A collaborative outcome resource network (ACORN): Tools for increasing the value of psychotherapy.

The authors describe a collaborative outcomes resource network (ACORN) and the suite of measurement and decision support tools (ACORN Toolkit) that have emerged from this collaboration for the purpose of providing clinical feedback to therapists. The ACORN Toolkit is most accurately described as a comprehensive clinical information system designed to increase the value of mental health services across large systems of care. It was built to integrate large datasets from multiple sources including outcome data, client demographics and diagnostic data, therapist credentialing information, pharmacy data, and service claims data. For the limited purposes of this article, the authors focus on the ACORN Toolkit for measuring and how it has contributed to improving outcomes in psychotherapy. Implications to current practice and future training are provided.

Benchmarking the effectiveness of psychotherapy treatment for adult depression in a managed care environment: a preliminary study.

This preliminary study evaluated the effectiveness of psychotherapy treatment for adult clinical depression provided in a natural setting by benchmarking the clinical outcomes in a managed care environment against effect size estimates observed in published clinical trials. Overall results suggest that effect size estimates of effectiveness in a managed care context were comparable to effect size estimates of efficacy observed in clinical trials. Relative to the 1-tailed 95th-percentile critical effect size estimates, effectiveness of treatment provided in this setting was observed to be between 80% (patients with comorbidity and without antidepressants) and 112% (patients without comorbidity concurrently on antidepressants) as compared to the benchmarks. Because the nature of the treatments delivered in the managed care environment were unknown, it was not possible to make conclusions about treatments. However, while replications are warranted, concerns that psychotherapy delivered in a naturalistic setting is inferior to treatments delivered in clinical trials appear unjustified.

Benchmarks for psychotherapy efficacy in adult major depression.

This study estimates pretreatment-posttreatment effect size benchmarks for the treatment of major depression in adults that may be useful in evaluating psychotherapy effectiveness in clinical practice. Treatment efficacy benchmarks for major depression were derived for 3 different types of outcome measures: the Hamilton Rating Scale for Depression (M. A. Hamilton, 1960, 1967), the Beck Depression Inventory (A. T. Beck, 1978; A. T. Beck & R. A. Steer, 1987), and an aggregation of low reactivity-low specificity measures. These benchmarks were further refined for 3 conditions: treatment completers, intent-to-treat samples, and natural history (wait-list) conditions. The study confirmed significant effects of outcome measure reactivity and specificity on the pretreatment-posttreatment effect sizes. The authors provide practical guidance in using these benchmarks to assess treatment effectiveness in clinical settings.

Estimating variability in outcomes attributable to therapists: a naturalistic study of outcomes in managed care.

To estimate the variability in outcomes attributable to therapists in clinical practice, the authors analyzed the outcomes of 6,146 patients seen by approximately 581 therapists in the context of managed care. For this analysis, the authors used multilevel statistical procedures, in which therapists were treated as a random factor. When the initial level of severity was taken into account, about 5% of the variation in outcomes was due to therapists. Patient age, gender, and diagnosis as well as therapist age, gender, experience, and professional degree accounted for little of the variability in outcomes among therapists. Whether or not patients were receiving psychotropic medication concurrently with psychotherapy did affect therapist variability. However, the patients of the more effective therapists received more benefit from medication than did the patients of less effective therapists.

Implementation of a feedback system in a managed care environment: what are patients teaching us?

Lessons about patient treatment response from a large-scale outcomes management project are summarized. More than 7,000 clinicians contributed outcome data. Overall, the data demonstrated that patients who have clinical levels of psychological distress and impairment showed a relatively rapid response to treatment. Furthermore, although it appears that the duration and intensity of treatment vary widely from case to case, clinicians and patients make sound judgments as to how much and what kind of treatment is appropriate. Results supported the conclusion that the most effective method to manage costs is to ensure that each patient receive effective care. There are large and stable differences in the effectiveness of clinicians, and outcomes can be improved by referring patients to effective clinicians. The data also suggested that patients who had a poor initial response to treatment eventually had positive outcomes, provided that they remained engaged in treatment. This finding suggests that outcomes can be improved by identifying at-risk patients and proactively keeping them engaged in treatment.

The partners for change outcome management system.

A number of systems provide feedback regarding client progress and experience of the therapeutic alliance to clinicians. Available evidence indicates that access to such data improves retention and outcome for clients most at risk for treatment failure. Over the last several years, the team at the Institute for the Study of Therapeutic Change has worked to develop an outcome management system that not only provides valid and reliable feedback, but also is as user-friendly as possible for therapists and consumers. In this article, we describe the system and summarize current research findings.