Prior to therapy sessions, patients complete the Outcome Questionnaire 45 (OQ-45), a 45-item self-report instrument. Responses are entered into a computer with OQ-A software, and a report is generated for use by the therapist. The OQ-A uses these responses to measure the quality of the therapeutic alliance, client motivation/expectation, quality of social supports, negative life events, and possible need for medication referral. The OQ-A then suggests an appropriate course of treatment.
The OQ-A is designed to detect treatment effectiveness regardless of treatment modality, diagnosis, or discipline of the treating professional. It is suitable for use in inpatient and outpatient settings.
Quality of Research
Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
Study 1Hawkins, E. J., Lambert, M. J., Vermeersch, D. A., Slade, K. L., & Tuttle, K. C. (2004). The therapeutic effects of providing patient progress information to therapists and patients. Psychotherapy Research, 14(3), 308-327. Study 2Harmon, S. C., Lambert, M. J., Smart, D. W., Hawkins, E. J., Nielsen, S. L., Slade, K., & Lutz, W. (2007). Enhancing outcome for potential treatment failures: Therapist-client feedback and clinical support tools. Psychotherapy Research, 17(4), 379-392.
Supplementary Materials Lambert, M. J., Whipple, J. L., Bishop, M. J., Vermeersch, D. A., Gray, G. V., & Finch, A. E. (2002). Comparison of empirically-derived and rationally-derived methods for identifying patients at risk for treatment failure. Clinical Psychology and Psychotherapy, 9, 149-164.
Vermeersch, D. A., Whipple, J. L., Lambert, M. J., Hawkins, E. J., Burchfield, C. M., & Okiishi, J. C. (2004). Outcome questionnaire: Is it sensitive to changes in counseling center clients? Journal of Counseling Psychology, 51, 38-49.
Outcomes
| Outcome 1: Psychological dysfunction |
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Description of Measures
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Psychological dysfunction was assessed using the OQ-45, a 45-item self-report instrument designed to measure client progress repeatedly throughout the course of therapy. Client progress is monitored along three dimensions: subjective discomfort, interpersonal relationships, and social role performance. Possible scores range from 0 to 180; higher scores reflect more severe distress. The OQ-45 total score, a global assessment of client functioning, was used in the reviewed studies.
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Key Findings
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In one study, participants were randomly assigned to one of three groups: feedback provided to patients and therapists, feedback provided to therapists only, or no feedback/usual care. Patients' progress in therapy was categorized as on track or not on track based on OQ-A assessments of the trajectory of recovery. This study found that:
- The patient/therapist feedback group showed the most improvements, while the usual care group showed the least improvements.
- The difference between the patient/therapist feedback group and the usual care group was significant (p < .05) with a small effect size (eta-squared = 0.04).
- The difference between the feedback groups (both patient/therapist and therapist-only) and the usual care group was significant (p < .05) with a small effect size (eta-squared = 0.02).
- The difference between the patient/therapist and therapist-only feedback groups was significant (p < .05) with a small effect size (eta-squared = 0.02).
- Among not-on-track clients, there were no significant differences between the feedback groups and the usual care group, nor between the two feedback groups.
In another study, participants were randomly assigned to one of two groups: feedback provided to therapists and patients, or feedback provided to therapists only. For a comparison condition, the study used an archival group that received no feedback. Patients' progress in therapy was categorized as on track or not on track based on OQ-A assessments of the trajectory of recovery. This study found that:
- The feedback groups showed greater improvements than the archival comparison group (p < .001). There were no significant differences between the two feedback groups.
- Among on-track patients, both feedback groups showed greater improvements than the archival comparison group (p < .001). Similarly, among not-on-track patients, both feedback groups showed greater improvements than the archival comparison group (p < .001).
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Studies Measuring Outcome
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Study 1, Study 2
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Study Designs
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Experimental, Quasi-experimental
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Quality of Research Rating
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3.3
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
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Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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18-25 (Young adult)
26-55 (Adult)
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68.2% Female
31.8% Male
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94.5% White
1.5% Black or African American
1.5% Hispanic or Latino
1.5% Native Hawaiian or other Pacific Islander
1% Asian
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Study 2
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18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
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64% Female
36% Male
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88% White
5% Hispanic or Latino
2% Native Hawaiian or other Pacific Islander
2% Race/ethnicity unspecified
1% American Indian or Alaska Native
1% Asian
1% Black or African American
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Quality of Research Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
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Outcome
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Reliability
of Measures
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Validity
of Measures
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Fidelity
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Missing
Data/Attrition
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Confounding
Variables
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Data
Analysis
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Overall
Rating
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1: Psychological dysfunction
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3.5
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3.5
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3.0
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3.1
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3.0
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3.4
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3.3
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Study Strengths The OQ-45 is a reliable and valid measure. Both studies were well controlled and randomized. The sample sizes were sufficient. The analyses were appropriate for the data and questions posed.
