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Open Access Research article

A qualitative process evaluation of electronic session-by-session outcome measurement in child and adolescent mental health services

Charlotte L Hall15*, John Taylor1, Maria Moldavsky2, Michael Marriott2, Sarah Pass1, Karen Newell1, Robert Goodman3, Kapil Sayal4 and Chris Hollis4

Author Affiliations

1 CLAHRC-NDL, University of Nottingham, Nottingham, UK

2 Nottinghamshire Healthcare NHS Trust, Nottingham, UK

3 King's College London, Institute of Psychiatry, London, UK

4 Developmental Psychiatry, University of Nottingham, Queen’s Medical Centre, Nottingham, UK

5 B07 Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham NG7 2TU, UK

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BMC Psychiatry 2014, 14:113  doi:10.1186/1471-244X-14-113

Published: 15 April 2014

Abstract

Background

Regular monitoring of patient progress is important to assess the clinical effectiveness of an intervention. Recently, initiatives within UK child and adolescent mental health services (CAMHS) have advocated the use of session-by-session monitoring to continually evaluate the patient’s outcome throughout the course of the intervention. However, the feasibility and acceptability of such regular monitoring is unknown.

Method

Semi-structured qualitative interviews were conducted with clinicians (n = 10), administrative staff (n = 8) and families (n = 15) who participated in a feasibility study of an electronic session-by-session outcome monitoring tool, (SxS), which is based on the Strengths and Difficulties Questionnaire (SDQ). This study took place in three CAMHS clinics in Nottinghamshire. The interview transcripts were thematically analysed.

Results

We found clinicians accepted the need to complete outcome measures, particularly valuing those completed by the patient. However, there were some difficulties with engaging clinicians in this practice and in the training offered. Generally, patients were supportive of completing SxS in the waiting room prior to the clinic session and assistance with the process from administrative staff was seen to be a key factor. Clinicians and families found the feedback reports created from SxS to be helpful for tracking progress, facilitating communication and engagement, and as a point of reflection. The use of technology was considered positively, although some technological difficulties hindered the completion of SxS. Clinicians and families appreciated the brevity of SxS, but some were concerned that a short questionnaire could not adequately encapsulate the complexity of the patient’s issues.

Conclusions

The findings show the need for appropriate infrastructure, mandatory training, and support to enable an effective system of session-by-session monitoring. Our findings indicate that clinicians, administrative staff and young people and their parents/carers would support regular monitoring if the system is easy to implement, with a standard ‘clinic-wide’ adoption of the procedure, and the resulting data are clinically useful.

Keywords:
Session by session; CAMHS; Qualitative evaluation; Parent; Clinician; Outcome measures