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Aim: Routine outcome monitoring (ROM), including the use of feedback, has become a much vaunted method in psychological therapies but is little used in university/college counselling and mental health services, perhaps because its adoption raises questions for many practitioners and service leaders. There is a need for both clinical‐ and research‐based statements to clarify the reasoning and rationale for ROM. This paper aims to present and respond to common challenges of and reservations about using ROM in student counselling and/or mental health services. Method: The article poses 15 questions and issues about the adoption of ROM drawn from the literature on this topic and further refined by practitioner‐ and researcher‐members of a consortium comprising service leads, practitioners, and researchers working in the field of student counselling in the UK. The questions address nine themes: (1) the purpose and yield of ROM; (2) the burden of measurement; (3) the impact on clients and process of therapy; (4) consistency with therapeutic theory; (5) client groups and settings; (6) concern from practitioners; (7) equality, diversity, and inclusion; (8) implementation; and (9) relationship with the paradigm of practice‐based evidence. Findings: Responses to each of the 15 questions are provided from a methodological, evidence‐based, and clinical perspective. Conclusions: The responses provide practitioners with the necessary information to enable them to make informed decisions as to the value, or otherwise, of adopting ROM, including feedback, in the delivery of counselling interventions, and generating evidence created from clinical practice. [ABSTRACT FROM AUTHOR]

There remain barriers to securing robust and complete datasets from counselling embedded in Higher Education (HE). This study aimed to provide the first step towards developing a national dataset of student counselling outcomes drawn from differing outcome measures, platforms and reporting on all clients. Data from four counselling services using two clinical outcome measures and two platforms were pooled and analysed. Students presented to counselling with low levels of wellbeing and functioning, and high levels of depression, anxiety, academic distress and trauma. Counselling was particularly effective for improving depression, anxiety, wellbeing, hostility, social anxiety and academic distress. Results demonstrate value in pooling complete data from HE counselling services and we argue for developing a national dataset of university counselling data. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the study was to investigate the administration and use of routine outcome monitoring session by session in the context of improving guided‐self‐help interventions when delivered remotely at Step 2 care in the English Improving Access to Psychological Therapies (IAPT) services. Design: Qualitative research using recordings of telephone‐treatment sessions. Method: Participants (11 patients and 11 practitioners) were recruited from four nationally funded IAPT services and one‐third sector organisation commissioned to deliver Step 2 IAPT services, in England. Data collection took place prior to the COVID‐19 pandemic. Transcripts of telephone–treatment sessions were analysed using thematic analysis. Results: Four themes were identified: (1) lack of consistency in the administration of outcome measures (e.g. inconsistent wording); (2) outcome measures administered as a stand‐alone inflexible task (e.g. mechanical administration); (3) outcome measures as impersonal numbers (e.g. summarising, categorising and comparing total scores); and (4) missed opportunities to use outcome measures therapeutically (e.g. lack of therapeutic use of item and total scores). Conclusions: The administration of outcome measures needs to ensure validity and reliability. Therapeutic yield from session‐by‐session outcome measures could be enhanced by focusing on three main areas: (1) adopting a collaborative conversational approach, (2) maximising the use of total and items scores and (3) integrating outcome measures with in‐session treatment decisions. Shifting the perception of outcome measures as impersonal numbers to being process clinical tools ensures a personalised delivery of psychological interventions and has the potential to enhance engagement from practitioners and patients what may reduce drop‐out rates and improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Occupational burnout is common in mental health professionals, but its impact on patient outcomes is as yet uncertain. This study aimed to investigate associations between therapist-level burnout and patient-level treatment outcomes after psychological therapy.Methods: We used multilevel modeling using depression (PHQ-9) and anxiety (GAD-7) outcomes data from 2,223 patients nested within 49 therapists. Therapists completed a survey including the Oldenburg Burnout Inventory (OLBI) and a job satisfaction scale (JDSS).Results: After controlling for case-mix, around 5% of variability in treatment outcomes was explained by therapist effects (TE). Higher therapist OLBI-disengagement and lower JDSS scores were significantly associated with poorer treatment outcomes, explaining between 31 and 39% of the TE estimate. Higher OLBI scores were also correlated with lower job satisfaction ratings.Conclusions: Therapist burnout has a negative impact on treatment outcomes and could be the target of future preventive and remedial action. [ABSTRACT FROM AUTHOR]

