Longitudinal measurement invariance of the Behavioral Health Measure in a clinical sample.

The practice of routine outcome monitoring (ROM) has grown in popularity and become a fixture in feedback-supported clinical practice and research. However, if the interpretation of an ROM measure changes over time, treatment outcome scores may be inaccurate and produce erroneous or misguided interpretations of client progress and therapist efficacy. The current study examined whether factorial invariance held when using the Behavioral Health Measure (BHM-20) longitudinally in a clinical sample (n = 12,467). Using multidimensional item response theory-based models for the investigation of the BHM-20 factor structure, at a single time point and then longitudinally. Based on the original factor structure of the BHM-20 a unidimensional model, a three-factor orthogonal model, and a three-factor correlated model were fit to the data, indicating poor model fit with the proposed three-factor or unidimensional models. Next, using exploratory factor analysis and subsequent multidimensional item response theory procedures, a new 4-factor (General Distress, Life Functioning, Anxiety, and Alcohol/Drug Use) model was proposed with improved model-fit statistics. Finally, when testing the longitudinal invariance of the BHM-17 over 10 sessions of treatment, it was found to be fully consistent. The current study proposes the use of a 17-item, 4-factor model for a new understanding of the BHM-17. Implications for use in ROM and limitations are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychotherapy racial/ethnic disparities in treatment outcomes: The role of university racial/ethnic composition.

OBJECTIVE: Mental health disparities between racial/ethnic minorities (REM) and White individuals are well documented. These disparities extend into psychotherapy and have been observed among clients receiving care at university/college counseling centers. However, less is known about if campus RE composition affects outcomes from psychotherapy for REM and White clients. METHOD: This study examined psychotherapy outcomes from 16,011 clients who engaged in services at 33 university/college counseling centers. Each of these clients completed the Behavioral Health Measure as a of part routine practice. Campus RE composition was coded from publicly available data. RESULTS: The results demonstrated that White clients had better therapy outcomes than REM clients when they were at campuses where there were more White students. For universities 1 SD below the mean percentage of White students, the average difference in therapy outcomes for White and REM clients was Cohen's d = .21 (with White students experiencing more improvement); however, for universities 1 SD above the mean, the between group outcome disparity was greater (Cohen's d = .38). CONCLUSION: Therapists and higher education professionals should consider environmental impacts on counseling services. Implications for higher education, counseling centers, and mental health disparities are provided. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Are high-performing therapists both effective and consistent? A test of therapist expertise.

OBJECTIVE: Therapist effectiveness has primarily been defined as being the aggregate of the client therapy outcomes within a therapist's caseload. It may seem intuitive that the most skilled therapists are both effective (in the way defined above) and consistent in facilitating positive outcomes across their clients; however, this premise has not been fully tested. The present study sought to empirically examine this question in a large, multisite, geographically diverse sample. We first computed a consistency variable and an aggregate outcome variable for each therapist among a subset of each individual therapist's caseload (the first 30 clients per therapist within our data set). We then utilized this consistency score and aggregate outcome score to predict the therapy outcomes of their remaining clients. Clients' pretreatment severity scores were also included as a moderator of the association between therapist consistency, therapist aggregate outcome, and client outcomes. METHOD: The sample included 27,778 clients who were treated by 275 therapists. At the start of each session, clients completed the Behavioral Health Measure-20 as a measure of psychological functioning. RESULTS: Polynomial regression and response surface analysis indicated a discrepant effect, such that subsequent clients' outcomes were highest when therapists' aggregate outcome with their first 30 clients was high and the consistency in the outcomes of their first 30 clients was also high. This relationship was not moderated by clients' pretreatment severity. CONCLUSION: Therapists' expertise consists of both high performance and consistency. Therapists who achieved better outcomes consistently were top performers with their subsequent clients. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Psychotherapy Outcome Problem: The Development of the Outcome Stability Index.

OBJECTIVE: Psychotherapy research commonly utilizes clients' last session score as an indicator of treatment outcome. We examined whether this last session score is consistent with what would be predicted based on clients' general trajectory in psychological functioning across sessions. We focused on the unstandardized residual variance at the last session, as this represents the degree to which the session score is divergent (or not) from what is predicted from the previous sessions (i.e., Outcome Stability Index; OSI). METHOD: The sample included 27,958 clients who attended on average 9.41 sessions. Each session, clients completed the Behavioral Health Measure-20 as a measure of psychological functioning. We converted the unstandardized residual variance for clients' last session score into a Cohen's d coefficient to aid in interpretation. RESULTS: The mean OSI was 0.07 (SD = 0.58), suggesting excellent stability in their last session therapy outcome scores. However, approximately 33% of clients demonstrated poor or extremely problematic stability in their last session therapy outcome scores. Clients who demonstrated poor stability were classified as demonstrating reliable deterioration. CONCLUSIONS: Researchers may want to consider reporting OSI to assist readers' understanding of the stability of therapy outcomes. Clinical or methodological significance of this article: Therapy outcome scores can vary from session to session, which can influence how we understand therapy outcomes that rely on last session scores. Studies examining therapy outcomes could report the Outcome Stability Index to better contextualize the results.

