A qualitative exploration of attitudes towards the use of outcome measures in child and adolescent mental health services

Abstract

The aim of the present research was to explore clinician attitudes to outcome measures and, in particular, the facilitators and barriers to implementing outcome measures. An up-to-date exploration of clinician attitudes is especially needed in the context of recent policies on the implementation of outcome measures in child and adolescent mental health services (CAMHS), and because evidence suggests that there is a disparity between policy recommendations and the use of outcome measures in clinical practice. Semi-structured interviews were conducted with nine CAMHS clinicians from a Mental Health Trust in South London. Two levels of implementation emerged from the analysis: (1) the service level, regarding the implementation of outcome measures across a service to inform service improvement and (2) the session level, regarding the implementation of outcome measures within individual clinical sessions. The present research described training and ongoing support as a crucial facilitator of use at both service and session levels. This included help overcoming local contextual barriers, such as resources, information systems and administrative processes. The research showed that a balance is needed between a mandatory and uniform approach across a service and providing clinicians with support to use outcome measures with all service users for whom they are appropriate.

What are “good outcomes” for adolescents in public mental health settings?

“…For instance, clinicians’ values and attitudes towards outcome monitoring is a documented implementation hindrance [ 28 – 30 ]. Some clinicians argue that existing outcome measures tend to alienate their young clients and does not consider the differences in client needs [ 29 ]. Others argue that current measures are too focused on symptom reduction (“curing aspects”), overlooking coping and contextual variables important to track other aspects of improvement [ 28 ].…”

How do patient reported outcome measures (PROMs) support clinician-patient communication and patient care? A realist synthesis

“…First, it offers an extended analysis of existing literature by a closer interrogation of context and outcome patterns in an existing systematic review [ 8 ]. Second, it provides an updated review of recent literature by conducting further searches to capture studies published since 2016; nine additional papers were included in the synthesis [ 21 – 29 ]. Third, it advances the interpretation of our findings by drawing on theory from the philosophy of measurement [ 30 ] and current debates in clinician-patient communication [ 31 ].…”

“…In primary care and specialist mental health care, some patients felt that standardised PROMs simply did not fully capture the complexity or dynamic nature of their symptoms, particularly for patients with mental health problems [ 67 , 75 , 76 ]. These observations were shared by clinicians [ 67 , 77 – 79 ] who expressed concern that the wording of some PROMs upset or alienated patients [ 29 , 80 , 81 ]. Those studies that directly compared individualised and standardised PROMs found that patients felt the former had greater validity and were less distressing [ 82 ]; clinicians also preferred individualised measures [ 70 ].…”

“…In primary care, some patients felt that the ‘impersonal’ nature of standardised PROMs was helpful in enabling them to share issues [ 67 ]. Similarly, in specialist mental health care, clinicians [ 29 ] and service users [ 21 ] perceived that patients liked the structured nature of PROMs as it gave a framework for discussion and made talking about problems easier. While patients were generally supportive of the use of standardised PROMs as means of enabling them to share their experiences, clinicians expressed some reservations.…”

“…GPs also found it difficult to incorporate PROMs completion and review into the natural flow of consultations [ 77 , 85 ]. In specialist mental health care, clinicians expressed concern that asking patient to complete PROMs to comply with the reporting requirements of the Improving Access to Psychological Therapies programme when clients did not wish to complete them was detrimental to the therapeutic alliance [ 29 ]. In palliative care, the picture was mixed.…”