Therapists and counselors are increasingly required to formally gather outcome data on their work. This is good: The more data that we have on our work, the more intentional and effective our clinical decisions can become. Regularly collecting and attending to outcome data, therefore, suggests constant movement towards improvement.
Many therapists struggle, however, with questions about what data to gather, and how to best gather it. Even among those who philosophically agree that regularly collecting outcome data helps to more meaningfully direct therapy, they often don’t do it.
Thankfully, there are a number of easy ways for therapists to collect outcome data. Many come at no cost. The following are just three of the many different tools/assessments therapists can use to collect and interpret outcome data.
Session Rating Scale and Outcome Rating Scale
The Outcome Rating Scale (ORS) and the Session Rating Scale (SRS) were developed by Scott Miller, Barry Duncan, and Lynn Johnson. These two assessments were designed to be incredibly brief, intuitive, and easy to administer. Clients simply rate their experience by placing a mark along a 10cm line. The therapist then measures the location of that mark to determine a score out of 10. The line intentionally has no markers so that clients don’t feel obligated to mark a specific “score.” The ORS is a four-question scale designed to be given at the beginning of each session, measuring therapeutic progress to date. The SRS is a four-question scale designed to be given at the end of each session, measuring the client’s response to that specific meeting. When administered regularly, these assessments can provide incredibly meaningful feedback about client satisfaction and potential client dropout. Individual licenses to use the measures are free.
DSM-5 Level 1 measure
The DSM-5 Level 1 Cross-Cutting Symptom Measure helps clinicians to more effectively and efficiently identify additional areas of inquiry that are likely to impact the client’s diagnosis and treatment. The measure is a 23 question, self- or informant-rated measure that assesses 13 mental health domains. The domains assessed include: depression, anger, mania, anxiety, somatic symptoms, suicidal ideation, psychosis, sleep problems, memory, repetitive thoughts and behaviors, dissociation, personality functioning, and substance use. Each domain inquires about how much the client has been bothered by the specific problem during the past 2 weeks. Domains with significant responses should then be further addressed through use of the DSM-5 Level 2 Symptom Measures. The Level 2 measures provide more detailed information on the specific symptoms associated with Level 1 domains.
One benefit of the Level 1 measure is that if it is given at regular intervals, it can be used to track changes in the client’s symptoms over time. All of the DSM measures are free.
Symptom-specific measures
In some settings though, professionals or clinics specialize in working with clients with a specific diagnosis. One such example would be for a clinical specializing in Substance Use Disorders. In that clinic, the above DSM-5 level 1 Cross-Cutting Symptom Measure would likely not be an effective use of time. That being said, there are a number of more specific assessments that those settings can, and should use.
An example of a symptom-specific assessment is The National Institute on Drug Abuse (NIDA) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), which helps clinicians to assess for the frequency of use and abuse of substances. The assessment begins with a pre-screen that determines whether the client has ever used any substances in their lifetime. By identifying clients who have never used any substances in their lifetime, clinicians are able to switch to an assessment tool that better predicts future risk of substance use. If a client has used any substance in their lifetime, then the clinician can administer the NIDA-Modified ASSIST.
The assessment is composed of 7 questions, with each question having specifiers for each of the 9 identified categories of substances. The questions assess for substance use over lifetime, use over the past 3 months, and even attempts to stop use. The client’s responses to each of the questions will determine their score, or risk level, for continued substance abuse. The NIDA-Modified ASSIST identifies three different score ranges: Lower Risk (0-3), Moderate Risk (4-26), and High Risk (27+). In addition, because the assessment measures lifetime use, it also provides a score range for each substance that the patient has used in their entire lifetime.
Whether you chose to use the above tools or one of the many other options available to you, what matters most is that you are consistently collecting data. Attending to the client feedback provided by these measures has been repeatedly shown to have positive impacts on the therapeutic alliance and achievement of treatment goals.