Why should I measure and monitor client outcomes

when I use an empirically-supported intervention?

1:To Obtain the Best Client Outcomes Even when you use an empirically

supported intervention, you still don’t know how it will work with a particular client

Many factors other than your intervention have an effect on client outcomes Ongoing, relatively objective feedback to

the practitioner reduces deterioration and treatment dropout, improves overall outcome, and leads to fewer treatment sessions

2: To Avoid Natural Biases Practitioners tend to overestimate

improvement and underestimate deterioration, in relation to client self-reports

Practitioners have much more confidence in their abilities to judge clients’ progress than is warranted by the data

Bias

Tendency to see andinterpret informationconsistently with anemotional preferenceor preconceivedexpectation

Falsification

Deliberate process of seeking information to discount or disprove a hypothesis or theory

Confirmation Bias

Tendency to gather evidence that confirms one’s preconceptions by emphasizing or pursuing supporting evidence while dismissing or failing to seek contradictory evidence

“If all you have is a hammer, everything looks like a nail.”

3: To Improve Clinical Decision-Making You’ll have more and better information

with which to make practice decisions How else would you know if what you’re

doing is working?

What practice decisions? Intervene or not? Continue an intervention? Modify an intervention? Change to a new intervention? Discontinue intervention altogether?

4: To Prevent Client Deterioration 5 to 10% of adult, and 14 to 24% of

child clients deteriorate while receiving services

Practitioners find itespecially difficult to detectclient deterioration

Measuring and monitoringclient outcomes can reducerates of deterioration,partly by reducing rates ofdropout from treatment

5: To Bridge the Gaps in EBP Evidence-based practice is the place to

start, but it is not sufficient: RCTs tell us whether interventions work with

the average client, not a particular client Clients have individual characteristics and

circumstances Methodologies underlying EBP are by no

means perfect Empirically-supported interventions are not

available for every client problem you encounter

Suppose you have… Empirically-supported intervention (ESI)

backed up by good research e.g., recent meta-analysis of randomized

clinical trials with consistent results concerning the effectiveness of the intervention for the type of problem presented by your client

Why no guarantee? ESIs beneficial for average research

subject, some unchanged some worse Research participants

may not be representativeof your clients (e.g., race,ethnicity, sexualorientation)

ESIs may be difficult totransport to your practicesetting

Why no guarantee? (cont’d) Marked differences among practitioners

in terms of the speed and overall amount of client change Less effective practitioners aren’t

necessarily aware that they are less effective

Practitioners tend to overestimate improvement and underestimate deterioration

Why no guarantee? (cont’d) Specific elements of ESIs are one

ingredient in the recipe that contributes to client success

Quality of alliance you have with your client influences your client’s outcome whatever intervention you use

Why no guarantee? (cont’d) ESIs are templates that need to be

customized to individual clients Tailored to personal, contextual, and

changing situations causing and maintaining problems faced by a particular client

6: To Improve Your Relationships with Your Clients Demonstrates your respect for your

client by giving your client an important voice

Demonstrates conscientiousness on your part, and may enhance your client’s confidence in you

7: To Enhance Your Development as a Practitioner Huge differences in client outcomes

among therapists, even when using the same intervention methods

Clinical practice withoutongoing feedback is likelearning archery whilewearing a blindfold; yourskills are unlikely toimprove if you cannot seewhere the arrow is landing

8: To Be Accountable Monitoring client outcomes constantly

and modifying the intervention as needed provides an important tool for achieving clients’ goals in as short a time as possible and conserving limited resources

Some argue that, at least for psychotherapy services, outcome-based accountability is coming—and soon

Accountability

Extent to which a person is answerable to another (e.g., a supervisor or official review body) for his or her behaviors, decisions, orjudgments, especially ina professional capacity

9: To Meet Your Ethical ObligationsFor example… NASW Code of Ethics, 5.02 Evaluation

and Research (a) Social workers should monitor and

evaluate policies, the implementation of programs, and practice interventions.