With reports continually demonstrating increased demand and severity of student mental health needs, it is important to gain a fuller understanding of the impact on embedded student counselling services. The aims of this research were to identify (a) service similarities, (b) factors which impact on services, (c) characteristics of service users, and (d) the use of therapeutic technology (e.g. online self-help). An online survey was completed by 113 heads of UK student counselling services across Higher Education (HE), Further Education (FE), and Sixth Form Colleges (SFCs), to capture service data from the academic year 2013/14. Students predominantly received high-intensity support (e.g. counselling) and referrals increased over 3 years. Challenges to embedded counselling services and their implications for development are discussed. [ABSTRACT FROM AUTHOR]

Background: Outcome measures for mental health services need to adopt a service-user recovery focus. Aims To develop and validate a 10- and 20-item self-report recovery-focused quality of life outcome measure named Recovering Quality of Life (ReQoL).Method: Qualitative methods for item development and initial testing, and quantitative methods for item reduction and scale construction were used. Data from >6500 service users were factor analysed and item response theory models employed to inform item selection. The measures were tested for reliability, validity and responsiveness.Results: ReQoL-10 and ReQoL-20 contain positively and negatively worded items covering seven themes: activity, hope, belonging and relationships, self-perception, well-being, autonomy, and physical health. Both versions achieved acceptable internal consistency, test-retest reliability (>0.85), known-group differences, convergence with related measures, and were responsive over time (standardised response mean (SRM) > 0.4). They performed marginally better than the Short Warwick-Edinburgh Mental Well-being Scale and markedly better than the EQ-5D.Conclusions: Both versions are appropriate for measuring service-user recovery-focused quality of life outcomes. Declaration of interest M.B. and J.Co. were members of the research group that developed the Clinical Outcomes in Routine Evaluation (CORE) outcome measures. [ABSTRACT FROM AUTHOR]

Background Many outcome measures for young people exist, but the choices for services are limited when seeking measures that (a) are free to use in both paper and electronic format, and (b) have evidence of good psychometric properties. Method Data on the Young Person's Clinical Outcomes in Routine Evaluation ( YP- CORE), completed by young people aged 11-16, are reported for a clinical sample ( N = 1269) drawn from seven services and a nonclinical sample (N = 380). Analyses report item omission, reliability, referential distributions and sensitivity to change. Results The YP- CORE had a very low rate of missing items, with 95.6% of forms at preintervention fully completed. The overall alpha was .80, with the values for all four subsamples (11-13 and 14-16 by gender) exceeding .70. There were significant differences in mean YP- CORE scores by gender and age band, as well as distinct reliable change indices and clinically significant change cut-off points. Conclusions These findings suggest that the YP- CORE satisfies standard psychometric requirements for use as a routine outcome measure for young people. Its status as a free to use measure and the availability of an increasing number of translations makes the YP- CORE a candidate outcome measure to be considered for routine services. [ABSTRACT FROM AUTHOR]

