The Heroic Agencies Vision
We envision a future where clients' heroic stories overshadow descriptions of illness and client-directed partnerships revolutionize "mental health" as we know it.
______________________
RESEARCH PROTOCOL FOR THE CORS VALIDATION STUDY
The CORS validation study is a multisite, multicultural investigation of a client based outcome measure, the first of its kind, designed specifically for everyday clinical use with children. This study also includes the use of the adult form of the outcome measure with adolescents. Each agency or organizational participant, hereafter called the site investigator, will be responsible for implementing the research and managing the data using Excel sheets supplied by the principle investigator. All consent and participation forms will be provided for each site by the principle investigator.
PURPOSE AND POTENTIAL BENEFITS
The measurement and management of change has become an important topic in the delivery of mental health services (Brown, Burlingame, Lambert, Jones, & Vaccaro, 2001). Managed care and public funding entities increasingly require clinicians and agencies to prove the outcome of clinical services (Lambert, Okiishi, Finch & Johnson, 1998). Unfortunately, many efforts are done at the discretion of the clinicians themselves, leaving the assessment of outcome in the hands of the person delivering it, not the person receiving it (Duncan & Miller, 2000).
More recent trends emphasize the clients’ perspective of both outcome and the quality of the service (Duncan, Miller, & Sparks, 2004; Lambert, Burlingame, Umphress, Hansen, Vermeersch, Clouse & Yanchar, 1996). Such efforts have revealed that the client’s subjective experience of improvement is a robust predictor of eventual treatment outcome (Brown et al., 2001). Moreover, monitoring client based outcome, when combined with feedback to the clinician, has increased the effectiveness of clinical services by an amazing 65% in real clinical settings (Lambert et al., 2003; Miller, Duncan, Brown, Sorrell, & Chalk, in press)
Currently, these substantial benefits of outcome management cannot be extended to children; there are no valid and reliable self-report outcome tools for children under the age of 12. The Youth Life Status Questionnaire (YLSQ) is a shortened version of the sixty four item Youth Outcome Questionnaire (Y-OQ) (Burlingame, Mosier, Wells, Atkin, Lambert, Whoolery and Latkowski, 2001). As a parent-report measure, it measures treatment progress for children ages 4-17 as reported by primary caretakers. Adolescents do report their progress, but children under 13 have no such opportunity. Parents or others with extensive interaction with the client complete the YLSQ at intake to establish a severity baseline and then complete it at regular intervals to track the progress of the child’s treatment (Burlingame, Jasper, Peterson, Wells, Lambert, Reisinger, & Brown, 2001).
To fill this void, the CORS was designed. It is a simple four item visual analog scale designed to assess areas of life functioning for children (Duncan, Miller, & Sparks, 2003). Visual analogue scales have demonstrated their feasibility in many contexts and have face validity with clients and clinicians often missing in longer research oriented measured (Miller et al., 2004). It offers a visual component as well as language oriented towards children. The CORS also allows parents or primary caretakers to rate the well being of the child.
The true value of an outcome assessment tool rests in its ability to track change over time (Burlingame et al., 2001). One of the more attractive features of the CORS is its simplicity and the ability to visually track ongoing change. The CORS allows children to visually place themselves on a continuum, and will therefore allow the child, clinician and caretaker to track the ongoing treatment the child is receiving, from the perspective of the child.
The purpose of this study is to validate the CORS for its use in tracking the effectiveness of therapy and counseling services offered to children, as reported by children and their parents or caretakers, from age 6 through 12. Although numerous child assessment instruments are currently available, few have been designed for the sole purpose of child psychotherapy outcome assessment. Most have been developed to provide profile typologies, to serve as screening instruments for psychosocial dysfunction, or to assess specific areas of psychological dysfunction (Burlingame, Mosier, Wells, Atkin, Lambert, Whoolery, & Latkowski, 2001). In addition, nearly all measures developed for children are research instruments, not intended for everyday clinical use.
