1. Why should I measure and monitor client outcomes when I use an empirically-supported intervention?

2. 1:To Obtain the Best Client Outcomes
Even when you use an empirically supported intervention, you still don’t know how it will work with a particular client
Many factors other than your intervention have an effect on client outcomes
Ongoing, relatively objective feedback to the practitioner reduces deterioration and treatment dropout, improves overall outcome, and leads to fewer treatment sessions

3. 2: To Avoid Natural Biases
Practitioners tend to overestimate improvement and underestimate deterioration, in relation to client self-reports
Practitioners have much more confidence in their abilities to judge clients’ progress than is warranted by the data

4. Bias
Tendency to see and interpret information consistently with an emotional preference or preconceived expectation

5. Falsification
Deliberate process of seeking information to discount or disprove a hypothesis or theory

6. Confirmation Bias
Tendency to gather evidence that confirms one’s preconceptions by emphasizing or pursuing supporting evidence while dismissing or failing to seek contradictory evidence “If all you have is a hammer, everything looks like a nail.”

7. 3: To Improve Clinical Decision-Making
You’ll have more and better information with which to make practice decisions
How else would you know if what you’re doing is working?

8. What practice decisions?
Intervene or not?
Continue an intervention?
Modify an intervention?
Change to a new intervention?
Discontinue intervention altogether?

9. 4: To Prevent Client Deterioration
5 to 10% of adult, and 14 to 24% of child clients deteriorate while receiving services
Practitioners find it
especially difficult to detect
client deterioration
Measuring and monitoring
client outcomes can reduce
rates of deterioration,
partly by reducing rates of
dropout from treatment

10. 5: To Bridge the Gaps in EBP
Evidence-based practice is the place to start, but it is not sufficient:
RCTs tell us whether interventions work with the average client, not a particular client
Clients have individual characteristics and circumstances
Methodologies underlying EBP are by no means perfect
Empirically-supported interventions are not available for every client problem you encounter

11. Suppose you have…
Empirically-supported intervention (ESI) backed up by good research
e.g., recent meta-analysis of randomized clinical trials with consistent results concerning the effectiveness of the intervention for the type of problem presented by your client

12. Why no guarantee?
ESIs beneficial for average research subject, some unchanged some worse
Research participants
may not be representative
of your clients (e.g., race,
ethnicity, sexual
orientation)
ESIs may be difficult to
transport to your practice
setting

13. Why no guarantee? (cont’d)
Marked differences among practitioners in terms of the speed and overall amount of client change
Less effective practitioners aren’t necessarily aware that they are less effective
Practitioners tend to overestimate improvement and underestimate deterioration

14. Why no guarantee? (cont’d)
Specific elements of ESIs are one ingredient in the recipe that contributes to client success
Quality of alliance you have with your client influences your client’s outcome whatever intervention you use

15. Why no guarantee? (cont’d)
ESIs are templates that need to be customized to individual clients
Tailored to personal, contextual, and changing situations causing and maintaining problems faced by a particular client

16. 6: To Improve Your Relationships with Your Clients
Demonstrates your respect for your client by giving your client an important voice
Demonstrates conscientiousness on your part, and may enhance your client’s confidence in you

17. 7: To Enhance Your Development as a Practitioner
Huge differences in client outcomes among therapists, even when using the same intervention methods
Clinical practice without
ongoing feedback is like
learning archery while
wearing a blindfold; your
skills are unlikely to
improve if you cannot see
where the arrow is landing

18. 8: To Be Accountable
Monitoring client outcomes constantly and modifying the intervention as needed provides an important tool for achieving clients’ goals in as short a time as possible and conserving limited resources
Some argue that, at least for psychotherapy services, outcome-based accountability is coming—and soon

19. Accountability
Extent to which a person is answerable to another (e.g., a supervisor or official review body) for his or her behaviors, decisions, or judgments, especially in a professional capacity

20. 9: To Meet Your Ethical Obligations
For example…
NASW Code of Ethics, 5.02 Evaluation and Research
(a) Social workers should monitor and evaluate policies, the implementation of programs, and practice interventions.