Project aims and designs
What are the aims of the project?
The project primarily aims to pilot an online system for collecting routine outcome measures in private practice. It will evaluate the:
- acceptability of the platform to practitioners
- utility and impact of the system on practice and the therapeutic process
- feasibility of rolling-out the system to the wider BACP membership, if they wanted to use it (ie on a voluntary basis)
The secondary aims of the project are to:
- evaluate the effectiveness of counselling in a private practice setting
- provide training resources to support members to use the system and monitor their client outcomes
- promote outcome monitoring to members as one way of enhancing client outcomes, augmenting their therapeutic work, and contributing to the evidence-base for counselling and psychotherapy
- encourage best practice in outcomes monitoring
What data will be collected as part of the project?
There are two main sources of data for this project: client demographics and outcomes, and practitioner or member feedback. Data from clients who have consented for it to be used anonymously for research purposes will be exported from the system for analysis by the BACP research team.
Practitioner feedback will be gathered through evaluation questionnaires and more informal feedback mechanisms (such as email correspondence). The evaluation questionnaires will be sent out no more than once a quarter.
The legal basis for processing this data is informed consent.
How will data collected be analysed?
In some respects, this will depend on the quality of the data available. For example, to conduct any meaningful pre-post analysis on the client outcomes data, there will need to be enough data available. This will depend on the number of clients completing the same measures and is not something that we’ll be able to specify in advance of accessing the data.
Depending on the quality of the data, some analyses might include:
- pre- and post-therapy outcomes for clients
- descriptive statistics of client demographics (where available)
- pre- and post-therapy comparison of therapeutic alliance
- analysis of client outcomes in relation to therapeutic alliance
Practitioner feedback questionnaires will incorporate a mixture of open and closed questions, providing both quantitative and qualitative data. Analysis of these data might include:
- descriptive statistics from quantitative data
- thematic or content analysis of qualitative data
Any other qualitative feedback data gathered (such as through written feedback by email) will also be analysed using thematic or content analysis.
How does the client consent process work?
Prior to asking a client for their consent to complete measures and to share data, it’s important that you consider first whether the potential involvement of a specific client is in their best interests. If you decide to ask your client if they want to be involved, it's important that you carefully explain what this would mean, what the benefits might be and also that you explore any questions or concerns they might have. There is no obligation for any client to use the system so if you have any sense that a client is hesitant or uncertain then it’s best not to proceed. This is also true if you get a sense that a client who has consented subsequently changes their mind.
There’s a dual client consent process built into the system: one for data to be held securely on an online system and the second for anonymised data to be used for research purposes. If a client doesn’t want their data to be used for research purposes but they’re happy for it to be held on a secure online system, then this data will not be accessible to the BACP Research team.
How can a client withdraw from the project?
A client can ask you for their data to be withdrawn at any time. Due to the dual consent process (as outlined above) clients can withdraw their consent for their data to be used for research purposes and/or for their data to be stored in an online platform. A client might want to withdraw their data from being used for research purposes but be happy for their data to be stored in an online system as part of the note keeping process.
If a client withdraws their consent for their data to be used for research purposes but is happy for their data to be held in an online system:
You can withdraw consent on the clients’ behalf by editing the research client consent boxes on their client profile which can be checked or unchecked by you at any time. It is your responsibility to ensure that any changes to a client’s consent are made on the system. We can provide guidance on how to do this.
If a client tells you that that they want to withdraw their consent for their data to be used for research purposes, please let us know by emailing firstname.lastname@example.org so that we can advise you of when we last received an export of the anonymised client data. Anonymised client data is exported from the system and securely sent to BACP on a quarterly basis. If a client withdraws their consent once their anonymised data has been sent to us at BACP, we are unable to delete the data as, given its anonymous nature, we would be unable to identify the client who has withdrawn.
If a client withdraws their consent for their data to be stored in an online system:
If a client wants to withdraw their consent for their data to be held in an online platform then it is your responsibility to delete their client profile from the online platform. We can provide guidance on how to do this. In line with the requirements set out in the Ethical Framework, you’ll still need to ensure that you’re keeping appropriate client notes.