The CORS, although including the parents or caretakers perspective, will finally bring the child’s voice to the process. More often than not, the child receives services as a mandated client; i.e. someone else thought he or she needed it. This leaves the child with little or no control over the process. With more and more children participating in therapy, it becomes even more important that their voices become an integral part of therapeutic process. In addition, with the call for accountability from third party payers, the CORS extends the benefits of client based outcome as an important predictor of ultimate treatment benefit to children. Children, therefore, become central to the way services are both delivered and funded.
This study also offers the option of studying the use of measures with adolescents. The adult Outcome Rating Scale (Miller & Duncan, 2000: Miller et al., 2004) has demonstrated its reliability, validity, and feasibility with adults, but not with adolescents (13-17).
LOCATION OF THE STUDY
The study will take place at various clinics that provide therapeutic services to children and families, including outpatient services, home based therapy services, and residential treatment facilities. The normative sample will come from local schools, churches, and aftercare programs.
DATES OF STUDY
To be determined.
PARTICIPANTS
Participants are parents and/or caregivers of children ages 6-12 for the CORS, and 13-17 for the ORS, as well as the children (and adolescents) themselves. The participants must be voluntary, interested, and easily accessible. Families with children in therapy or counseling will be given an option to participate in the study, and it will be made perfectly clear that if they do not want to participate, they will in no way be reprimanded or their therapy affected. The normative sample will come from local schools, aftercare sites, and churches. In some cases network sampling (Stewart, 2002), where participants recommend others who may be interested in volunteering for the study will be utilized.
METHODS AND PROCEDURES
The study will assess the reliability and validity of the CORS as an outcome measure tool for children and caretakers, and the reliability and validity of the ORS with adolescents.
The CORS (or ORS with adolescents) and the YLSQ will be administered to 100 parents or primary caretakers of children between the age 6 through 12 (or 13-17) undergoing therapy or counseling for any reason. The questionnaires will be administered at the location where the therapy or counseling takes place prior to the session until the client completes therapy, or for a maximum of 7 sessions. Additionally, the CORS (or ORS) will be similarly administered to the 100 children (or adolescents). The YLSQ will be administered to the adolescents.
Figures 1 and 2 depict the process.
Figure 1: CORS with Children 6-12
Figure 2: ORS with Adolescents 13-17
The normative sample will be derived from a community sample (churches, aftercare programs, and schools). The normative sample will include 150 parents and 150 children ages 6 through 12, or ages 13-17 if the site chooses the adolescent option, who will fill out the the CORS (or ORS if adolescents) and the YLSQ on three (3) different occasions. The normative sample may not be receiving psychotherapy or medication treatment.
In addition to filling out the outcome measure tools, all participants will be asked to complete a one time Demographic Data Sheet (DDS).
Optional Addition: The Child Session Rating Scale
For those sites desiring to gather data about children’s perspectives of the alliance, an optional component of this study addresses the Child Session Rating Scale (CSRS) (Duncan, Miller, & Sparks, 2003). There is a long research tradition that demonstrates the relationship between the alliance and positive outcome in psychotherapy (Lambert, 2004). Unbelievably, there are no alliance scales for children currently available. Therefore, the benefits of monitoring the alliance and ensuring its strength to secure a positive outcome have not been possible.
The CSRS was developed to address this omission and is also a four item visual analogue scale that is easy to administer. The CRS (or SRS with adolescents) would simply be administered at the end of each session up to 7 sessions.
PARTICIPANT PAYMENTS OR COSTS
There are no costs or payments associated with this study.
POTENTIAL RISKS TO PARTICIPANTS
Anticipated risks will be minimal. People may find the filling out the two tools bothersome and some dropouts are anticipated. Participants will be assured in writing of the purpose of the study, their free choice to participate, the confidentiality of their responses, and how the data will be used. A signed Informed Consent Form will be procured from each participant prior and each participant will receive a copy of the Informed Consent Form. In the event a child or parent/caretaker of the clinical sample experiences any distress whatsoever from filling out the forms, the site investigator will consult with the participant and coordinate services with the primary therapist or counselor. In the event a child or parent/caretaker of the normative sample experiences any distress whatsoever from filling out the forms, the site investigator will consult with the participant and provide a list of referrals for mental health services. Prior to signing the Informed Consent Form, all participants will be given the option to review the tools in question.
