Introduction
The aim of this essay is to discuss whether routine outcome measures (ROMS) can or cannot capture therapeutic work done in Child & Adolescent Mental Health Services (CAMHS). The author intends to consider what ROMs are, and what they do or do not capture; reflecting on their use and purpose within the process of therapy; by considering established research and documented evidence found in literature to assist the discussion; in order to determine what the therapeutic work to be captured is, and the possibility of being able to measure this therapeutic work in its various forms. For the purposes of this essay, clients, service users and recipients of CAMHS therapeutic services will be termed as patients in line with NHS practices; and therapy refers generally to psychological therapies including counselling, psychotherapy, psychological and clinical interventions.
Use of Routine Outcome Measures in CAMHS
Outcome measures used within a health context have existed for many years. In 1910, Ernest Amory Codman was an orthopaedic surgeon who developed the "end result idea". At its heart was "the common sense notion that every hospital should follow every patient it treats, long enough to determine whether or not the treatment has been successful, and then to inquire 'if not, why not?' with a view of preventing similar failures in the future”. The term ‘outcome measure’ in itself suggests the measurement of health outcomes only. Mosby’s Medical Dictionary (2012) defines an outcome measure as ‘a measure of the quality of medical care, the standard against which the end result of the intervention is assessed’.
Walport, (2013) found that many Patient Reporting Outcome Measures (PROMs) were intended to help detect pattern...
... middle of paper ...
...ess of therapeutic interventions; the numbers and demographics of patients treated, and outcomes of treatment. ROMs do not capture the internal changes for a patient; they do not capture the invisible dialogue that forms a major part of talking and psychological therapies within CAMHS. Used in conjunction with clinical judgement and patient perspective ROMS have more than one purpose. These are:
• providing evidence based practice for psychological treatments, with service user voice contributing to ownership of their journey, helping to shape the therapeutic intervention;
• providing quantitative data to monitor some clinical effectiveness to satisfy the Governments ‘payment by results’ (PBR) agenda and health commissioners for funding; contributing to national data sets for research (CORC).
The authors view is they cannot capture therapeutic work in CAMHS.
Thornicroft, G., & Tansella, M. (2005). Growing recognition of the importance of service user involvement in mental health service planning and evaluation. Epidemiologia e Psichiatria Sociale, 14(01), 1-3.
...to change of youth treatment outcome measures: A comparison of the CBCL, BASC-2 and Y-OQ. Journal of Clinical Psychology, 67, 11-125.
The therapeutic aspect is focussed on the care received, and how it creates a positive outcome for the service user, this includes good communication, building strong relationships, person centred planning and the choices available to the person in receipt of care. (Miller, J, 2015) (Gibb and Miller, 2007)
The overall goal of performance management is to ensure that an organization and its subsystems (processes, departments, teams, etc.), are optimally working together to achieve the results desired by the organization. Performance management has a wide variety of applications including measuring the leader performance, such as, staff performance, business performance, or in health care, health outcome performance measures. To manage and measure performance of leaders are directed to the organizational strategic goals and mission. The primary reason to measure and manage performance of leaders is to drive quality improvement. The Clinical performance of a leader are derived from evidence-based clinical guidelines and measurement allows an evaluation of an important outcome of care for patients, and it is a proxy to understand the effectiveness of the underlying systems of care. Just as there are evidence-based care guidelines for many conditions, there also are established measures that indicate how leaders has effectively guidelines and has translated to
An important change that needs to happen within mental health services is for service users to be involved in all aspects of their care. This is called a working partnership where information is shared, choices are given and decisions are made together. The Department of Health (1999) states that service users should be involved in the planning and delivery of the care they receive. Drawing from course materials and external research this essay will discuss why developing this working relationship is important. It will look at past and current service provision, discuss what happens in practice, consider what change needs to take place for a working partnership to be achieved and how this relationship can benefit both service user and practitioner. The essay will also discuss whether there might be resistance to the idea of this working partnership and how these barriers might be addressed so that this change can be implemented in practice.
...p their own solutions to problems. Clients may need some guidance, education, or direction depending on their abilities and how the therapy is going. It is then that I want to be able to help them feel more empowered and recognize that they can make changes with effort on their part.
In B. L. Duncan, S. D. Miller, B.E. Wampold, & M.A. Hubble (Eds.), The heart and soul of change: Delivering what works in therapy (2nd ed., pp. 143-166). Washington, DC: American Psychological Association.
Goal 2- Garner experience and practice in treatment planning and assessments through performing psychosocial and diagnostic assessments; consider methods of interventions appropriate to client presentation; develop treatment plans with supervisor for assigned clients.
Berwick, D. M. (2002). A user's manual for the IOM's 'quality chasm' report. Health Affairs,
Furthermore, my goal is to let client fix their problems on their own through insight and guidance from the therapist. I envision a successful therapeutic process being when a client follows their goals and achieves positive outcomes in their lives. I seek to gain a therapeutic process with my clients by building rapport, trust, and helping them gain insight. When my clients are stuck and need motivation, I plan to remind them about their goals and the positive things that will come with change. If family is important to a client, informing the client about their family and their happiness may help motivate them to continue to
Randomized Controlled Trials can be used to in several types of evaluations, including new therapies (i.e. Cognitive behavioral therapy versus emotionally focused therapy when treating couples), community interventions, and diagnostic techniques (O'Brien, 2013). The RCT study design randomly assigns participants into an experimental group or a control group. As the study is conducted, the only expected difference between the control and experimental groups is the outcome variable being studied (O'Brien, 2013).
The counselor accomplishes the above by expressing empathy, developing discrepancies, going along with resistance and supporting self-efficacy. Moreover, the counselor guides the client toward a solution that will lead to permanent posi...
Stickley,T. & Freshwater, D. (2006). “The Art of Listening to the Therapeutic Relationship” Journal of Mental health Practice. 9 (5) pp12 - 18.
...le, “Recovery of evidence-based practice” highlights the importance of utilizing evidence-based practice to care for mentally ill patients. “They also found a similar consensus in requirements that mental health care be based on evidence, be focused on effective treatments and best practices, and result in measurable outcomes” (Gordon & Ellis, 2013, p. 4).
“Quantitative research guides health care decision makers with statistics--numerical data collected from measurements or observation that describe the characteristics of specific population samples. Descriptive statistics summarize the utility, efficacy and costs of medical goods and services. Increasingly, health care organizations employ statistical analysis to measure their performance outcomes. Hospitals and other large provider service organizations implement data-driven, continuous quality improvement programs to maximize efficiency.” (Castro, 2012). Examples of quantitative research include; (Scerbo,2013)