Copyright of Psychotherapy Research is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives The study investigated whether psychological wellbeing practitioners (PWPs) working within the UK government's Improving Access to Psychological Therapies (IAPT) initiative are differentially effective (i.e., therapist effect size) and differentially efficient (i.e., rate of clinical change), and the moderating effect of demographic and process factors on outcomes. Design and Methods Routine clinical outcome data (depression, anxiety, and functional impairment) were collected from a single IAPT service. A total of 6111 patients were treated by 56 PWPs. Multilevel modelling (MLM) determined the size of the therapist effect and examined significant moderators of clinical outcomes. PWPs were grouped according to below average, average, and above average patient outcomes and compared on clinical efficiency. Results Therapist effects accounted for 6–7% of outcome variance that was moderated by greater initial symptom severity, treatment duration, and non-completion of treatment. Clinically effective PWPs achieved almost double the change per treatment session. As treatment durations increased beyond protocol guidance, outcomes atrophied. Treatment non-completion was particularly detrimental to outcome. Conclusions PWPs appear to be differentially effective and efficient despite ostensibly delivering protocol driven interventions. Implications for services, training, and supervision are outlined. [ABSTRACT FROM AUTHOR]

Copyright of Psychotherapy Research is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background Stepped care service delivery models involve treatments that become increasingly intense through successive steps, with patients re-assigned via pre-defined decision criteria. This article reviews the clinical effectiveness of stepped care systems for depression in working age adults. Methods Systematic literature review of quantitative clinical outcome evidence comprising 14 controlled and uncontrolled studies meeting specified criteria. Principal outcomes were (a) recovery rates, defined as patients no longer meeting clinical cut-off criteria for the specific outcome measure and (b) treatment response rates, defined as a 50% decrease in outcome measure score. Results Stepped care systems had recovery rates ranging predominantly between 40% and 60% and response rates approximating 60%. Studies comparing stepped care with usual/enhanced usual care tended to find significant differences favouring stepped care. The median recovery odds ratio was 1.31 (interquartile intervals of 1.05 and 1.66; k =7 studies). The median comparative Cohen׳s d effect size estimate was 0.41 (interquartile intervals 0.25 and 0.45; k =5 studies). Limitations The inclusion of uncontrolled studies could be seen as reducing the overall quality of evidence and a meta-analysis was not included due to limitations with the available data. Conclusions Evidence suggested that stepped care interventions for depression are at least as effective as usual care. However, the clinical and organisational superiority of stepped care is yet to be scientifically verified. Differential benefits of stepped care may ultimately depend on service quality. Further research investigating and comparing the specific components and configurations of stepped care interventions are indicated. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to establish staff and patient opinions on the acceptability, feasibility, and utility of using the Clinical Outcomes in Routine Evaluations - Outcome Measure (CORE-OM) in secure hospitals. Design/methodology/approach - Patients and nurses (male patients and their key workers) from high, medium and low secure hospitals participated in semi-structured interviews after completing CORE-OM or CORE-OM (SV). Findings - Template themes were acceptability, feasibility, relevance, suitability, changes to treatment, and understanding. Findings suggest that the CORE-OM is acceptable and potentially useful in secure settings. Practical implications - This paper suggests that the CORE-OM is acceptable to patients and staff in secure settings and appears to be a feasible measure for such settings. Further research and accumulation of a referential database of item scores is needed for PROMS, including the CORE-OM, to be fully useful in secure settings. Originality/value - This paper will be of use to clinicians working with forensic mental health settings. It is one of only two papers which investigate the use of the CORE-OM in forensic settings. [ABSTRACT FROM AUTHOR]

Objectives. The question of how effective therapies are in routine practice is crucial. The answer depends on how we define effectiveness. Both the definition of who was treated and the index chosen to represent outcome can affect estimates dramatically. Design. We used data from the Clinical Outcomes in Routine Evaluation (CORE) Primary Care National Practice-Based Evidence database-2005 on the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) from 33,587 patients and examined rates of improvement in psychological therapies in UK National Health Service (NHS) primary care services using various definitions of effectiveness. Methods. We constructed successively more restrictive sub-samples of patients, including practice-based analogues of several types of intent-to-treat (ITT) groups and completer groups. We focussed on patients scoring above clinical cut-off at intake, but we also considered samples that included sub-clinical patients. We assessed two types of recovery rates, improvement rates, mean pre-post change, and pre-post effect sizes for each sub-sample. Results. There was wide variation in the overall effectiveness of treatments as a function of which subset of data was considered and which specific criterion of recovery rate was adopted. Recovery rates and pre-post effect sizes ranged from 19% to 65% and 0.60 to 1.95, respectively. Conclusions. Because estimates of effectiveness could have significant policy implications, clarity on the meanings of the differing constructions is essential. [ABSTRACT FROM AUTHOR]

