Monitoring the young persons and carers feedback on progress with the Outcome Rating Scale (ORS) and the alliance with Session Rating Scales (SRS) is a natural fit for clinicians who strive for a collaborative clinical practice. The ORS and SRS gives young people and carers a voice in treatment as it allows them to provide immediate feedback on what is working and what is not. This section details how clinicians can use the ORS and SRS for real time feedback to inform treatment thereby improving the outcome of services they offer to young people and families. A brief overview of the empirical evidence of both scales, and the research of their combined use will be provided. In addition, the majority of this section will be practical and provide an introductory illustration to the use of the ORS and SRS throughout the therapy process. At the end you will be sign posted to how to access the measures and resources available to support your use of them.
Full Answer
How does the ORS work?
· Clients are asked to reflect on the session, complete the brief form and then discuss their feedback with the counselor. The Outcome Rating Scale (ORS) is a brief four-item tool for measuring the client’s perspective of change or improvement (or lack of improvement) in relation to the initial score at intake.
How are the ORS and SRS scales being used in practice?
The ORS is a simple, four-item session by session measure designed to assess areas of life functioning known to change as a result of therapeutic intervention (see appendix). To encourage a collaborative discussion of progress with clients, Miller and Duncan (2000) developed the ORS as an ultra brief alternative to longer measures whose length
What is feedback informed treatment (fit)?
Feedback Informed Treatment (FIT) WHAT IS IT? FIT is an empirically supported, pantheoretical approach for evaluating and improving the quality and effectiveness of ... problems in the therapeutic relationship or in the implementation of the goals of the treatment)” 2 The ORS and SRS were vetted by the Substance Abuse and Mental Health Services
When is a change on the ORS reliable?
The Outcome Rating Scale (ORS) and Child Outcome Rating Scale (CORS) are measures used to monitor children’s, young people and their families’ or carers’ feedback on therapeutic progress. The ORS is a simple, four-item session-by-session measure designed to assess areas of life functioning known to change as a result of therapeutic ...
What is FIT therapy?
Feedback-Informed Treatment (FIT) — using measures to solicit feedback about progress and the quality of the therapeutic relationship — is a transtheoretical, evidence-based approach. The most recent research shows clients whose therapists use FIT on an ongoing basis are 2.5 times more like to experience benefit from treatment.
How does Fit work?
Under the first shell: FIT works because clinicians use measures to monitor their performance. The second: Feedback helps clinicians select the most effective treatment methods. Third: FIT enhances the therapeutic relationship.
Why is feedback important in therapy?
Feedback was especially critical for clients who weren’t getting better, since this group tends to leave therapy early ( Lambert, Harmon, Slade, Whipple & Hawkins, 2005).
Why do we use feedback measures?
Research conducted at mental health agencies has found that using feedback measures leads to fewer no-shows and dropouts. One reason, Seidel said, may be that it gives the therapist the opportunity to repair damage or small rifts that they might not know about otherwise. FIT also has been shown to shorten the course of treatment, he said.
What is FIT treatment?
An approach called feedback-informed treatment or FIT does just that — uses a client’s feedback to inform their treatment. FIT “is all about empowering the client and increasing the client’s voice,” said Jason Seidel, PsyD, founder and director of The Colorado Center for Clinical Excellence in Denver. Seidel has been using FIT at his private practice since 2004.
How many Norwegian couples were in the 2009 randomized clinical trial?
A 2009 randomized clinical trial of 205 Norwegian couples—“the largest randomized study of couples ever done,” Seidel said—had similar findings: Giving therapists feedback on their performance and the couples’ wellbeing almost doubled the effectiveness of therapy ( Anker, Duncan & Sparks, 2009). Also, interestingly, at the six-month follow-up, couples in the feedback group had a significantly lower rate of divorce and separation than the no-feedback group.
What is the SRS in therapy?
The SRS, which is filled out at the end, asks about the therapist’s performance. For instance, one item asks if the client felt heard, understood and respected during the session. Another asks if they worked on or talked about what they wanted to.
What is the outcome rating scale?
Today, two of the most popular measures are the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS), which both feature four items. The ORS, which a client completes at the start of a session, asks about their wellbeing. The SRS, which is filled out at the end, asks about the therapist’s performance. For instance, one item asks if the client felt heard, understood and respected during the session. Another asks if they worked on or talked about what they wanted to.
