Outcomes mental health programs

Students will gain knowledge and skills associated with group facilitation and the group counseling process. Students will gain knowledge associated with appraisal and testing. Students will gain knowledge associated with research and program evaluation to inform counseling practice. Students will gain the knowledge associated with working in multidisciplinary mental health systems. Students will gain the knowledge and skills associated with mental health diagnosis.

These five outcome measures were used effectively in studies of samples spanning the 12 to 25 year age range, even though they were originally developed for use with adults. None of these measures has been tested specifically for its clinical utility or psychometric properties for the youth age range. The current review did not identify any outcome measures developed specifically for the adolescent and young adult demographic.

While these five measures seem promising, further tests of psychometrics and clinical utility are needed. Despite the lack of targeted measures, there were 22 out of 29 outcome measures identified in the review that were used in at least one study with a sample that ranged across the 18 years of age mental health service system demarcation point. This reveals the need for specifically developed and targeted measures for young people.

There are major developmental changes that occur for young people from the ages of 12 years, around the time of the onset of puberty, to 25 years, which is well into adulthood [ 66 ]. It is highly likely that useful measures for this age range would need some clearly defined flexibility to accommodate developmental changes, particularly in areas of psychosocial functioning such as intimate relationships, education and work.

Outcome measures can be self-report, clinician report or reported by relevant others such as parents or teachers , and these different perspectives are all important for treatment [ 46 ]. In particular, self-report measures are essential for youth, to recognise their growing maturity and independence and engage them in their own treatment progress.

The place of parent reports may need further consideration, however, the current review identified very little use of parent reporters across the 12—25 age range, and only for children and adolescents [ 22 ]. New models of youth-focused care recognise the critical role of family, and parent reports may be relevant for clients up to 25 years of age [ 42 ], by providing another source of insight, particularly around changes in behavioural difficulties [ 67 ].

Careful attention would, however, need to be given to consent and confidentiality issues [ 66 , 68 ]. All the outcome measures identified in this systematic review were used to track change over time.

There were eight measures used primarily within a six month period, suggesting they might be more sensitive to change in a relatively short time frame. Routine use of outcome measures is a necessity when used as a feedback monitoring system, and this was demonstrated in studies using the SDQ and SFSS.

Only seven outcome measures were used to report reliable change, and only five of these also reported clinically significant change. This is concerning as studies have shown that reliable and clinically significant are more clinically meaningful change measures for mental health research [ 13 ]. These methods were designed to account for measurement error and clinical thresholds, requiring change to be statistically reliable and demonstrate movement from a dysfunctional to the functional population distribution [ 15 ].

Using these criteria, individuals can be classified into the outcome categories of recovered, improved, unchanged, or deteriorated, which are meaningful and interpretable categories [ 16 ]. However, it should be noted, that calculations of reliable change and clinical significance produce more conservative change results than other approaches [ 16 , 69 ].

Further, in an early intervention context, clinical significance may not be appropriate as most clients may not present in the dysfunctional range to start with. In these contexts, clinical deterioration should be monitored, however, to determine whether clients change from the functional to the dysfunctional distribution, indicating need for higher levels of intervention. More research is needed in this area to determine optimal change indices for youth outcome measures.

There has been an increase in demand for outcome measures to be used as a feedback monitoring system for clinicians [ 8 ]. Very few outcome measures were identified in the current systematic review that were used in this way, and these were designed for children and adolescents under 18 years [ 70 ]. The SDQ used young person and parent reporters and this information was fed back to clinicians to discuss with the young person.

Treatment as usual with SDQ feedback showed statistically significant change on the CGAS post treatment, however, the study did not have a comparison group so it was unknown whether the change was due to the feedback, treatment as usual or the combination of both [ 56 ].

The SFSS study used young person, parent and clinician reporters and this information was fed back to clinician, but the study did not specify if this information was fed back to the young person. Feedback was found to improve client change, and this was heightened when feedback came from multiple sources [ 12 ].

Multiple feedback sources can provide different change perspectives of value to the clinician and young person client [ 46 ]. Of special note, the study using the SDQ within a feedback monitoring system showed that the measure had to be modified to be used in this way [ 56 ]. This suggests the possibility of other measures being modified or adapted to be used routinely.

There are, however, several barriers to routine feedback, which may account for the small number of measures identified here [ 2 , 71 ]. These include constraints around time, resources and training needed, and perceived lack of clinical utility [ 72 ].

There are likely to be additional barriers for young people as clients, as they are a unique client group with higher dropout rates, are often referred by parents or teachers rather than being self-referred, and have different goals for therapy and therapeutic expectations compared with adults [ 20 ]. A thorough search strategy was employed in this systematic review and it identified a large number of outcome measures and studies, but it is possible that relevant measures were missed.

Notably, article authors were not contacted for additional information and the methodology excluded articles that were not written in English, meaning measures used specifically in other cultures were excluded.

The eligibility criteria also excluded articles pertaining to participants with other health conditions, including substance use and situational stressors. This was done partly to make the review more manageable, but may have excluded relevant measures. Together, the databased yielded an initial articles, which was filtered to a comprehensive studies, identifying 29 outcome measures.

Nevertheless, some measures, especially those not often used for research purposes and primarily used in clinical practice, may have been missed. The DASS is a self-report measure which comes in a 21 or item version [ 74 ]. It is commonly used as individual scores for depression, anxiety and stress and, therefore, was excluded as measuring specific mental health conditions.

