School of Health Sciences, Division of Nursing, Midwifery and Social Work, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
Psychol Psychother. 2022 Sep;95(3):820-837. doi: 10.1111/papt.12400. Epub 2022 May 16.
The objective of the study was to investigate the administration and use of routine outcome monitoring session by session in the context of improving guided-self-help interventions when delivered remotely at Step 2 care in the English Improving Access to Psychological Therapies (IAPT) services.
Qualitative research using recordings of telephone-treatment sessions.
Participants (11 patients and 11 practitioners) were recruited from four nationally funded IAPT services and one-third sector organisation commissioned to deliver Step 2 IAPT services, in England. Data collection took place prior to the COVID-19 pandemic. Transcripts of telephone-treatment sessions were analysed using thematic analysis.
Four themes were identified: (1) lack of consistency in the administration of outcome measures (e.g. inconsistent wording); (2) outcome measures administered as a stand-alone inflexible task (e.g. mechanical administration); (3) outcome measures as impersonal numbers (e.g. summarising, categorising and comparing total scores); and (4) missed opportunities to use outcome measures therapeutically (e.g. lack of therapeutic use of item and total scores).
The administration of outcome measures needs to ensure validity and reliability. Therapeutic yield from session-by-session outcome measures could be enhanced by focusing on three main areas: (1) adopting a collaborative conversational approach, (2) maximising the use of total and items scores and (3) integrating outcome measures with in-session treatment decisions. Shifting the perception of outcome measures as impersonal numbers to being process clinical tools ensures a personalised delivery of psychological interventions and has the potential to enhance engagement from practitioners and patients what may reduce drop-out rates and improve clinical outcomes.
本研究旨在调查在远程提供第二阶段关爱服务（即英国改善心理治疗服务计划中的 IAPT 服务）时，如何在改进指导自助干预措施的过程中，逐次进行常规结果监测管理。
使用电话治疗会议记录进行的定性研究。
参与者（11 名患者和 11 名从业者）从四个由国家资助的 IAPT 服务机构和一个负责提供第二阶段 IAPT 服务的第三部门组织中招募，地点在英格兰。数据收集在 COVID-19 大流行之前进行。使用主题分析对电话治疗会议的记录进行分析。
确定了四个主题：（1）结果测量的管理缺乏一致性（例如，措辞不一致）；（2）将结果测量作为单独的僵化任务进行管理（例如，机械地进行管理）；（3）结果测量作为客观的数字（例如，总结、分类和比较总分）；（4）错失了治疗性使用结果测量的机会（例如，缺乏对项目和总分的治疗性使用）。
结果测量的管理需要确保有效性和可靠性。通过关注三个主要领域，可以提高逐次结果测量的治疗效果：（1）采用协作对话的方法；（2）最大限度地利用总分和项目得分；（3）将结果测量与治疗中的决策相结合。将结果测量视为客观数字的观念转变为过程临床工具，确保了心理干预措施的个性化实施，并有潜力提高从业者和患者的参与度，从而降低流失率并改善临床结果。
