Using Progress Feedback to Enhance Treatment Outcomes: A Narrative Review
Administration and Policy in Mental Health and Mental Health Services Research, vol. 52, pp. 210–222
Abstract
We face increasing demand for greater access to effective routine mental health services, including telehealth. However, treatment outcomes in routine clinical practice are only about half the size of those reported in controlled trials. Progress feedback, defined as the ongoing monitoring of patients' treatment response with standardized measures, is an evidence-based practice that continues to be under-utilized in routine care. The aim of the current review is to provide a summary of the current evidence base for the use of progress feedback, its mechanisms of action and considerations for successful implementation. We reviewed ten available meta-analyses, which report small to medium overall effect sizes. The results suggest that adding feedback to a wide range of psychological and psychiatric interventions (ranging from primary care to hospitalization and crisis care) tends to enhance the effectiveness of these interventions. The strongest evidence is for patients with common mental health problems compared to those with very severe disorders. Effect sizes for not-on-track cases, a subgroup of cases that are not progressing well, are found to be somewhat stronger, especially when clinical support tools are added to the feedback. Systematic reviews and recent studies suggest potential mechanisms of action for progress feedback include focusing the clinician's attention, altering clinician expectations, providing new information, and enhancing patient-centered communication. Promising approaches to strengthen progress feedback interventions include advanced systems with signaling technology, clinical problem-solving tools, and a broader spectrum of outcome and progress measures. An overview of methodological and implementation challenges is provided, as well as suggestions for addressing these issues in future studies. We conclude that while feedback has modest effects, it is a small and affordable intervention that can potentially improve outcomes in psychological interventions. Further research into mechanisms of action and effective implementation strategies is needed.
Authors 19
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Kim de Jong corresponding Aachen Clinical Psychology Unit Institute of Psychology, Leiden University
Affiliation as printed
Clinical Psychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, The Netherlands. KJong@fsw.leidenuniv.nl
Clinical Psychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, The Netherlands
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Affiliation as printed
Department of Leadership, Policy and Organizations, Vanderbilt University, Nashville, TN, USA
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Affiliation as printed
Division of Psychology and Language Sciences, Department of Clinical, Education and Health Psychology, University College London, United Kingdom, UK
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Affiliation as printed
Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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LMU Klinikum · Ludwig-Maximilians-Universität München
Affiliation as printed
Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
Faculty of Psychology and Educational Sciences, LMU Munich, Munich, Germany
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University of Groningen · Dimence
Affiliation as printed
Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
Dimence, Center for mental health care, Deventer, The Netherlands
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Leiden University · Leiden University Medical Center
Affiliation as printed
Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
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Affiliation as printed
Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
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Anna Freud Centre · University College London
Affiliation as printed
Evidence Based Practice Unit, Anna Freud National Centre for Children and Families, University College London, London, UK
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Affiliation as printed
Pro Persona Research, Renkum, The Netherlands
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Affiliation as printed
Department of Psychology, University of Trier, Trier, Germany
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Western Norway University of Applied Sciences · Helse Førde
Affiliation as printed
Department of Health and Caring Science, Western Norway University of Applied Science, Førde, Norway
District General Hospital of Førde, Førde, Norway
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Affiliation as printed
Department of Behavioral Health, Reliant Medical Group, Worcester, MA, USA
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Affiliation as printed
Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Affiliation as printed
Institute of Psychology, University of Osnabrück, Salzburg, Austria
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Affiliation as printed
Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Salzburg, Austria
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Affiliation as printed
Department of Psychology, University of Trier, Trier, Germany
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Affiliation as printed
Pro Persona Research, Renkum, The Netherlands
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Affiliation as printed
Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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