Correction to: Reliability of Therapist Effects in Practice-Based Psychotherapy Research: A Guide for the Planning of Future Studies.

The original version of this article unfortunately contained a mistake. In Results section, under the heading the "Application", CI difference values were incorrect in one of the sentences. The corrected sentence is given below.

Reliability of Therapist Effects in Practice-Based Psychotherapy Research: A Guide for the Planning of Future Studies.

This paper aims to provide researchers with practical information on sample sizes for accurate estimations of therapist effects (TEs). The investigations are based on an integrated sample of 48,648 patients treated by 1800 therapists. Multilevel modeling and resampling were used to realize varying sample size conditions to generate empirical estimates of TEs. Sample size tables, including varying sample size conditions, were constructed and study examples given. This study gives an insight into the potential size of the TE and provides researchers with a practical guide to aid the planning of future studies in this field.

As good as it gets? Therapy outcomes of trainees over time.

There is a paucity of empirical studies that demonstrate psychotherapy trainees improve at assisting their clients' therapy outcomes over time. We examined whether trainees (i.e., practicum, predoctoral interns, and postdoctoral fellows) improved in their clients' therapy outcomes over time. We examined 114 trainees (i.e., who were trainees for the first client in the database) and had over 12 months of client outcome data (M = 45.31 months). At the start of their time in our database, about half of the participants (48.2%) were predoctoral interns, 42.1% were practicum students, and 9.6% were postdoctoral fellows. Collectively, they treated 2,991 clients (M = 26 clients per trainee). Clients completed the Behavioral Health Measure, which assesses general psychological functioning (i.e., well-being, symptom distress, and life functioning), as a measure of therapy outcomes. Trainees demonstrated small-sized growth in their clients' outcomes over time (d = 0.04 per year); however, this growth was moderated by client severity. That is, trainees demonstrated growth over time in working with clients who were less distressed (d = -0.13 to 0.10 over time), but there was no change over time for trainees when working with more distressed clients (d = 0.67 to .65 over time). The results were consistent across trainee level (i.e., practicum, predoctoral intern, postdoctoral fellow), yet trainees varied in their patterns of growth. Psychotherapy training has a small, but positive, effect on trainees' ability to foster positive outcomes with their clients over time. (PsycINFO Database Record

Measuring psychotherapy outcomes with the Behavioral Health Measure-20: Efficient and comprehensive.

The Behavioral Health Measure-20 (BHM-20; Kopta & Lowry, 2002) through the computer-based CelestHealth System-MH (CHS-MH) has proven to be an effective and efficient instrument for assessing psychotherapy outcomes and providing feedback to psychotherapists. This article describes its features, the psychometric and research support of the measure, as well as its use in clinical training and practice. Additionally, we offer some hopes and possibilities for the future of clinical feedback systems.

Trajectories of Change in Psychotherapy.

OBJECTIVE: The current study used multilevel growth mixture modeling to ascertain groups of patients who had similar trajectories in their psychological functioning over the course of short-term treatment. METHOD: A total of 10,854 clients completed a measure of psychological functioning before each session. Psychological functioning was measured by the Behavioral Health Measure, which is an index of well-being, symptoms, and life-functioning. Clients who attended 5 to 25 sessions at 46 different university/college counseling centers and one community mental health center were included in this study. Client diagnoses and the specific treatment approaches were not known. RESULTS: A 3-class solution was a good fit to the data. Clients in classes 1 and 3 had moderate severity in their initial psychological functioning scores, and clients in class 2 had more distressed psychological functioning scores. The trajectory for clients in class 1 was typified by early initial change, followed by a plateau, and then another gain in psychological functioning later in treatment. The trajectory for clients in class 2 demonstrated an initial decrease in functioning, followed by a rapid increase, and then a plateau. Last, the clients in class 3 had a steady increase of psychological functioning, in a more linear manner. CONCLUSION: The trajectories of change for clients are diverse, and they can ebb and flow more than traditional dose-effect and good-enough level models may suggest.