Purpose: To describe a new approach for deriving a preference-based index from a condition specific measure that uses Rasch analysis to develop health states. Methods: The CORE-OM is a 34-item instrument monitoring clinical outcomes of people with common mental health problems. The CORE-OM is characterised by high correlation across its domains. Rasch analysis was used to reduce the number of items and response levels in order to produce a unidimensional measure and to generate a credible set of health states corresponding to different levels of symptom severity using the Rasch item threshold map. Results: The proposed methodology resulted in the development of CORE-6D, a 2-dimensional health state descriptive system consisting of a unidimensional 5-item emotional component (derived from Rasch analysis) and a physical symptom item. Inspection of the Rasch item threshold map of the emotional component helped identify a set of 11 plausible health states, which, combined with 3 physical symptom item levels, form 33 plausible health states that can be used for the valuation of the instrument, resulting in the development of a preference-based index. Conclusions: This is a useful new approach to develop preference-based measures from existing instruments with high correlations across domains. The CORE-6D preference-based index will enable calculation of Quality-Adjusted Life Years in people with common mental health problems. [ABSTRACT FROM AUTHOR]

Purpose. To review the published material on practice-based research and to compare results with benchmarks derived from efficacy studies. Methods. Electronic and manual searches were carried out up to and including 2008. Studies were screened for content relevance and selected according to specified inclusion criteria. Data were extracted from all studies that met criteria and were quality assessed using an adapted version of a checklist designed for the appraisal of both randomized and non-randomized studies of health care interventions. Studies were synthesized according to (I) the type of problem being treated and (2) study design using descriptive and meta-analytic methods where appropriate. Results. Psychological treatment conducted in routine clinic settings is effective for a range of client problems, particularly common mental health problems (uncontrolled effect size= 1.29; 95% CI = 1.26-1.33, N= 10,842). When benchmarked against data from efficacy studies, practice-based studies yielded effect sizes that fell short of the selected benchmark. In contrast, the practice-based studies achieved the benchmark for percentage of clients meeting a stringent criterion for recovery. Conclusions. Clients receiving treatment as normally delivered within routine practice report significant relief of symptoms. However, the result of comparisons with efficacy benchmarks is dependent on the outcome index used. Notwithstanding this, substantive factors are also likely to contribute. Therefore, in addition to attending to methodological issues, further work is required to understand the relative contribution of these factors. [ABSTRACT FROM AUTHOR]

Background: There is a need for a user-friendly measure of change for use in school and youth counselling services which is easy for practitioners to administer and score, and which is appropriate for brief interventions. Aims: To develop such a measure and to present psychometric data on reliability, validity and sensitivity to change for the measure. Method: We employed a three-stage approach: first, creating a pool of potential items; second, developing an 18-item version; and third, refining to a final version comprising 10 items. We called the measure the Young Person's CORE (YP-CORE). Results: The measure comprised eight negative and two positive items and included a single (negatively-framed) risk-to-self item. Psychometric properties were all acceptable. Sensitivity to change was good and yielded an average improvement of 10 points on the YP-CORE in a clinical group, broadly equivalent to changes in adult versions (e.g. Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM)). Conclusion: Initial validation work showed the measure to be well designed and sensitive to change. Analysis showed considerable variability as a function of age and gender suggesting the need for the collection of a large and diverse data set in order to produce gender and age-specific norms. [ABSTRACT FROM AUTHOR]

