John Mellor-Clark

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...

Developing and Delivering Practice-Based Evidence

List of Contributors. Foreword. Preface. Acknowledgements. SECTION I: EVIDENCE-BASED PRACTICE AND PRACTICE-BASEDEVIDENCE. 1 The Current View of Evidence and Evidence-Based Practice(Peter Bower and Simon Gilbody). 2 Building a Rigorous and Relevant Knowledge Base for thePsychological Therapies (Michael Barkham, William B. Stiles,Michael J. Lambert and John Mellor-Clark). SECTION II: METHODOLOGICAL PLURALISM FOR INDIVIDUALPRACTITIONERS. 3 Scientific, Practical and Personal Decisions in SelectingQualitativeMethods (Nancy Pistrang and Chris Barker). 4 Theory-Building Case Studies as Practice-Based Evidence(William B. Stiles). 5 Single Case Quantitative Methods for Practice-Based Evidence(Dean McMillan and Stephen Morley). SECTION III: MEASUREMENT SYSTEMS FOR INDIVIDUAL PRACTITIONERSAND SERVICES. 6 Outcome Questionnaire System (The OQ System): Development andPractical Applications in Healthcare Settings (Michael J.Lambert, Nathan B. Hansen and S. Cory Harmon). 7 Treatment Outcome Package (TOP) - Development and use inNaturalistic Settings (David Kraus and Louis G.Castonguay). 8 Clinical Outcomes in Routine Evaluation (CORE) - The COREMeasures and System:Measuring,Monitoring andManaging QualityEvaluation in the Psychological Therapies (Michael Barkham, JohnMellor-Clark, Janice Connell, Chris Evans, Richard Evans and FrankMargison). SECTION IV: MONITORING STRATEGIES FOR INDIVIDUALPRACTITIONERS AND SERVICES. 9 Using Benchmarks and Benchmarking to Improve Quality ofPractice and Services (Robert J. Lueger and MichaelBarkham). 10 Constructing and DisseminatingOutcome Data at the ServiceLevel: Case Tracking and Benchmarking(Chris Leach and WolfgangLutz). SECTION V: MANAGING IMPROVEMENT VIA ORGANIZATIONS ANDPRACTICE NETWORKS. 11 Organizational and Conceptual Framework for Practice-BasedResearch on the Effectiveness of Psychotherapy and PsychotherapyTraining (Robert Elliott and Alberto Zucconi). 12 Practice Research Networks and Psychological ServicesResearch in the UK and USA (Glenys Parry, Louis G. Castonguay,Tom D. Borkovec and Abraham W. Wolf). SECTION VI: DEVELOPING AND DELIVERIPRACTICE-BASEDEVIDENCE. 13 Improving Practice and Enhancing Evidence (MichaelBarkham, Gillian E. Hardy and John Mellor-Clark). Index.

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...

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.

Counselling outcomes in primary health care: a CORE system data profile

The availability of counselling in primary health care has increased substantially in recent years. As a result, the findings of a range of research studies have been collated to inform a series of published reviews assessing the evidence to support continued expansion. Until recently no supportive research evidence could be found. However, the most recent reviews have refined the focus and specificity for assessing the efficacy of counselling in primary care and evidence is now slowly beginning to emerge to support counselling as an evidence-based practice. Concurrent with this review activity, National Health Service (NHS) policy documentation has introduced a series of initiatives to enhance service quality throughout health care. This has placed a premium on routine audit, evaluation and outcomes monitoring for the development and dissemination of practice-based evidence. In this paper we briefly summarize this background to introduce an initiative that tested the feasibility and utility of using a standardized approach to profile patients and outcomes in primary care counselling practice. The results suggest that it is feasible to routinely monitor and profile service provision and that counselling interventions have considerable potential to alleviate client distress for a wide range of psychosocial difficulties that commonly present in primary care. These findings are discussed in the context of the NHSs commitment to monitoring National Service Framework Standards for Mental Health Services.

Counselling in primary care: A systematic review of the research evidence

Counselling in primary care in the UK is expanding rapidly, and its evidence base needs to be established. We present the rationale for conducting controlled trials of counselling in primary care, and suggest that a systematic review of controlled trials of counselling in primary care is timely. We describe the process of conducting the review in accordance with Cochrane Collaboration guidelines. The review aimed to assess the effectiveness and cost-effectiveness of counselling in primary care, by systematically reviewing cost and outcome data from randomised controlled trials and controlled patient preference trials of counselling interventions, for patients with psychological and psychosocial problems considered suitable for counselling. The search strategy, inclusion and exclusion criteria, data collection and data analysis are described. The results of the review are presented. The review included only controlled trials of counselling in which counsellors accredited by the British Association for Counselling (or equivalent) provided non-directive counselling in primary care. Four trials met the inclusion criteria. Results indicated that patients who receive counselling show a modest but significant improvement in symptom levels compared with those who receive GP care. Levels of satisfaction with counselling are high. There is very tentative evidence to suggest that counselled patients are more likely to be considered recovered than usual GP care patients. There is limited information about the cost-effectiveness of counselling. We conclude by reflecting upon the results of the review and their implications for counselling research.