Janice Connell

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.

Dose-Effect Relations and Responsive Regulation of Treatment Duration: The Good Enough Level

This study examined rates of improvement in psychotherapy as a function of the number of sessions attended. The clients (N=1,868; 73.1% female; 92.4% White; average age=40), who were seen for a variety of problems in routine primary care mental health practices, attended 1 to 12 sessions, had planned endings, and completed the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at the beginning and end of their treatment. The percentage of clients achieving reliable and clinically significant improvement (RCSI) on the CORE-OM did not increase with number of sessions attended. Among clients who began treatment above the CORE-OM clinical cutoff (n=1,472), the RCSI rate ranged from 88% for clients who attended 1 session down to 62% for clients who attended 12 sessions (r=-.91). Previously reported negatively accelerating aggregate curves may reflect progressive ending of treatment by clients who had achieved a good enough level of improvement.

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.

A core approach to practice-based evidence: A brief history of the origins and applications of the CORE-OM and CORE System

Abstract This article reviews the development of the CORE-OM and CORE System from 1995 to 2005 in the context of the need to measure, monitor, and manage the delivery of counselling and the psychological therapies in service of providing best quality care for clients. The origins and philosophy of these tools are summarised and practical aspects of how to use them in routine service settings are set out, including an easy to use look-up table of differing ways of presenting CORE-OM scores and their associated meaning. The wider family of CORE outcome measures is briefly outlined to show the relationship between the various versions and how each is designed for a specific purpose. These outcome tools are set within the broader context of the CORE System. In turn, the CORE-OM and CORE System are placed within the paradigm of practice-based evidence and examples are provided of how these tools have been applied in routine as well as more traditional evaluative settings. The aim of the present article is two-...

The CORE-10: A short measure of psychological distress for routine use in the psychological therapies

Abstract Background: There is a need for a generic, short, and easy-to-use assessment measure for common presentations of psychological distress in UK primary care mental health settings. This paper sets out the development of the CORE-10 in response to this need. Method: Items were drawn from the CORE-OM and 10 items were selected according to a combination of usefulness, coverage of item clusters, and statistical procedures. Three CORE-OM datasets were employed in the development phase: (1) a primary care sample, (2) a sample from an MRC platform trial of enhanced collaborative care of depression in primary care, and (3) a general population sample derived from the Office of National Statistics Psychiatric Morbidity Follow-up survey. A fourth dataset comprising a sample from an occupational health setting was used to evaluate the CORE-10 in its standalone format. Results: The internal reliability (alpha) of the CORE-10 was .90 and the score for the CORE-10 correlated with the CORE-OM at .94 in a clinica...

Quality of life of people with mental health problems: a synthesis of qualitative research

PurposeTo identify the domains of quality of life important to people with mental health problems.MethodA systematic review of qualitative research undertaken with people with mental health problems using a framework synthesis.ResultsWe identified six domains: well-being and ill-being; control, autonomy and choice; self-perception; belonging; activity; and hope and hopelessness. Firstly, symptoms or ‘ill-being’ were an intrinsic aspect of quality of life for people with severe mental health problems. Additionally, a good quality of life was characterised by the feeling of being in control (particularly of distressing symptoms), autonomy and choice; a positive self-image; a sense of belonging; engagement in meaningful and enjoyable activities; and feelings of hope and optimism. Conversely, a poor quality life, often experienced by those with severe mental health difficulties, was characterized by feelings of distress; lack of control, choice and autonomy; low self-esteem and confidence; a sense of not being part of society; diminished activity; and a sense of hopelessness and demoralization.ConclusionsGeneric measures fail to address the complexity of quality of life measurement and the broad range of domains important to people with mental health problems.

