This article reviews the benefits, obstacles, and challenges that can hinder (and have hindered) implementation of routine outcome monitoring in clinical practice. Recommendations for future routine outcome assessment efforts are also provided. Spanning three generations, as well as multiple developed tools and approaches, the four authors of this article have spent much of their careers working to address these issues and attempt to consolidate this learning and experience briefly here. Potential "elephants in the room" are brought into the discussion wherever relevant, rather than leaving them to obstruct silently the field's efforts. Some of these topics have been largely ignored, yet must be addressed if we are to fulfill our promise of integrating science and practice. This article is an attempt to identify these important issues and start an honest and open dialogue.

AMH is only diagnosed by microscopy; a dipstick reading suggestive of hematuria should not lead to imaging or further investigation without confirmation of three or greater red blood cells per high power field. The evaluation and follow-up algorithm and guidelines provide a systematic approach to the patient with AMH. All patients 35 years or older should undergo cystoscopy, and upper urinary tract imaging is indicated in all adults with AMH in the absence of known benign causation. The imaging modalities and physical evaluation techniques are evolving, and these guidelines will need to be updated as the effectiveness of these become available. Please visit the AUA website at http://www.auanet.org/content/media/asymptomatic_microhematuria_guideline.pdf to view this guideline in its entirety.

Little empirical research exists about highly effective psychotherapists, and none about the factors that mediate the acquisition and maintenance of superior performance skills (e.g., Ericsson, 1996, 2006; Ericsson, Krampe, & Tesch-Romer, 1993). In the full sample, a 3-level multilevel modeling (Level 1: clients; Level 2: therapists; Level 3: organization types) of practitioner outcomes was used to examine the contribution of the therapist to treatment effectiveness. Consistent with prior research, in the full sample (n = 69 therapists; n = 4,580 clients) it was found that therapist effects explained 5.1% of the variance in outcome, after adjusting for initial severity. Therapist gender, caseload, and age were not found to be significant predictors. In a subsample of therapists, the relationship between outcome and therapist demographic variables, professional development activities, and work practices was analyzed (n = 17 therapists, n = 1,632 clients). Therapist characteristics (e.g., years of experience, gender, age, profession, highest qualification, caseload, degree of theoretical integration) did not significantly predict client-reported outcomes. Consistent with the literature on expertise and expert performance, the amount of time spent targeted at improving therapeutic skills was a significant predictor of client outcomes. Further, highly effective therapists indicated requiring more effort in reviewing therapy recordings alone than did the rest of the cohort. Caveats and implications for clinical practice, continuing professional development, and training are discussed.

Implications of these findings for the development of expertise in psychotherapy are explored. (PsycINFO Database Record

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.