How can I, as a practitioner, withdraw from the project?
You’d need to let us know by emailing us at email@example.com. We would then ask you for some feedback on why you’re withdrawing so that we can use this to inform our evaluation of the system. However, you are not obligated to provide us with a reason for your decision.
We would work with you to ensure that you’re able to retrieve appropriate data for your records. We would then delete any identifiable data that we hold about you in relation to the project and instruct Manyother Ltd to permanently delete your data from the platform, including your clients’ data.
Has the project undergone an independent ethical review process?
Yes. The project has been through an independent ethical review process as set out in the Ethical Guidelines for Research in the Counselling Professions.
As this project is not being undertaken in collaboration with a Higher Education Institute (HEI) we have not had access to a Research Ethics Committee (REC). We take the safety and trust of clients and members participating in any research very seriously and this has been at the forefront of our thinking throughout the development of the project and particularly in relation to issues of client and member consent. All participation in the project is entirely voluntary and is done so on the basis of informed consent.
We continue to assess and review the ethical aspects of the research on an ongoing basis in light of feedback from participants. Any further extensions of the project will also be subject to additional independent ethical review.
Data and security
Is the system secure?
The system is operated from a dedicated private server housed in a UK-based high security data centre. It is protected by a firewall and threat monitoring systems. Communications between you and the server is encrypted and sensitive data, like contact details and notes, are encrypted in the database.
The system ensures your login password is suitably long and complex. Repeated login failures will result in your account being locked. The system includes event monitoring functionality to ensure suspicious activity is highlighted.
There is a double-backup system designed to ensure recovery of the system and data in the event of a major failure.
What happens with the data that’s held in the system?
All sensitive and personal client data, such as contact details and client notes are encrypted and are not accessible to BACP.
For all other data, for example questionnaire responses and demographic information, Manyother Ltd will anonymise the data using a pseudo-ID and securely send these data to the research team at BACP for analysis. These data will be pooled with data from clients seen by other practitioners using the system and analysed collectively to give a general picture of counselling in private practice. Once the data has been anonymised and sent to us, we’re not able to delete it on request given it’s completely anonymous.
Can I allow my supervisor to access the system on my behalf if I die or become incapacitated?
We recommend you give the contact details of the BACP research department and the system providers, Manyother Ltd, to your supervisor, a trusted colleague, or specially appointed trustee, and add those details to your clinical will.
In the event of your death or incapacity, this designated person should contact BACP and Manyother Ltd with suitable credentials to show they have your authority. Your account would be suspended until it is clear what your instructions are for the data.
You should not give your login details to anyone.
At the end of the trial, who would ‘own’ the client data? Could I remove the data, or would it be ‘lost’ to the trial?
Any anonymised data that has already been exported will continue to be available to the Research department at BACP, for a maximum of 10 years after the end of the trial period. After this, the anonymised data would be deleted.
If I choose to carry out research in the future, would I be free to use my data in my own research at any stage?
Yes. You are the data controller and you own the data. Obviously, you’d need to ensure that you have the appropriate consent from your clients to use the data for research purposes, and that any research you undertake adheres to the Ethical Framework and the Ethical Guidelines for Research in the Counselling Professions.
Which outcome measures can I use with my clients?
We’re recommending that you collect the CORE-10 or YP-CORE and Session Rating Scale (SRS) or Child Session Rating Scale (CSRS) at regular intervals, along with PHQ-9 or GAD-7 if you deem them to be clinically appropriate. However, if other outcome measures are more appropriate for your work, please let us know by emailing firstname.lastname@example.org and, where possible, we’ll do what we can to support this.
Do I have to use measures at every session?
In short, no. We want the system to work for everyone and to fit into their usual way of working. While we would usually recommend collecting outcome measures at every session to ensure that an ‘end point’ score is captured in the event that a therapeutic relationship is terminated early, we appreciate that this doesn’t work for everybody. We suggest that you collect outcome measures at intervals that you deem to be clinically appropriate for your work as a whole and for each individual client.