PARTICIPANT CONFIDENTIALITY
Confidentiality of participants will be maintained by each site investigator. To maintain confidentiality of collected data, each participant will be assigned an alpha/numeric code (based on his or her geographic location and the date and time of the initial data collection); each site will code the participants name before data transmission to the principal investigator. Only the Principal Investigator and the Advisor will have access to the collected data.
All Informed Consent Forms will be maintained in a set of locked file drawers in the office of the Principal Investigator; no one except the Investigator will have a key to access the Forms. All forms will be destroyed a year after the completion of the study.
All published reports that emerge from this research will refer to the data collection as a whole after it has been gathered, not individual information. All written records containing names of the participants will be maintained in a locked file drawer in each of the participating sites. The accumulated data will be kept in a locked file in the office of the Principal Investigator.
All forms will be made available to researchers interested in this study. For more information please contact Karen Kinchin, LMFT at Karen@heroicagencies.org or Dr. Barry Duncan at barrylduncan@cs.com
To obtain a license for the use of the CORS, please email Dr. Barry Duncan.
References
Brown, G. S., Burlingame, G. M., Lambert, M. J., Jones, E., & Vaccaro, J., (2001). Pushing the Quality Envelope: A New Outcomes Management System. Psychiatric Services. Vol. 52. No.7. 925-934.
Burlingame, G. M., Jasper, B. W., Peterson, G., Wells, M. G., Lambert, M. J., Reisinger, C. W. & Brown, G. S. (2001). Administration and Scoring Manual for the Y-LSQ. Stevenson, MD: American Professional Credentialing Services LLC and Pacificare Behavioral Health, Inc.
Burlingame, G. M., Mosier, J. I., Wells, M. G., Atkin, Q. G., Lambert, M. J., Whoolery, M., and Latkowski, M., (2001). Tracking the Influence of Mental Health Treatment: The Development of the Youth Outcome Questionnaire. Clinical Psychology and Psychotherapy. 8, 361-379.
Duncan, B. L., & Miller, S., (2000). The heroic client: Doing client directed, outcome nformed therapy. San Fransisco: Jossey Bass.
Duncan, B. L., Miller, S., Sparks, J. (2003). The Children’s Outcome Rating Scale. Authors: Chicago, IL.
Duncan, B. L., Miller, S., Sparks, J. (2003). The Children’s Session Rating Scale. Authors: Chicago, IL.
Duncan, B. L., Miller, S., Sparks, J. (2003). The heroic client: A revolutionary way to improve effectiveness. San Francisco: Jossey Bass.
Lambert, M. J., Burlingame, G. M., Umphress, V., Hansen, N. B., Vermeersch, D. A., Clouse, G. C., & Yanchar S. C., (1996). The Reliablility and Validity of the Outcome Questionnaire. Clinical Psychology and Psychotherapy. Vol. 3 (4), 249-258.
Lambert, M. J., Okiishi, J. C., Finch, A. E., & Johnson, L. D., (1998). Outcome Assessment From Conceptualization to Implementation. Professional Psychology: Research and Practice. Vol. 29, No. 1, 63-70.
Lambert, M. J., Whipple, J. L., Hawkins, E. J., Vermeersch, D. A., Nielsen, S. L., &Smart, D. W. (2003). Is it time for clinicians routinely to track patient outcome? A meta-analysis. Clinical Psychology, 10, 228-301.
Miller, S. D., Duncan, B. L., Brown, J., Sparks, J. A., & Claud, D. A. (2004). The Outcome Rating Scale: A preliminary study of the reliability, validity, and feasibility of a brief, visual, analog measure. Journal of Brief Therapy, 6, 68-88.
Miller, S. D., Duncan, B.L., Brown, J., Sorrell, R., & Chalk, M. B. (in press). Using outcome to inform and improve treatment outcomes. Journal of Brief Therapy.
Stewart, T., (2002). Principles of Research in Communication. Boston: Allyn and Bacon.