The Y-OQ, which was included in this review, also comes from the same family of measures. There is a growing body of research around the ORS, particularly regarding its use as a feedback monitoring system for clinicians [ 76 ]. However, in this review, it was excluded as it was unique to only one study with young people aged 12 to 25 years [ 77 ].

Mental health outcome measures are essential for quality assurance and monitoring the effectiveness of services, and for tracking longitudinal health trends across time [ 5 , 6 ]. Although this review identified a large number of measures used with young people aged 12 to 25 years, only eight were used across this whole age range, each with strengths and weaknesses.

Overall, the review found no measures designed specifically for young people. There is a growing push for outcome measures to be routinely used as feedback monitoring systems, and to determine clinically meaningful change [ 7 , 20 ]. Only two measures were identified here as being used in this way and this is an area of particular research need for youth mental health because of the potential for such an approach to benefit clients [ 12 ]. Future research should focus on development of mental health outcome measures designed specifically for young people aged 12 to 25 years to accompany changes in mental health services that target this age range.

The measures should be sensitive to reliable and possibly clinically significant change that is meaningful to young people, and also suitable for routine use as feedback to clinicians and young people themselves.

This will provide services with age-appropriate measures with better clinical utility and comparative usefulness to drive delivery of the better mental health outcomes for young people, who have such a heightened need for early and effective mental health care.

PDF kb. Mental health outcome measures used with young people 12 to 25 years [ 78 — ]. XLSX 46 kb. Competing interests. BK designed and undertook the systematic review and drafted the article.

DJR supervised the design, reviewed the results, and revised the article. All authors read and approved the final version of the manuscript. Benjamin Kwan, Email: ua. Debra J. Rickwood, Email: ua. National Center for Biotechnology Information , U. BMC Psychiatry. Published online Nov Benjamin Kwan 1 and Debra J. Rickwood 1, 2. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Apr 20; Accepted Oct This article has been cited by other articles in PMC.

Abstract Background Mental health outcome measures are used to monitor the quality and effectiveness of mental health services. Results A total of published articles were identified, covering 29 different outcome measures. Conclusions With changes to mental health service systems that increasingly focus on early intervention in adolescence and young adulthood, there is a need for outcome measures designed specifically for those aged 12 to 25 years.

Electronic supplementary material The online version of this article doi Table 1 Search terms. Open in a separate window. Eligibility criteria The eligibility criteria included articles reporting global measures of mental health, used with a range of mental health populations for young people aged 12 to 25 years, and measuring change over time. To be included, studies had to: be written in English; include participants with a mean age in the range of 12 to 25 years; describe an outcome measure used as a general measure of mental health, including measures of emotion and cognition, functioning, quality of life and multidimensional mental health; report outcome measures tracking change over at least two measurement time points; and be applicable to a general mental health population or used with a variety of specific mental health populations rather than be unique to a particular mental disorder or condition.

Data extraction Following the database search, duplicates were firstly removed. Results Search results The search strategy identified published articles covering 29 different outcome measures, with many articles identifying more than one measure.

Intervention types All outcome measures were used in at least one trial or treatment interventions. Change magnitude The review determined whether the outcome measures were used to assess change using tests of significance, effect size, reliable change and clinical significance. Follow-up time frame The systematic review extracted follow-up time frames for the outcome measure studies, and categorised these as: short-term 0—6 months , medium-term over 6 months-1 year , and long-term over 1 year.

Sample demographics The outcome measures were all used with a range of sample demographics, according to gender, ethnicity and socioeconomic status. Feedback systems The review identified three outcome measures used routinely, however only two of these measures were used as part of a feedback monitoring system, the SDQ and SFSS. Discussion This systematic review identified 29 mental health outcome measures, reported in articles examining change in mental health status for young people aged from 12 to 25 years.

Age range appropriate measures There were eight outcome measures identified as being used across the whole 12 to 25 year age range. Type of reporter Outcome measures can be self-report, clinician report or reported by relevant others such as parents or teachers , and these different perspectives are all important for treatment [ 46 ].

Tracking change All the outcome measures identified in this systematic review were used to track change over time. Routine feedback There has been an increase in demand for outcome measures to be used as a feedback monitoring system for clinicians [ 8 ]. Limitations A thorough search strategy was employed in this systematic review and it identified a large number of outcome measures and studies, but it is possible that relevant measures were missed.

Conclusions Mental health outcome measures are essential for quality assurance and monitoring the effectiveness of services, and for tracking longitudinal health trends across time [ 5 , 6 ]. Acknowledgements None. PDF kb Additional file 2: 46K, xlsx Mental health outcome measures used with young people 12 to 25 years [ 78 — ].

Footnotes Competing interests The authors declare that they have no competing interests. Contributor Information Benjamin Kwan, Email: ua. References 1. Slade M. What outcomes to measure in routine mental health services, and how to assess them: a systematic review. Aust N Z J Psychiatry. Implementing routine outcome measures in child and adolescent mental health services: from present to future practice.

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Steinberg L. Once again, this is not the case with many types of outcome measures. An important question emerges about the data: Whose data is it and what does it really mean for treatment planning? Bottom Line: PCOMS is the only evidence-based clinical process that includes clients as full partners, involving them in all decisions affecting their care.

Select a systematic solution — one proven in eight randomized clinical trials to significantly improve effectiveness in real clinical settings as well as substantially reduce costs related to length of treatment and provider productivity.

Categorized in: Insider. Types of Outcome Measures in Mental Health. February 10, PM Measuring outcomes in behavioral health has become a quagmire of misinformation and marketing buzzwords.