A systematic review, psychometric analysis and qualitative assessment of generic preference-based measures of health in mental health populations and the estimation of mapping functions from widely used specific measures

BACKGROUND Generic preference-based measures of health like the EQ-5D and SF-6D(®) are increasingly being used in economic evaluation and outcome assessment. However, there are concerns as to whether or not these generic measures are appropriate for use in people with mental health problems. OBJECTIVES The EQ-5D and SF-36(®) (including its derivatives the SF-12(®) and SF-6D) were assessed using the psychometric criteria of validity and responsiveness using quantitative and qualitative methods. Another aim was to estimate mapping functions between the EQ-5D and SF-6D and condition-specific measures, where appropriate. DESIGN Four studies were undertaken to examine the appropriateness of the measures: (1) a systematic review of quantitative evidence on validity and responsiveness; (2) a further quantitative assessment of these criteria using existing data sets; (3) a review of qualitative research on the quality of life of people with mental health problems; and (4) qualitative semistructured interviews of people with a full range of problems. A fifth study estimated mapping functions between mental health-specific measures and the EQ-5D and SF-6D. SETTING A choice of venue was offered for the interviews including the participants own home, a room at the university or a centre frequently used by mental health services. PARTICIPANTS The interviews were undertaken with 19 people with a broad range of mental health problems at varying levels of severity. MAIN OUTCOME MEASURES The reviews included the EQ-5D and SF-36 (and the SF-12 and SF-6D). The psychometric analysis included the Hospital Anxiety and Depression Scale (HADS), Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), Generalised Anxiety Disorder Assessment (GAD-7), General Health Questionnaire (GHQ-12) and Patient Health Questionnaire (PHQ-9). RESULTS (1) and (2) The EQ-5D and SF-36 achieved an adequate level of performance in depression, and to some extent in anxiety and personality disorder. Results from the psychometric analyses in schizophrenia and bipolar disorder have been more mixed. (3) A framework analysis of 13 studies identified six major themes. (4) The interview data fitted the themes from the review well and resulted in minor modifications to the themes. The final set of themes comprised: well-being and ill-being; control, autonomy and choice; self-perception; belonging; activity; hope and hopelessness; and physical health. CONCLUSIONS The EQ-5D and SF-36 achieved mixed results in the quantitative testing against psychometric criteria. The qualitative analysis suggests this is because they provide a very limited coverage of themes identified by people with mental health problems. Recommendations for future work include the development of new preference-based measures in mental health that are based on, or substantially revise, an existing measure. FUNDING The Medical Research Council.

Practice-based evidence and standardized evaluation: Informing the design of the CORE system

Abstract This paper provides the contextual and empirical foundation that informed the design of a core set of audit and evaluation tools for UK psychological therapy service provision. the initiative was committed to working in collaboration with practitioners to obtain information on the requirement for, and the characteristics of, a quality evaluation system. the inception of this project occurred in parallel with the publication of the Department of Health Strategic Review of NHS Psychological Therapy Services in England which identified the need for improved service access and enhanced treatment appropriateness, effectiveness and efficiency. the empirical base of the paper reports retrospectively on the results of a survey of National Health Service practitioners and purchasers. Undertaken in 1996, the survey was designed to gather ‘intelligence’ on information collection and dissemination practice. the results of the survey are discussed in order to introduce the characteristics and content of the C...

The Young Person's CORE: Development of a brief outcome measure for young people

Abstract Background: There is a need for a user-friendly measure of change for use in school and youth counselling services which is easy for practitioners to administer and score, and which is appropriate for brief interventions. Aims: To develop such a measure and to present psychometric data on reliability, validity and sensitivity to change for the measure. Method: We employed a three-stage approach: first, creating a pool of potential items; second, developing an 18-item version; and third, refining to a final version comprising 10 items. We called the measure the Young Persons CORE (YP-CORE). Results: The measure comprised eight negative and two positive items and included a single (negatively-framed) risk-to-self item. Psychometric properties were all acceptable. Sensitivity to change was good and yielded an average improvement of 10 points on the YP-CORE in a clinical group, broadly equivalent to changes in adult versions (e.g. Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM))....

CORE-OM mental health norms of students attending university counselling services benchmarked against an age-matched primary care sample

ABSTRACT Whilst concern has been expressed at the increasing severity of the mental health of students, there has been very little research on this growing population outside of small, single institution studies. The aims of this paper are to provide CORE Outcome Measure (CORE-OM) norms for the psychological health of students across multiple sites receiving university counselling, and benchmark these against an age-matched sample of people receiving treatment in NHS primary care settings. Results indicate that students using university counselling services show severity levels only marginally lower than young people presenting in primary care, with the differences being at a functional/relationship rather than a symptomatic level and with levels of risk to self being similar. This suggests that university counselling services deliver a service to people who closely resemble NHS primary care clients in terms of severity and risk to self.