SxS

Drawing on the success of the widely used and well-validated Strengths and Difficulties Questionnaire (SDQ), SxS provides Session-by-Session monitoring that is quick and universally relevant

The challenge of session by session monitoring
Therapists and researchers increasingly recognize the value of monitoring every treatment session. However, finding the right way to do it is harder than it seems. Many solutions use symptom scales tailored to the individual. It sounds a great idea, and it certainly has its advantages. For example, if you were running a treatment trial for pure behavioural problems, you would indeed want to monitor progress by using a behavioural symptom scale. But in the everyday world of clinical practice, most referrals do not have pure anything. For example, those with behavioural problems may well also have ADHD, depression, peer problems or autistic features - to name just a few of the possible comorbidities. Do you need separate symptoms scales for every possible symptom area? That's one possible solution, but if respondents are asked to fill in not one but multiple measures, then what was supposed to be a brief screen soon becomes an unpleasant chore. To make matters worse, services that treat a diverse range of conditions cannot easily compare success rates in different conditions if they are not using the same assessment for everyone.

Our unique solution
SxS focuses on three things that are universal:

• Change in the recent past: Have things improved since last time?
  
  
• Impact on everyday life at present: To what extent are current difficulties interfering with home life, friendship, learning and leisure?
  
  
• Hope for the future - How much improvement does the respondent anticipate in the next month?
  

Practicalities

• The SxS is so quick to fill in that some clinics and studies choose to administer it along with one or more symptom scales too. That can be the best of both worlds, with symptom scales providing within-domain sensitivity while SxS provides cross-domain comparability. Be careful, however, not to overload respondents or the combination of scales may get too long for routine completion every session.
  
  
• If the SxS is completed just before a treatment session, e.g. in the wating room, the answers can be reviewed jointly at the beginning of the session. This can make a good starting point and potentially avoids wasted sessions and drop-out. For instance, if the SxS reports little improvement, rising impact and low hope, this may be the last chance for turning things around before losing the family entirely. Turnng things around could involve reviewing the diagnostic formulation or treatment plan - or rebuilding the therapeutic alliance in some other way.
  
  
• The SxS is built into the online Development and Well-Being Assessment (DAWBA). Teams using the DAWBA for the initial diagnostic assessment can subsequently switch the system to session by session mode so that respondents can use their existing ID and password to complete the SxS online before each session (and get immediate graphical feedback too).
  
  

Download PDF files
	SxS for self report by 11-17 year olds
	SxS for parent (or other carer) report on 4-17 year olds

Paper versions of SxS may be downloaded and subsequently photocopied without charge by individuals or non-profit organizations provided they are not making any charge to families. No one except youthinmind is authorized to create or distribute electronic versions for any purpose.

Relevant publication:

Abstract
Background
Recent UK initiatives have advocated the use of session-by-session outcome measurement in CAMHS. However, little is known about the feasibility of this approach.
Method The PROMPT study (Patient Reported Outcome Monitoring Progress Tracker) piloted an iPad administered brief session-by-session measure (SxS) related to the Strengths and Difficulties Questionnaire impact supplement in three CAMHS teams. We report adherence to electronic SxS monitoring and a preliminary analysis of sensitivity to change.ResultsAdherence to SxS was 57%, which is higher than the completion rates for the standard set of outcome measures usually completed by clinicians and young people. SxS showed some sensitivity to change.
Conclusions
Session-by-session monitoring in CAMHS is worthy of further pursuit.

Last modified : 4th October 2013