Objective To evaluate benefits for postnatal women of two psychologically informed interventions by health visitors. Design Prospective cluster trial randomised by general practice, with 18 month follow-up. Setting 101 general practices in Trent, England. Participants 2749 women allocated to intervention, 1335 to control. Intervention Health visitors (n=89 63 clusters) were trained to identify depressive symptoms at six to eight weeks postnatally using the Edinburgh postnatal depression scale (EPDS) and clinical assessment and also in providing psychologically informed sessions based or cognitive behavioural or person centred principles for an hour a week for eight weeks. Health visitors in the contra group (n=49 38 clusters) gave usual care. Main outcome measures Score ≥12 on the Edinburgh postnatal depression scale at six months. Secondary outcomes were mean Edinburgh postnatal depression scale, clinical outcomes in routine evaluation-outcome measure (CORE-OM), state-trait anxiety inventory (STAI), SF-12, and parenting stress index short form (PSI-SF) scores at six, 12,18 months. Results 4084 eligible women consented and 595 women had a six week EPDS score ≥12. Of these, 418 had score: available at six weeks and six months. At six months, 34% (93/271) of women in the intervention group and 46% (67/147) in the control group had a score ≥l2. The odds ratio for score ≥12 at six months was 0.62 (95% confidence interval 0.40 to 0.97, P=0.036) for women in the intervention group compared with women in the control group. After adjustment for covariates, the odds ratio was 0.60 (0.38 to 0.95, P=0.028). At six months, 12.4% (234/1880) of all women in the intervention group and 16.7% (166/995) of all women in the control group had scores ≥12 (0.67, 0.51 to 0.87, P=0.003). Benefit for women in the intervention group with a six week score ≥12 and for all women was maintained at 12 months postnatally. There was no differential benefit for either psychological approach over the other. Conclusion Training health visitors to assess women, identify symptoms of postnatal depression, and deliver psychologically informed sessions was clinically effective at six and 12 months postnatally compared with usual care. [ABSTRACT FROM AUTHOR]

Background: Although measures of psychopathology are designed for use in clinical populations, their meaning derives from comparison with normal populations.Aims: To compare the distribution of scores on the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) from a general population sample with the distribution in an aggregated clinical sample to derive recommended cut-off points for determining clinical significance.Method: The CORE-OM general population sample was based on a weighted subsample of participants in the psychiatric morbidity follow-up survey who completed valid CORE-OM forms following their interview (effective n=535).Results: Comparison of the CORE-OM general population sample with a clinical sample aggregated from previous studies (n=10761) yielded a cut-off score of 9.9 on the 0-40 scale of the CORE-OM. The CORE-OM was highly correlated (r=0.77) with the Clinical Interview Schedule-Revised, supporting convergent validity.Conclusions: We recommend rounding the CORE-OM cut-off score to 10. However, cut-off scores must be used thoughtfully and adjusted to fit context and purpose. [ABSTRACT FROM AUTHOR]

This paper presents a profile of the development of the tools and support services that define the CORE System as a unique resource for routine evaluation. After contextualizing developments against a backcloth of policy development, the paper sequentially explores five key areas. The first two profile the development and content of the paper tools that make up the CORE System and include the CORE Outcome Measure (CORE-OM), the Therapy Assessment Form and the End of Therapy Form. Subsequent sections then move on to profile the background and iterative development of standardized software in the form of CORE-PC and the critical role of preparatory training to support services in meeting the challenge of organizational change introduced by routine evaluation. The final section looks at the development and structure of CORE benchmarks to resource benchmarking for service quality development. Overall the paper hopes to convey a sense of the positive benefits that can be accrued from a close working collaboration between a research-practice collaboration developing a range of unique and innovative resources and support tools over the past decade. [ABSTRACT FROM AUTHOR]

