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Intervention Summary

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OQ-Analyst

The OQ-Analyst (OQ-A) is a computer-based feedback and progress tracking system designed to help increase psychotherapy treatment effectiveness. By assessing the attainment of expected progress during therapy, the tracking system provides feedback to therapists on whether patients are staying on track toward positive treatment outcomes. This information may be shared with the patient at the therapist's discretion. In addition, the OQ-A can provide decision support to the therapist to maximize the likelihood of a positive outcome for the client.

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.

Descriptive Information

Areas of Interest Mental health treatment
Outcomes Review Date: August 2008
1: Psychological dysfunction
Outcome Categories Mental health
Social functioning
Ages 18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
Genders Male
Female
Races/Ethnicities American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or other Pacific Islander
White
Race/ethnicity unspecified
Settings Outpatient
Geographic Locations Urban
Implementation History The OQ-A was first used in 2001 in the United States by a managed behavior health care company. Hundreds of sites across the United States have used the program, and more than 100,000 clients have received the intervention. It also has been used in Australia, Germany, and Norway.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: No
Evaluated in comparative effectiveness research studies: Yes
Adaptations Spanish-language versions of the OQ-A instrument are available.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories IOM prevention categories are not applicable.

Quality of Research
Review Date: August 2008

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 1

Hawkins, 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 2

Harmon, 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
Description of Measures 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.
Key Findings 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).
Studies Measuring Outcome Study 1, Study 2
Study Designs Experimental, Quasi-experimental
Quality of Research Rating 3.3 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 18-25 (Young adult)
26-55 (Adult)
68.2% Female
31.8% Male
94.5% White
1.5% Black or African American
1.5% Hispanic or Latino
1.5% Native Hawaiian or other Pacific Islander
1% Asian
Study 2 18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
64% Female
36% Male
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

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:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Psychological dysfunction 3.5 3.5 3.0 3.1 3.0 3.4 3.3

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.

Readiness for Dissemination
Review Date: August 2008

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:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
4.0 3.8 4.0 3.9

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.

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.

Item Description Cost Required by Developer
OQ-A software system, user manuals, and documentation $250 per clinician per year for three measures Yes
Additional measures $40 per clinician per year for additional measures No
Technical manuals for additional measures $25 each No
Training and Orientation video Free No
Webinars and other training videos Varies depending on site needs No
Half-day to 1-day, on-site initial and follow-up trainings Varies depending on site needs No
Technical assistance and installation support $150 per site Yes

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.

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.

Contact Information

To learn more about implementation, contact:
Sue Jenkins
(888) 647-2673
sue.jenkins@oqmeasures.com

To learn more about research, contact:
Michael J. Lambert, Ph.D.
(801) 422-6480
michael_lambert@byu.edu

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

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