Routine outcome monitoring (ROM) is the practice of using self-or other report measures to inform treatment by monitoring client symptoms and treatment progress while providing feedback to clinicians and clients. Although ROM has been found to improve therapeutic outcomes and reduce early termination and is considered an evidence-based practice, this essential process is underutilized by clinicians due to philosophical and practical implementation barriers. To improve clinician knowledge and utilization, there have been several recent calls for the study of ROM education and training practices. This paper describes a multiyear study of standardized ROM implementation in a psychology training clinic following a process model. We discuss features of the model and the implementation process including procedures, barriers, facilitators, and outcomes. While initially there were barriers to ROM implementation consistent with the literature, the use of an implementation framework along with evaluation (e.g., clinician feedback, client surveys) helped to address these barriers and improve ROM implementation, resulting in high utilization and compliance rates. The discussion highlights lessons learned and identified facilitators to help aid successful ROM implementation within a training setting.

This study examined relationship satisfaction and health‐related quality of life (HRQOL) among spouse caregivers assisting service members and veterans (SMV) with comorbid uncomplicated mild traumatic brain injury (MTBI) and post‐traumatic stress disorder (PTSD). Spouse caregivers (N = 205) completed the Couples Satisfaction Index (CSI), 12 HRQOL measures, and the Mayo‐Portland Adaptability Inventory 4th Edition (MPAI‐4). T‐scores were classified as “clinically elevated” using a cutoff of ≥60T. The sample was also classified into “Satisfied” (≥13.5, n = 113, 55.0%) or “Dissatisfied” (<13.5, n = 92, 44.0%) relationship categories. Using stepwise regression analysis, Anxiety, Family Disruption, Vigilance, Emotional Support, Feeling Trapped, and MPAI‐4 Adjustment were identified as the strongest predictors of CSI total scores (p < 0.001), accounting for 41.6% of the variance. Squared semi‐partial correlations revealed that 18.1% of the variance was shared across all six measures, with 7.8% to 1.5% of unique variance accounted for by each measure separately. When comparing the number of clinically elevated measures simultaneously, the Dissatisfied group consistently had a higher number of clinically elevated scores compared to the Satisfied group (e.g., 3‐or‐more clinically elevated scores: Dissatisfied = 40.2%, Satisfied = 8.8%, OR = 6.93, H = 0.76). Caring for a SMV with comorbid TBI and PTSD can have a profound impact on the spouse caregiver's HRQOL, relationship satisfaction, and family functioning. The findings from the current study continue to support the need for family involvement in the SMV’s treatment plan, but more effort is needed to integrate behavioral health treatment that focuses on the family member's own issues into military TBI and PTSD systems of care.

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