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Introduction

There are many different types of outcome measures that can be used to measure client outcomes in clinical psychology, therapy and mental health. The criteria for selecting outcome measures are:

• How much information you need to collect

• How many domains you want to cover and if you want these specifically tailored to your client group

• How much you want to be able to compare your results with similar data collected by others

• How many times you can practically administer the instrument when tracking the progress of a client

• How much tolerance clients have for filling in the instrument (when they are involved in doing so)

• How much tolerance clinicians have for filling in the instrument

• What outcome reporting requirements there are from management, funders or others within the particular setting.

Below are listed some practical outcomes measurement instruments and approaches that can be used in clinical psychology, therapy or related service delivery settings.

HoNOS

The Health of the Nation Outcome Scale (HoNOS) is a scale covering a number of different domains. There are many resources for using that HoNOS produced by Te Pou, the New Zealand mental health workforce development organisation. The HoNOS takes longer to fill out than the other approaches below, but provides more comprehensive information. It is the standard outcome measure for mental health currently used in New Zealand with an 80% coverage of both community and inpatient services. It covers the following areas: overactive, aggressive or agitated behaviour; non-accidental self-injury; problem drinking or drug-taking; cognitive problems; physical illness or disability problems; problems associated with hallucinations and delusions; other mental and behavioural problems; problems with relationships; problems with activities of daily living; problems with living conditions; and, problems with occupation and activities. The pro of this measure are that it is generally used. This means that one can potentially compare a client or client group’s progress against normative data that is available. For instance, the graph below shows the average HoNOS scores for treatment within the New Zealand mental health system. The con is that it covers a range of areas that may, or may not be relevant to a particular client group.

Goal Achievement Rating

In this approach, the clinican and/or the client specify a set of goals that the client is wanting to achieve (e.g. less worry; feeling more in control of my life; and, being better at making major decisions about my life direction). At the end of therapy a judgement is made as to how much progress has been made on each goal. This can be summarised, for instance, with a statement such as ‘the client made improvements on 3 out of the 4 goals that were set for the therapy’. The pro of this approach is that it is flexible and does not require a lot of time on the part of the client or the therapist. A con is that if more than one therapist is using the approach, there needs to be some guidance or review of the ‘level’ at which goals are being set so that they are comparable between clients. Otherwise you may have the situation where one set of clients is achieving a set of goals but the goals have been set at a very low level and are therefore not comparable to sets of higher-level goals identified by other clinicians for their clients.

Simple rating scales

This is a simple approach where clients are given a set of items to rate, for instance, at the end of each session that is held. For instance, this might consist of five items including the following: ‘Success at dealing with psychological and mental stress - rate from 5 high to 1 low’. ‘Getting on with my partner and family - rate from 5 high to 1 low’. The pro of this approach is that it is fast and it can be tailored to a particular client group. The con is that if the items are tailored to a particular client group there is not going to be normative data beyond the information being collected by the particular group of therapists.

Please note when you are doing any type of psychological or self-development work, if you find yourself feeling overwhelming emotions, troubling thoughts or actions, you need to talk to a health professional.