Making decisions about patient progress: the application of routine outcome measurement in stepped care psychological therapy services
Abstract:In a stepped care system, initial treatment is the most efficient intervention that is still likely to be effective. Patient outcome is then monitored, and patients are 'stepped up' to a more intensive treatment if the initial treatment is deemed to be unsuccessful. Stepped care has been proposed as a method of organising psychological therapy services that provides the optimal balance between effectiveness and access. However, the practical application of stepped care is complex, and a key challenge is making effective decisions about which patients are 'stepped up' to more complex and intensive services in the stepped care pathway. Routine outcome measures have been proposed as one method of improving the delivery of psychological therapy services, and in this article, we set out a range of issues concerning the use of routine outcome measures in support of stepped care within mental health. These include measurement issues (such as reliability, validity and acceptability), and the key issues relating to their use in decision making, including the role of patient preferences and choice. We conclude with recommendations for researchers, practitioners, and measure developers to maximise the yield from routine outcome measurements in the implementation of stepped care.
Document Type: Research Article
Publication date: March 1, 2006