Graeme McGrath

Service profiling and outcomes benchmarking using the CORE-OM: Toward practice-based evidence in the psychological therapies.

To complement the evidence-based practice paradigm, the authors argued for a core outcome measure to provide practice-based evidence for the psychological therapies. Utility requires instruments that are acceptable scientifically, as well as to service users, and a coordinated implementation of the measure at a national level. The development of the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) is summarized. Data are presented across 39 secondary-care services (n = 2,710) and within an intensively evaluated single service (n = 1,455). Results suggest that the CORE-OM is a valid and reliable measure for multiple settings and is acceptable to users and clinicians as well as policy makers. Baseline data levels of patient presenting problem severity, including risk, are reported in addition to outcome benchmarks that use the concept of reliable and clinically significant change. Basic quality improvement in outcomes for a single service is considered.

The rationale for developing and implementing core outcome batteries for routine use in service settings and psychotherapy outcome research

The Department of Health (DoH; 1996) Strategic Review of Psychotherapy identified the need for practitioners to use sim ilar outcom e m easures as part of the fram ework of clinical effectiveness. In this paper, we present the rationale for developing and im plementing a core outcom e battery in routine clinical practice as well as psychotherapy research. W e outline the forces that have determ ined the current corpus of outcome measures and contrast these with rational criteria for two levels of outcome batteries: a core battery, and problem-specific batteries. In addition, we identify potential referential measures that act as links between a core and problem-specific outcom e batteries. Criteria are set out that a core battery should meet. Em phasis is given to tw o unique criteria: a collaborative approach to instrum ent development between researchers and clinicians, and the collection of a subsequent national database. M eeting such suggestions will benefit researchers and clinicians as w ell as promoting innovation in m easurem ent practice.

Psychiatric day hospitals — another route to institutionalization?

SummaryNineteen long-stay day patients were referred to a rehabilitation team and their outcome after a year is compared with 19 day patients who were not referred, but were matched for age, sex and diagnosis. Seven rehabilitation team patients had been discharged at 12 months as against 3 of the non-rehabilitation patients, but this was not a significant difference. Discharged patients were less disturbed at the beginning of the study and had fewer negative symptoms throughout. Discharge did not reduce the frequency of social contact. There was a suggestion that morale was sustained better in the rehabilitation patient and in their nurses. We conclude that rehabilitation planning may have beneficially accelerated the discharge of less ill day-patients, but that more resources are needed to prevent ‘Intitutionalization’ within the day-hospital.

Dynamic Psychotherapy Explained

This small and user-friendly book does exactly what it says on the cover. The author acknowledges that she herself felt the need for a straightforward introductory text when learning about psychotherapy. Anyone setting out to explore the jungle of theory and jargon that is the basis of