This study followed up one by Stiles et al. (2003), which identified sudden gains -- large reductions from one session to the next on a short form of clinical outcomes in routine evaluation outcome measure (CORE-SF) -- by some clients in routine clinical practice. We interviewed the therapists who had treated sudden gain and non-sudden gain clients. Results showed that therapists could retrospectively identify which clients had or had not experienced sudden CORE-SF gains at substantially better than chance rates, although they identified only about half of the clients who had experienced such gains. [ABSTRACT FROM AUTHOR]

Background: There is a need for reliable assessment tools that are suitable for the counselling and the psychological therapy services in primary and secondary care settings.Aims: To test the suitability and utility of the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) and CORE-Assessment (CORE-A) assessment tools.Method: Service intake data were analysed from counselling and psychological therapy services in 32 primary care settings and 17 secondary care settings.Results: Completion rates exceeded 98% in both of the settings sampled. Intake severity levels were similar but secondary care patients were more likely to score above the risk cut-off and the severe threshold and to have experienced their problems for a greater duration.Conclusions: The CORE-OM and CORE-A are suitable assessment tools that show small but logical differences between psychological therapy services in primary- and secondary-based care. [ABSTRACT FROM AUTHOR]

Objectives. The aims of this study were to use symptom intensity measures collected at each session (1) to describe the outcomes of clients who received cognitive therapy (CT) for depression in a clinically representative sample, and (2) to compare the outcomes of clients who completed the agreed number of sessions with those who did not. Design and method. Clients (N = 58) contracted to attend between 12 and 20 sessions of CT completed the Beck Depression Inventory (BDI) immediately prior to each therapy session. The BDI and other measures were collected at intake and, for those who completed therapy, at a post-therapy assessment. Results. Completers' BDI scores improved significantly from intake to post-treatment and significantly more from intake to their final session than did those of non-completers. However, when non-completers' final session scores were matched with scores of randomly selected completers at the corresponding session, the difference in improvement was not significant. A significantly higher proportion of clients who completed the agreed number of sessions achieved reliable and clinically significant change (71.4%, 25/35), compared with just 13% (3/23) of clients who did not. Conclusions. (1) CT for depression can be effective in a clinically representative population. (2) Attrition from clinical trials may bias estimates of treatment effectiveness. [ABSTRACT FROM AUTHOR]

Background: An acceptable, standardised outcome measure to assess efficacy and effectiveness is needed across multiple disciplines offering psychological therapies.Aims: To present psychometric data on reliability, validity and sensitivity to change for the CORE-OM (Clinical Outcomes in Routine Evaluation--Outcome Measure).Method: A 34-item self-report instrument was-developed, with domains of subjective well-being, symptoms, function and risk. Analysis includes internal reliability, test-retest reliability, socio-demographic differences, exploratory principal-component analysis, correlations with other instruments, differences between clinical and non-clinical samples and assessment of change within a clinical group.Results: Internal and test-retest reliability were good (0.75-0.95), as was convergent validity with seven other instruments, with large differences between clinical and non-clinical samples and good sensitivity to change.Conclusions: The CORE-OM is a reliable and valid instrument with good sensitivity to change. It is acceptable in a wide range of practice settings. [ABSTRACT FROM AUTHOR]

Focuses on the need for a core outcome measure to provide practice-based evidence for psychological therapies to complement for evidence-based practice paradigm. Development of the Clinical Outcomes in Routine Evaluation--Outcome Measure (CORE-OM); Basic quality improvement in outcomes for a single service.

