fill it out at the beginning of each session. Their answers are tracked by the program and the program tracks whether they are making progress.

Lambert, M. J. (2012). Helping clinicians to use and learn from research-based systems: The OQ-analyst. Psychotherapy, 49(2), 109-114.
http://dx.doi.org/10.1037/a0027110

In private practice? How do you administer it?

 

[PsyDr]

I would HIGHLY recommend considering the liabilities associated with using outcome measures.

 

[LadyHalcyon]

I would HIGHLY recommend considering the liabilities associated with using outcome measures.

Interesting. They seem to have failed to mention that aspect of outcome measures while I was in training.

 

[PsyDr]

Interesting. They seem to have failed to mention that aspect of outcome measures while I was in training.

Examples:

1) Patient reports something in the measure, but denies it in session. There is an adverse outcome. Guess how the trier of fact weighs a piece of paper saying "X is going to happen" when X does happen.

2) Measures show no improvement. Third party payor audits that file, and requests repayment for inappropriate care.

3) Third party payor refuses to pay for that many units of testing. In audit, they show that because the measure takes 15 minutes, the appropriate CPT code is a shorter session. And ask for money back.

 

[calimich]

Perhaps more of a philosophical question:

How do we reconcile what PSYDR shares with the trend toward evidence-based practice?

 

[Sanman]

Perhaps more of a philosophical question:

How do we reconcile what PSYDR shares with the trend toward evidence-based practice?

Well, evidence-based practice does not mean measuring every outcome. It also depends on the payor source. The only outcome that matters in self-pay is whether the customer is happy with services rendered.

 

[LadyHalcyon]

I do like the SRS I mentioned previously bc it only takes 30 seconds and the SRS measures what they thought about the session. Also, the ORS (the picture I attached) also only takes 30 seconds and does not ask specific questions regarding suicide/self-harm etc

Perhaps more of a philosophical question:

How do we reconcile what PSYDR shares with the trend toward evidence-based practice?

 

[AbnormalPsych]

Not sure that the patient's perception of and reliance on their subjective measurement of various constructs (that may or may not have anything to do with therapeutic improvement) have anything to do with evidence-based practice.

"EBP is traditionally defined in terms of a "three legged stool" integrating three basic principles: (1) the best available research evidence bearing on whether and why a treatment works, (2) clinical expertise (clinical judgment and experience) to rapidly identify each patient's unique health state and diagnosis, their individual risks and benefits of potential interventions, and (3) client preferences and values."

In general, I like to check-in with my patients on their progress, and use my judgement. I don't need them to fill out more forms. I have actually used such forms in the past for weekly visits (required by an employer) and had patients tell me towards the end of treatment they just randomly filled them out most of the time.

 

[MCParent]

Not sure that the patient's perception of and reliance on their subjective measurement of various constructs (that may or may not have anything to do with therapeutic improvement) have anything to do with evidence-based practice.

"EBP is traditionally defined in terms of a "three legged stool" integrating three basic principles: (1) the best available research evidence bearing on whether and why a treatment works, (2) clinical expertise (clinical judgment and experience) to rapidly identify each patient's unique health state and diagnosis, their individual risks and benefits of potential interventions, and (3) client preferences and values."

In general, I like to check-in with my patients on their progress, and use my judgement. I don't need them to fill out more forms. I have actually used such forms in the past for weekly visits (required by an employer) and had patients tell me towards the end of treatment they just randomly filled them out most of the time.

Have you read the PCOMS outcome studies? The effect sizes are gigantic.

 

[foreverbull]

I’d be curious to see if better outcomes via PCOMS indirectly shows evidence of just the general effectiveness of interpersonal approaches/relational interventions (checking in with clients about their thoughts/feelings about therapy regularly via their scores), and also indirectly, the alliance.

I regularly assess via asking clients how they feel therapy is progressing, and give them the direct invitation to let me know if things aren’t working in therapy, etc. because I know that without that open invitation, some folks will be more hesitant to share concerns, which is part of alliance-building.

Is it possible that therapists providing TAU in these studies aren’t using interpersonal approaches in the first place so there’s no interpersonal feedback happening at all (or a minimal amount), or did they also use interpersonally-based therapists as controls in the studies to better match this open/bidirectional dialogue about therapy but without a standard form of assessment?