Researchers: Yuval Bloch^1,2, Lior Biran^1,2, Ori Ganor¹, Dana Tzur-Bitan^1,3

Background: Routine outcome monitoring (ROM) is the repeated assessments of the treatment process and outcome measures, feedbacking therapists. Its benefits in mental health have been widely demonstrated, but few such attempts have been made with highly distressed patients in public psychiatric-hospital settings, none of them in Israel.

Objectives: We aimed to assess the feasibility and the effectiveness of implementing ROM in four outpatient clinics of Shalvata MHC, as a pilot study overcoming unique challenges inherent to these settings.

Method: The study included 381 patients appointed to various therapies, regardless of diagnosis. In the implementation phase, staff discussions and instructions were held, and 150 patients were recruited (101 remained in therapy and research). The patients completed outcome and alliance questionnaires every session, with graphic reports sent to their therapists. In the RCT phase, 231 patients were randomly assigned to two groups: ROM (n=121), and a control group (n=111) filling questionnaires only at baseline and after six months, without feedback.

Findings: Various challenges were encountered in implementation, related to the sensitivity of the data, the constant need for organizational support, along with therapists’ and patients’ objections. Multivariate analyses indicated that patients in the ROM group showed higher gains in alliance (a well-established predictor of therapy outcome) compared to the control group, but no statistically significant differences were found in symptoms.

Conclusions: Implementation of routine measurements within public mental health therapies with severely distressed patients is very challenging, yet potentially feasible, and promising.
It is possible that longer time, as well as better organizational-technological implementation, are required.

Recommendations: Deep and effective implementation of ROM in these settings probably requires large top-down systematic processes for realizing its full potential.

Research end date: 12/2018