Background Measurement is the foundation of evidence-based practice. Advances in measurement procedures should extend to psychotherapy practice. Aims To review the developments in measurement relevant to psychotherapy. Method Domains reviewed are: (a) interventions; (b) case formulation; (c) treatment integrity; (d) performance (including adherence, competence and skilfulness); (e) treatment definitions; (f) therapeutic alliance; and (g) routine outcome measurement. Results Modern methods of measurement can support evidence-based practice' for psychological treatments. They also support practice-based evidence', a complementary paradigm to improve clinical effectiveness in routine practice via the infrastructure of Practice Research Networks (PRNs). Conclusions Advances in measurement derived from psychotherapy research support a model of professional self-management (practice-based evidence) which is widely applicable in psychiatry and medicine. [ABSTRACT FROM AUTHOR]

Discusses the rationale for developing and implementing a core outcome battery in routine clinical practice as well as psychotherapy research. Uses of outcomes measurement; Analysis of the previous efforts to achieve a core outcome battery; Reasons for lack of consensus on a core outcome battery; Factors in the development of outcome measures in psychotherapy.

Background: A previously published article in this journal reported the service effects from 103 services within the UK Improving Access to Psychological Therapies (IAPT) initiative and the comparative effectiveness of CBT and Counselling provision. All patients received High-intensity CBT or High-intensity Counselling, but some also received Low-intensity CBT before being stepped-up to High intensity treatments. The report did not distinguish between patients who received low-intensity CBT before being stepped-up. This article clarifies the basis for collapsing low- and high-intensity interventions by analysing the four treatment conditions separately. Method: Data from 33,243 patients included in the second round of the National Audit of Psychological Therapies (NAPT) were re-analysed as four separate conditions: High-intensity CBT only (n = 5975); High-intensity Counselling only (n = 3003); Low-intensity CBT plus High-intensity CBT (n = 17,620); and Low-intensity CBT plus High-intensity Counselling (n = 6645). Analyses considered levels of pre-post therapy effect sizes (ESs), reliable improvement (RI) and reliable and clinically significant improvement (RCSI). Multilevel modelling was used to model predictors of outcome, namely patient pre-post change on PHQ-9 scores at last therapy session. Results: Significant differences obtained on various outcome indices but were so small they carried no clinical significance. Including the four treatment groups in a multilevel model comprising patient intake severity, patient ethnicity and number of sessions attended showed no significant differences between the four treatment groups. Comparisons between the two high-intensity interventions only (N = 8978) indicated Counselling showed more improvement than CBT by 0.3 of a point on PHQ-9 for the mean number of sessions attended. However, this result was moderated by the number of sessions and for 12 or more sessions, the advantage went to CBT. Conclusions: This re-analysis showed no evidence of clinically meaningful differences between the four treatment conditions using standard indices of patient outcomes. However, a differential advantage to high-intensity Counselling for fewer than average sessions attended and high-intensity CBT for more than average sessions attended has important service implications. The finding of equivalent outcomes between high-intensity CBT and Counselling for more severe patients also has important policy implications. Empirically-informed procedures (e.g., predictive modelling) for assigning patients to interventions need to be considered to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Background Improving Access to Psychological Therapy (IAPT) services have increased the number of people with common mental health disorders receiving psychological therapy in England, but concerns remain about how equitably these services are accessed. Method Using cohort patient data ( N =363) collected as part of the independent evaluation of the two demonstration sites, logistic regression was utilised to identify socio-demographic, clinical and service factors predictive of IAPT non-attendance. Results Significant predictors of IAPT first session non-attendance by patients were: lower non-risk score on the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM); more frequent thoughts of “being better off dead” (derived from the CORE-OM); either a very recent onset of common mental health disorder (1 month or less) or a long term condition (more than 2 years); and site. Limitations The small sample and low response rate are limitations, as the sample may not be representative of all those referred to IAPT services. The predictive power of the logistic regression model is limited and suggests other variables not available in the dataset may also be important predictors. Conclusions The clinical characteristics of risk to self, severity of emotional distress, and illness duration, along with site, were more predictive of IAPT non-attendance than socio-demographic characteristics. Further testing of the relationship between these variables and IAPT non-attendance is recommended. Clinicians should monitor IAPT uptake in those they refer and implement strategies to increase their engagement with services, particularly when referring people presenting with suicidal ideation or more chronic illness. [ABSTRACT FROM AUTHOR]