Discover the world at Leiden University
Outcome Monitoring Feedback with the OQ-45: Theory, Research and Practice Kim de Jong, PhD 20-03-2015 Discover the world at Leiden University Introductory exercise Discover the world at Leiden University Content • • • • Part I Why do we need feedback? Description of the Outcome Questionnaire-45 Types of outcome measurement Example cases Part II • Feedback theory • Exercise • Questions Discover the world at Leiden University Why do we need feedback? I’m not that satisfied with the therapy… Hmm… yes… I understand… That is part of your psychiatric problems. Discover the world at Leiden University “Without direct feedback on how their clients are progressing, clinicians are essentially wearing a blindfold while shooting at a target” (Sapyta, Riemer & Bickman, 2005) Discover the world at Leiden University Therapists’ predictions of outcome • Final outcome was predicted for 550 clients • 3 were predicted to have a negative outcome, whereas 40 had actual negative outcomes • Staff were accurate 1 time (2,5%) • Algorithms for feedback were correct 77% of the time in predicting deteriorated patients (Hannan, Lambert, Harmon, Nielsen, Smart, Shimokawa, Sutton, 2005) Discover the world at Leiden University Therapists’ predictions of outcome (2) Expected recovery Actual recovery 64,1 61,9 34,9 Control n=169; De Jong & Peetoom, in preparation 32,8 Feedback Discover the world at Leiden University Do we overestimate ourselves? • Self-serving bias: • 2/3 of clinicians consider themselves to be in the top 75% of their field • 0% belief themselves to be below average • Therapy rationale: • Do patients need to get worse before they get better? Discover the world at Leiden University The evidence on OM feedback (1) • Feedback improves communication between patient and clinician (Carlier et al., 2010) • Feedback improves accuracy of diagnosis (Carlier et al., 2010) • Effects on outcome: • Often no effect on “on track” cases • Effect on “not on track” cases ranges from small to large effect sizes (e.g. Bickman et al, 2012; d = 0.20) Shimokawa et al., 2010, d=0.92) • Some studies show effect on treatment duration Discover the world at Leiden University The evidence on OM feedback (2) • Largest effects found by Lambert e.a.: • High frequency (every session) • Expected recovery curves and warning signals (red flag) • Clinical support tools on common factors Discover the world at Leiden University Outcome Questionnaire • Brief: 45 items, administration in 5 min • Three domains: • Symptomatic Distress • Problems in Interpersonal Relations (partner, family, friends) • Social Role problems (work, free time) • Translated into more than 20 languages Discover the world at Leiden University Outcome Questionnaire (2) • Good psychometric properties (Amble et al., 2014): • • • • α across language versions 0.91-0.96 test-retest reliability 0.84-0.91 Good concurrent validity Sensitive to change Discover the world at Leiden University Symptom Distress • • • • • • • I feel no interest in things I blame myself for things I feel that something bad is going to happen I am a happy person I feel worthless I feel lonely Disturbing thoughts come into my mind that I can’t get rid of • I like myself Discover the world at Leiden University Interpersonal Relations • I get along well with others • I feel unhappy in my marriage/significant relationship • I am concerned about family troubles • I have frequent arguments • I have trouble getting along with friends and close acquaintances • I feel my love relationships are full and complete Discover the world at Leiden University Social Role • • • • • I feel stressed at work / school I find my work/school satisfying I work/study too much I am working/studying less well than I used to I have trouble at work/school because of drinking or drugs use • I feel that I am not doing well at work/school • I have too many disagreements at work/school Discover the world at Leiden University Risk items • Flagged when a patient endorses > never • I have thoughts of ending my life • After heavy drinking, I need a drink the next morning to get going • I feel annoyed by people who criticize my drinking or drug use • I have trouble at work/school because of drinking or drug use • I feel angry enough at work/school to do something I might regret Discover the world at Leiden University Types of outcome measurement • Pre-post: outcome measurement • Multiple: outcome monitoring • Continuous: outcome tracking Additional options: • Adding diagnosis specific instruments • Use of expected recovery curves • Use of clinical support tools Discover the world at Leiden University Pre-post measurement 70 60 50 Total SD IR SR 40 30 20 10 0 Pre-treatment Post-treatment Discover the world at Leiden University 35 30 score 25 20 BDI 15 10 5 0 1 2 3 4 5 6 7 8 9 10 11 12 13 Discover the world at Leiden University Outcome tracking Discover the world at Leiden University Discover the world at Leiden University Expected recovery curves Discover the world at Leiden University Clinical support tools Discover the world at Leiden University Therapeutic relationship manual • Discuss the agreement between you and your client in treatment goals • Explain your techniques, actions or behaviors to the client • Provide and ask for feedback on the working alliance • Accept responsibility for your share in the problems Discover the world at Leiden University BREAK Discover the world at Leiden University Imagine that you get feedback that your patient is not progressing well, whereas you thought things were going ok…. ... how does it make you feel? … what do you do? Discover the world at Leiden University FEEDBACK THEORY Discover the world at Leiden University Feedback: the three elements SOURCE Perceived validity X MESSAGE Valence (+ / -) X RECEIVER Feedback propensity Content Self-efficacy Timing Discover the world at Leiden University Feedback theory Goal commitment Goal or standard Self-efficacy Behavior change Valence (+ / -) Content Timing Feedback Locus of control Feedback propensity Perceived validity Adaptation of Concentualized Feedback Intervention Theory. Riemer & Bickman, 2011 Discover the world at Leiden University Goal commitment Goal commitment Expectations Self-efficacy Barriers Attractiveness Support Higher goals Discover the world at Leiden University Attention and acceptance • Validity of the source • Usefulness • Specificity • Content • Lay-out • Feedback preference (propensity) Discover the world at Leiden University Causal attribution Causality Control Stability Discover the world at Leiden University Exercise • How would you motivate (fellow) therapists to start using outcome monitoring feedback? • • • • What motivates therapists /are higher goals? What are promoting factors? What are the barriers in your organization? What can you control as implementer and what not? Discover the world at Leiden University Effect feedback on outcome 95 OQ-45 Total score 85 75 NOT controle NOT feedback 65 OT controle 55 OT feedback 45 35 Start Eind Discover the world at Leiden University Effect feedback active use 95 OQ-45 Total score 85 75 NOT controle NOT feedback 65 OT controle 55 OT feedback 45 35 Start Eind Discover the world at Leiden University Therapist characteristics • Effect on outcomes: • Therapists with higher internal feedback propensity achieve change slower • Therapists with a positive attitude towards ROM , achieve change faster • Therapists with a higher self-efficacy achieve faster change in NOT cases (de Jong et al., 2012) Discover the world at Leiden University Therapist effects on use of feedback Discover the world at Leiden University QUESTIONS www.kimdejong.net (English/Dutch mix) Follow me on twitter: kdej_psyres Discover the world at Leiden University
© Copyright 2024