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Brief Multidimensional Feedback Form

-- JebBrown - 19 Nov 2006

A number of different types of questionnaires have proven useful for providing information that can help clinicians achieve better clinical outcomes. Research by Michael Lambert, Ph.D. and others have shown that providing clinicians with feedback on client improvement using a global measure of client distress and symptoms, such as the OQ-45, can be used to prevent treatment failures. Of course, once a clinician learns that a client is at risk for potential treatment failure, he or she must determine how to proceed. At this point, a few pieces of additional information can give the clinician a significant advantage.

Routine use a therapeutic alliance measure, such as the 10-item Session Rating Scale (Copyright Johnson, 1994; Johnson & Miller, 2000) or the 4-item Session Rating Scale (Available through talkingcure.com), provides clinicians with feedback on the client's perception of the therapeutic relationship. Incorporating such feedback into the treatment process, and improving the therapeutic alliance, has been shown to improve treatment outcomes. In some cases, extra therapeutic factors, such as a lack of social and family support, may hamper clients in their ability to make positive changes. The use of a questionnaire to assess social support, therefore, may provide a clinician with valuable treatment information. Likewise, assessing the client's "stage of change" (i.e., What is their attitude and belief about therapy? Are they actively engaged in making changes in their life?) may provide another critical element of information to aid the clinician in making treatment decisions.

Ideally, one might wish that patients would routinely complete multiple questionnaires to assess all of these dimensions. However, the realities of day-to-day clinical practice make this approach unwieldy.

A more practical alternative would be to routinely use a brief questionnaire that includes representative items from each of these domains. For example, 10-12 items assessing symptoms of depression and anxiety will yield a global distress measure with a reliability of .90 or better. This leaves room on a single page form for additional items related to substance abuse, medical problems, impairment at work or other daily activities, stage of change, therapeutic alliance, etc.

To date, no formal clinical trails have tested the ability of a brief multidimensional questionnaire to impact treatment outcomes. There are, however, a variety of psychometric reasons to believe that much of the information obtained from longer questionnaires can be captured using fewer items. This fact, combined with the ease of use of a one page brief questionnaire, suggests that a brief multidimensional questionnaire may be ideal for outcomes informed care initiatives.

The D.C. Department of Mental Health and Substance Abuse is presently piloting an excellent example of such questionnaire (Download the DC Survey). The questionnaire was developed by Ann Doucette, Ph.D., and is available for use by other agencies and organizations, provided that they are willing to contribute to the data repository that is maintained by Dr. Doucette.



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