Do therapists want honest feedback?
Clients need to truly believe that their therapists want honest feedback and to “feel safe that they won’t be retaliated against [for] negative feedback.” Therapists aren’t “just collecting the data, [they’re] collecting accurate data.”
What is the ORS and SRS?
Monitoring the young persons and carers feedback on progress with the Outcome Rating Scale (ORS) and the alliance with Session Rating Scales (SRS) is a natural fit for clinicians who strive for a collaborative clinical practice . The ORS and SRS gives young people and carers a voice in treatment as it allows them to provide immediate feedback on what is working and what is not. This section details how clinicians can use the ORS and SRS for real time feedback to inform treatment thereby improving the outcome of services they offer to young people and families. A brief overview of the empirical evidence of both scales, and the research of their combined use will be provided. In addition, the majority of this section will be practical and provide an introductory illustration to the use of the ORS and SRS throughout the therapy process. At the end you will be sign posted to how to access the measures and resources available to support your use of them.
What is the purpose of the ORS/CORS?
The purpose of the ORS/CORS is to provide real time feedback on progress in client functioning.
What to do if no progress on 8th-10th visit?
If no progress by the 8th-10th visit discuss with the client and carer about whether they need to see someone else such as another clinician with a different approach, and/or a higher level of care.
What to do if there is no improvement by the 5th or 6th visit?
If there is no improvement by the 5th or 6th visit consider adding additional services with young person, carer, and supervisor. This may involve a referral to another agency.
What is supervision in clinical practice?
Supervision is a key mechanism for supporting supervisee’s integration of feedback into their clinical practice. Supervisees should bring the clients’ ORS/CORS and the SRS/CSRS and graphs to supervision. The measures and the graphs bring the feedback and voice of the young person and carer directly into the supervisory session which is an invaluable addition to the clinician’s perceptions of progress and the alliance. The measures can be used in a similar way in multi-disciplinary team/peer reviews and Care Plan Approach (CPA) reviews.
How old do you have to be to fill out the ORS?
The young person who is referred or is seeking help, is always asked to fill out the ORS (ages 13 to 18) or CORS (ages 6-12) on themselves.
Can you fill out ORS on yourself?
If it turns out that the carer and/or other family members are distressed, and the distress is related to problems in the family (including the child), then you can continue to have the carer and family members filling out the ORS/CORS on themselves. Your plan and approach should consider how those individual family members’ needs will be met.
What is Routine Use of the ORS and SRS?
practice. Routine use of the ORS and SRS involves “the integration of the best available research… and monitoring of patient progress…that may suggest the need to adjust the treatment… (e.g., problems in the therapeutic relationship or in the implementation of the goals of the treatment)”2
What is behavioral health?
behavioral health services. It involves routinely and formally soliciting feedback from clients regarding the therapeutic alliance and outcome of care and using the resulting information to inform and tailor service delivery1
What is the ORS scale?
The ORS is a simple, four-item session-by-session measure designed to assess areas of life functioning known to change as a result of therapeutic intervention. These areas include: personal or symptom distress (measuring individual well-being); interpersonal well-being (measuring how well the user is getting along in intimate relationships); social role (measuring satisfaction with work/school and relationships outside of home); and overall well-being. The ORS translates these four dimensions of functioning into four visual analogue scales which are 10cm lines, with instructions to place a mark on each line with low estimate to the left and high to the right. The ORS is designed to be accessible to a child with a 13-year-old’s reading level, making it feasible for adolescents and adults.
How reliable is the ORS test?
Research on the ORS test-retest reliability presents moderate to high estimates, .58 to .66 (Miller et al., 2003) and .80 to .84 (Bringhurst, Watson, Miller, & Duncan, 2006).
How old do you have to be to fill out a CORS?
The ORS can be completed by children aged 13-18 years old and the CORS can be completed by children aged 6-12 years old. Parents/carers can also complete the ORS/CORS. If the young person is 13 or over and fills out the ORS, the carer fills out the ORS on how they perceive the young person is doing. Similarly, if the young person is 12 and under and fills out the CORS, then the carer fills out the CORS on the young person.
What is the correlation between the OQ 45.2 and the ORS?
