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:
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|SxS for self report by 11-17 year olds
|SxS for parent (or other carer) report on 4-17 year olds
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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.
Session-by-session monitoring in CAMHS is worthy of further pursuit.
Last modified : 4th October 2013