Why should I measure and monitor client outcomes when I use an empirically-supported intervention?

1. Why should I measure and monitor client outcomes when I use an empirically-supported intervention?

2. 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

3. 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

4. Bias Tendency to see and interpret information consistently with an emotional preference or preconceived expectation

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

6. 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.”

7. 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?

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

9. 4: To Prevent Client Deterioration • 5 to 10% of adult, and 14 to 24% of child clients deteriorate while receiving services • Practitioners find it especially difficult to detect client deterioration • Measuring and monitoring client outcomes can reduce rates of deterioration, partly by reducing rates of dropout from treatment

10. 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

11. 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

12. Why no guarantee? • ESIs beneficial for average research subject, some unchanged some worse • Research participants may not be representative of your clients (e.g., race, ethnicity, sexual orientation) • ESIs may be difficult to transport to your practice setting

13. 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

14. 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

15. 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

16. 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

17. 7: To Enhance Your Development as a Practitioner • Huge differences in client outcomes among therapists, even when using the same intervention methods • Clinical practice without ongoing feedback is like learning archery while wearing a blindfold; your skills are unlikely to improve if you cannot see where the arrow is landing

18. 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

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

20. 9: To Meet Your Ethical Obligations For 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.