Implementation of routine outcome measurement in child and adolescent mental health services in the United Kingdom: A critical perspective

摘要

The aim of this commentary is to provide an overview of clinical outcome measures that are currently recommended for use in UK Child and Adolescent Mental Health Services (CAMHS), focusing on measures that are applicable across a wide range of conditions with established validity and reliability, or innovative in their design. We also provide an overview of the barriers and drivers to the use of Routine Outcome Measurement (ROM) in clinical practice. For the purpose of this paper, we define ROM as the use of generic measures that assess the clinical outcomes or patient/carer satisfaction with service delivery. Outcome measures are usually completed at first contact (baseline) and after a fixed interval, often 6 months after the initial measure [1]. Symptomatic measures or measures of broader functioning that are completed only at one time point (e.g. at the end of intervention) do not provide a measure of ithin-individual change which is an essential feature of symptomatic or functional outcome measurement. The exception to this rule is measures of patient or caregiver satisfaction with the service which are typically obtained once at the end of treatment or discharge [2, 3]. The purpose and use of outcome measures may differ depending upon the end user of the data. ROM should enable clinicians to assess change over the course of treatment and help them draw comparisons between the perspectives of the clinician, child, their parent/carer and other informants such as teachers [4, 5]. Outcome measures provide service users with a way of seeing change in their condition and functioning over time and an opportunity to express their level of satisfaction with the care received [2]. At a service level, outcome data can help identify areas for development, evaluate whether services are meeting targets and influence the allocation of funding [5]. Anonymised outcome data collected at a service level may satisfy commissioners demand for greater service accountability through service user feedback and objective measurement of clinical effectiveness [2]. Regular, consistent outcome measurement should lead to improvements in practice and patient outcome, provided that results are carefully interpreted in the clinical and organisational context [6]. Fitzpatrick and colleagues [7] outline several criteria that outcome measures should meet. ROM should be based on measures with good psychometric properties, including established reliability, validity and sensitivity to change. Measures should be simple and quick to complete, costeffective and easy to interpret. Furthermore, if outcome measures are to be used for benchmarking, they should be generic, relevant to the most frequent clinical diagnoses and applicable across a broad range of theoretical frameworks. Generic outcome measures do not cover factors specific to all disorders, but enable comparisons across disorders and services. Outcome measures data should be interpreted in the context of case mix and case complexity for each particular service.