A measure I normally use with clients isn’t currently available on the system – can it be added?
Yes, potentially. Depending on the copyright status of the measure it may be possible for us to introduce it at no cost. In some cases, we might not be able to add the measure if there is a cost associated with it, but if there’s enough demand for a particular measure then we may make a decision to add it at a later date. Any costs associated with the addition of measures would be covered by BACP and there is no expectation or plans to pass these costs on to members.
If you can’t see a measure you’d like to use, please email us at email@example.com.
Is it possible to send clients a link to the outcome measures I’d like them to complete before, or following, a session?
Absolutely. Measures can be securely emailed to clients through the Pragmatic Tracker system either prior to a session, or afterwards, depending on your preference and what you agree with each client. Alternatively, clients can complete paper copies of measures and you can manually input the data into the system.
Will BACP make it compulsory for members to use this system and/or collect outcome measures in the future?
No. There are no plans to make it compulsory for members to collect outcomes data with their clients, either through this system or by any other means.
Can I send clients appointment reminders through the system?
Yes. Appointment reminders can be sent securely through the system, either by text message or email.
Is it free to use?
For the duration of the pilot (until at least February 2022) we’re offering the system to members free of charge, distributing a limited number of licences on a first-come-first-served basis. Anyone using the system before February 2022 will be kept updated with funding information. If funding is not continued beyond February 2022, there’s no obligation for you to continue using the system, although you can choose to do so by paying the licence fee directly to Pragmatic Tracker.
Do you plan to charge members to use the system?
We have no plans to charge members for using the system. We are contractually committed to fund the system until at least February 2022, which means that members will not be charged for using it up to this point.
In the event that we do not renew our contract with Manyother Ltd, you will have the option to continue using the system (on a paid basis in a Single User System) through a direct contract for service between yourself and Manyother Ltd. BACP would not benefit financially or otherwise for your continued use of the system past the current pilot period.
Using the system with clients
Can I use the system with clients I see as part of my work within an organisation?
No. This pilot is only available to those who contract directly with an individual, couple, or family, rather than those seen as part of a tripartite agreement. This is due to the pilot nature of the study and the complexities concerning the data owner in tripartite agreements.
Can I use the system with clients I see as part of couple or family work?
Yes, and you can record this in the system as couple or family work.
I only see a small number of clients in private practice, am I still eligible?
Yes. There’s no upper or lower limit for how many clients you need to be seeing to be eligible.
Can I use the system for supervision sessions?
Yes. There are two ways in which the system can be used for supervision: You can add a session titled ‘supervision’ in which you can write notes about a client relating to discussion with your supervisor. Or, if you’re a supervisor, you can add your supervisees as though they are a client and track their supervision sessions. Supervision measures aren’t currently available on the system but if you use such measures as part of your work and would like to see these included, please let us know and we will see if we’re able to accommodate this.
I’m not taking on any new clients at the moment, but can I start using it with existing clients?
Potentially. If you’ve already been collecting outcome measures with existing clients, then manually and retrospectively adding data to the system may be ok providing you have the appropriate consent from your client or clients to do so.
Depending on how you’ve previously contracted with your client or clients with regards to their data, you may need to revisit the consent process to ensure that they’re happy for their data to be stored in the system and for anonymised data to be used for research purposes.
Do I need to change the way I practise to be able to use Pragmatic Tracker?
Only if you wish to. The idea is that Pragmatic Tracker supports how you already practise, with the aim of integrating the use of measures and session tracking seamlessly into the therapeutic process. This is about supporting and augmenting your clinical practice for the benefit of your clients.
As part of the project, training and support is offered to help you find the best way to integrate Pragmatic Tracker into your everyday practice so that it enhances what you offer to each individual client if you consider it to be of benefit to them. Some practitioners are more familiar with this way of working than others and we aim to support you with your learning about this, whatever your prior experience and knowledge.
Given the social contact restrictions now in place because of COVID-19, can I use the system to work remotely with my clients?
Yes. Pragmatic Tracker has been designed for remote working as well as face to face.
It’s an online system that can send measure invites and appointment reminders to clients by email.