Pearson product-moment correlations between the ORS total score and the Outcome Questionnaire-45.2 (OQ-45.2) total score revealed a consistent pattern of moderately strong correlations between ORS and OQ-45.2 items, subscales and total scores, with an overall correlation between of total scores of .59 (Miller et al., 2003). Similarly, Binghurst et al. (2006) found overall correlations between the scores of these two measures ranging from .57 to .69.
What age is the ORS?
The ORS is designed to be accessible to a child with a 13-year-old ’s reading level, making it feasible for adolescents and adults. The CORS was developed for children age 6–12.
What is outcome rating scale?
L., Brown, J., Sparks, J., & Claud, D. (2003). The Outcome Rating Scale: A preliminary study of the reliability, validity, and feasibility of a brief visual analog measure. Journal of Brief Therapy, 2, 91-100.
What is the purpose of measures and supported information displayed on our website?
The measures and supported information displayed on our website are intended to serve as an easily accessible resource for individuals looking for information on how to measure children and young people’s mental health and wellbeing.
When is a change on the ORS considered reliable?
Recall, a change on the ORS is considered reliable when the difference in scores exceeds the contribution attributable to chance, maturation, and measurement error.
What countries use the SRS scale?
Japan, Sweden, Norway, Denmark, Germany, France, Israel, Poland, Chile, Guam, Finland, Hungary, Mexico, Australia, China, the United States …and many, many more. What do all these countries have in common? In each, clinicians and agencies are using the ORS and SRS scales to inform and improve behavioral health services. Some are using web-based systems for administration, scoring, interpretation and data aggregation (e.g., myoutcomes.com and fit-outcomes ), many are accessing paper and pencil versions of the measures for free and then administering and scoring by hand.
When will counselors score and review the SRS?
The counselor will score and review the SRS during the last few minutes of that session to clarify client’s answers.
How long does it take to complete the session rating scale?
At the end of each session, you will fill out one additional form, the Session Rating Scale. Again, it’s very short, taking about a minute or less to complete and score. This scale helps me know how the session went. It takes the temperature of the visit, so to speak. We are doing this because the research shows your experience of our work together during the visit is a good predictor of whether we’re successful. I’ll explain more about this at the end of the session. Does this make sense?”
Why is the SRS rating important?
The Rating on the SRS can be very helpful to you as you try to create a therapeutic environment that helps meet the needs of the client. It is this end of session conversation that will be helpful to the counselor and client as they work to form a working alliance.
What to do after 3rd session?
After 3rd session, review Session Rating Scale item-by-item and consider making changes to treatment process
What is reliable deterioration?
3. Reliable deterioration = decrease in 6 points of more and below clinical cut-off
What is reliable change?
Reliable change = improvement of 6 pts. or more but below clinical cut-off score of 25
What to do if referred by someone?
If referred by someone, ask to get the client’s view of the referral source’s score. This might help with addressing motivation for treatment.
Fit’S History
Creating A “Culture of Feedback”
- Administering the scales isn’t the only important part of FIT. Therapists have to be “hungry to see their failures and be interested in becoming better,” Seidel said. So therapists must create a “culture of feedback” and communicate this to their clients. Clients need to truly believe that their therapists want honest feedback and to “feel safe tha...
What The Research Shows
- Earlier work by pioneer researcher Michael Lambert and colleagues at university counseling centers found that giving therapists feedback on their clients’ wellbeing had a huge impact on their improvement. Feedback was especially critical for clients who weren’t getting better, since this group tends to leave therapy early (Lambert, Harmon, Slade, Whipple & HawkinsTrusted Sou…
Fit in Practice
- Therapists are often amazed at how two simple and short scales change the therapy process, Seidel said. They receive a “whole other level of information,” which only helps their clients get better, and they don’t have to change the type of therapy they conduct. Even using the feedback measures during the first session yields valuable results. Take Seidel’s initial session with a mal…
What Clients Can Do
- Unfortunately, while there’s a community of therapists who use FIT (Miller founded what is now a large international group called the International Center for Clinical Excellence), it hasn’t caught on with the majority of clinicians. The reason? Seidel said that it differs by therapy setting. In mental health agencies, the staff is already swamped with caseloads and paperwork. Not only do they f…