Study Weaknesses Although the investigators had control over the presentation of the feedback therapists gave to the clients, there were no measures described that specifically examined the fidelity of the intervention.
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Readiness for Dissemination
Materials Reviewed
The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials.
Burlingame, G. M., Wells, M. G., Cox, J. C., Lambert, M. J., & Latkowski, M. (2005). Administration and scoring manual for the Y-OQ (youth outcome questionnaire). Salt Lake City, UT: OQ Measures.
Lambert, M. J., Morton, J. J., Hatfield, D., Harmon, C., Hamilton, S., Reid, R. C., et al. (2004). Administration and scoring manual for the OQ-45.2 (outcome questionnaire). Salt Lake City, UT: OQ Measures.
OQ-Analyst Demo Web site, https://demo.oqanalyst.com
OQ Measures. (2005). OQ-Analyst user's guide v 3.05.01. Salt Lake City, UT: Author.
OQ Measures. (2005). Orientation and training [DVD]. Salt Lake City, UT: Author.
OQ Measures. (2006). OQ Analyst Web demonstration instructions. Salt Lake City, UT: Author.
OQ Measures. (n.d.). Implementation guidelines for the OQ-Analyst (OQ-A). Salt Lake City, UT: Author.
OQ Measures. (n.d.). OQ Analyst system overview. Salt Lake City, UT: Author.
OQ Measures. (n.d.). Step x step training on OQ-A for clinical staff [PowerPoint slides]. Salt Lake City, UT: Author.
OQ Measures. (n.d.). Step x step training on OQ-A for support staff [PowerPoint slides]. Salt Lake City, UT: Author.
Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the intervention's Readiness for Dissemination
using three criteria:
- Availability of implementation materials
- Availability of training and support resources
- Availability of quality assurance procedures
For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
Implementation
Materials
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Training and Support
Resources
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Quality Assurance
Procedures
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Overall
Rating
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4.0
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3.8
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4.0
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3.9
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Dissemination Strengths Implementation and user guides are detailed and logically organized. Clear, step-by-step instructions are provided for installing software, administering the questionnaire, and interpreting reports. Specialized on-site or teleconferenced training is available for multiple staff roles. The questionnaire itself serves as a quality assurance instrument to track client progress and assess clinician skills.
Dissemination Weaknesses The mix of extensive research data with implementer information in some materials can be difficult to follow. No standardized training curriculum is provided to trainees to supplement the implementation materials.
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Costs
The cost information below was provided by the developer. Although this cost information
may have been updated by the developer since the time of review, it may not reflect
the current costs or availability of items (including newly developed or discontinued
items). The implementation point of contact can provide current information and
discuss implementation requirements.
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Item Description
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Cost
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Required by Developer
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OQ-A software system, user manuals, and documentation
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$250 per clinician per year for three measures
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Yes
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Additional measures
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$40 per clinician per year for additional measures
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No
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Technical manuals for additional measures
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$25 each
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No
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Training and Orientation video
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Free
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No
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Webinars and other training videos
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Varies depending on site needs
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No
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Half-day to 1-day, on-site initial and follow-up trainings
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Varies depending on site needs
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No
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Technical assistance and installation support
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$150 per site
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Yes
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Additional Information The initial start-up cost for the hosted system averages about $3 per patient per year, which includes software and hardware. The yearly cost thereafter is under $1 per patient per year.
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Replications
Selected citations are presented below. An asterisk indicates that the document
was reviewed for Quality of Research.
Lambert, M. J., Whipple, J. L., Vermeersch, D. A., Smart, D. W., Hawkins, E. J., Nielsen, S. L., & Goates, M. (2002). Enhancing psychotherapy outcomes via providing feedback on client progress: A replication. Clinical Psychology and Psychotherapy, 9, 91-103.
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