Routine outcome monitoring or measurement is the practice of regularly using outcome measures - or questionnaires - with clients during your therapeutic work together. This allows you and your clients to track the progress of your work over time.
Outcome measures are extremely varied and can focus on a wide range of issues, such as psychological distress, depression, anxiety, self-esteem, wellbeing and personal goals.
Why collect routine outcome measures?
There are several reasons why you might want to collect routine outcome measures. You may be asked to collect them by the service or organisation you work for, you might have used them previously and found them beneficial to both you and your clients, or perhaps you haven’t used them before and are curious to find out more.
The question of whether to collect ROMs is very nuanced and there is no simple answer. Some practitioners and some clients may find them useful, but they might not work for everyone.
Sometimes practitioners have very little say - for example, if it's a requirement of the service you work in. In these cases you may find our information on Implementing ROMs helpful.
For a more in-depth discussion, see our member-only good research practice resource on Using routine outcome measures in practice.
What are the benefits?
Research shows that routine outcome monitoring can have the following benefits for practitioners and clients:
- provides a focus and structure for the therapeutic work
- improved therapeutic relationship
- higher engagement in therapeutic work, with less chance of non attendance
- provides a conversational tool for practitioners and clients to help guide or start the conversation about therapeutic progress
- clients more involved in defining their own outcomes and therapeutic journey, so feel more autonomous
- offers clients another way to communicate their emotional state without needing to find their own words
- offers clients observable evidence of their progress
- enhances client self-awareness and reflection
- improved outcomes after attending therapy, for example reduced psychological distress, anxiety etc
What are the barriers and challenges?
Research has also identified potential barriers and challenges to routine outcome monitoring, including:
- perceived as a bureaucratic exercise, both by practitioners and clients
- clients may suspect it is only used by services to demonstrate effectiveness or for service funding
- inability of ROMs to capture the complexity of mental health, or focusing on symptoms at the expense of other salient issues such as personal goals, positive aspects of life and personal values
Use or misuse of data
- concerns over confidentiality
- concerns around how information might be used, for example, as evidence of ineffectiveness of practitioners or to limit or deny clients’ access to services
- issues associated with completing outcome measures, such as clients being able to read or understand the questions and response options
- concerns about ensuring clients complete outcome measures, particularly where therapy has ended unexpectedly
- administrative challenges associated with outcome measure use and analysis in services, such as staff time, resources, training and turnover
Which measures should I use?
Which measure or measures you use will depend on several factors, including whether you work for a service where your autonomy to choose is limited. You might want to consider:
- which measures are meaningful to you and your clients, and fit with your therapeutic approach?
- do you want or need to be able to benchmark your data against other available data?
If so, it's worth considering a measure which is widely used in the field, such as CORE-OM/CORE-10/YP-CORE, PHQ-9 or GAD-7
- the practicalities of a measure
Is it free to use? Do you want to collect measures frequently and require something brief? Is it a reliable and valid measure?
- the client group you work with
Do you work with clients with a particular presenting issue, such as trauma? If so, you might want to use a measure which specifically focuses on this.
If you work with a wide range of issues, you might want to consider something more generic, such as CORE-OM, CORE-10 or YP-CORE
This is covered in more depth in our good research practice resource on Using ROMs in practice. If you’re still unsure and want to speak to someone, contact email@example.com. We’re happy to talk through your requirements and give you some guidance.
See Implementing ROMs for more information