Routine outcome measurement

Routine outcome measurement (ROM), also known as routine outcome monitoring, refers to the systematic tracking of client progress during psychotherapy using a standardized self-report inventory or rating scale. ^[1] Therapists administer brief outcome measures at regular intervals (e.g. each session or monthly) to quantify symptoms, functioning, or well-being. The goal is to use this feedback to inform treatment decisions, tailor interventions, and promptly address issues if a patient is not improving as expected. ^[2]

Effects on treatment

Research studies and literature reviews have examined the impact of routine outcome measurement on psychotherapy effectiveness. ^{[3] [4]} Overall, the evidence from literature reviews suggests that integrating ROM with feedback to clinicians can modestly improve treatment outcomes, with especially notable benefits for clients at risk of poor outcomes. ^{[5] [6] [7] [8]} For example, a 2012 systematic review ^[9] of 45 randomized controlled trials covering psychotherapy in mental health settings reported generally positive effects of ROM with feedback. ^[10]

Frequently used outcome measures

A variety of standardized questionnaires are used for routine outcome measurement in psychotherapy. Five of the most frequently cited outcome measures include:

• Beck Depression Inventory (BDI-II) – a 21-item self-report questionnaire assessing the severity of depressive symptoms. ^[11] The BDI-II is often administered at intake and throughout therapy to gauge changes in mood. It is one of the most widely used instruments in both clinical practice and research for measuring depression. ^{[12] [13]}
• Symptom Checklist-90-R (SCL-90-R) – a broad-spectrum self-report inventory of 90 symptoms covering multiple psychological domains (such as depression, anxiety, paranoia, and somatic complaints). ^[14] The SCL-90-R provides an overall index of psychological distress and several subscale scores. It is a widely used measure of general psychopathology to track overall symptom levels during treatment. ^[15]
• Inventory of Interpersonal Problems (IIP) – a self-report instrument that identifies a person's predominant interpersonal difficulties (e.g. being too socially inhibited, too controlling, too self-sacrificing, etc.). ^{[16] [17]} The IIP is widely studied in the mental health field and commonly used in psychotherapy outcome research, especially for therapies focusing on relationship or personality issues. ^[18] Changes in IIP scores can indicate improved interpersonal functioning as therapy progresses. ^[19]
• Outcome Questionnaire 45 (OQ-45) – a 45-item self-report measure designed specifically for routine outcome tracking in psychotherapy. ^[20] It assesses three domains: symptom distress, interpersonal relationships, and social role performance. The OQ-45 is intended to be administered at each session; software-assisted systems using the OQ-45 (such as OQ-Analyst) can graph client progress and signal when a client is off-track. ^[21] A study ^[22] published in 2025 analyzed data from 456 clients who took 5,917 sessions of low-fee online counseling at the Sentio Counseling Center and found "sessions where the therapist reviewed the client's OQ score beforehand (rather than after hand) showed significantly larger symptom improvement by the next session than sessions without such a review" and therapists "who reviewed client OQ scores more frequently before (rather than after) therapy sessions achieved faster client symptom recovery across all clients." ^[23]
• Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM) – a 34-item self-report questionnaire measuring global distress and functioning. ^[24] It was developed in the UK as a generic outcome measure for routine clinical use, covering well-being, problems/symptoms, life functioning, and risk. ^[25] The CORE-OM is used both as an initial assessment and to track changes over the course of therapy. ^[26] It has seen widespread adoption internationally, with translations in over 30 languages, reflecting its popularity as a routine outcome tool in various services. ^[27]

References

1. "Evaluation of the National Mental Health Strategy: Final Report" . PsycEXTRA Dataset. 1997. doi:10.1037/e676382010-001 . Retrieved 2025-02-14.
2. Gondek, Dawid; Edbrooke-Childs, Julian; Fink, Elian; Deighton, Jessica; Wolpert, Miranda (2016). "Feedback from Outcome Measures and Treatment Effectiveness, Treatment Efficiency, and Collaborative Practice: A Systematic Review". Administration and Policy in Mental Health and Mental Health Services Research. 43 (3): 325–343. doi:10.1007/s10488-015-0710-5. PMC   4831994 . PMID   26744316.
3. Tarescavage, Anthony M.; Ben-Porath, Yossef S. (2014). "Psychotherapeutic Outcomes Measures: A Critical Review for Practitioners: Evaluating Outcome Measures" . Journal of Clinical Psychology. 70 (9): 808–830. doi:10.1002/jclp.22080. PMID   24652811.
4. Carlier, Ingrid V.E.; Meuldijk, Denise; Van Vliet, Irene M.; Van Fenema, Esther; Van der Wee, Nic J.A.; Zitman, Frans G. (2012). "Routine outcome monitoring and feedback on physical or mental health status: evidence and theory" . Journal of Evaluation in Clinical Practice. 18 (1): 104–110. doi:10.1111/j.1365-2753.2010.01543.x. PMID   20846319.
5. Whipple, Jason L.; Lambert, Michael J. (2011-04-27). "Outcome Measures for Practice" . Annual Review of Clinical Psychology. 7 (1): 87–111. doi:10.1146/annurev-clinpsy-040510-143938. ISSN   1548-5943. PMID   21166536.
6. Knaup, Carina; Koesters, Markus; Schoefer, Dorothea; Becker, Thomas; Puschner, Bernd (2009). "Effect of feedback of treatment outcome in specialist mental healthcare: meta-analysis". British Journal of Psychiatry. 195 (1): 15–22. doi:10.1192/bjp.bp.108.053967. ISSN   0007-1250. PMID   19567889.
7. Boswell, James F.; Kraus, David R.; Miller, Scott D.; Lambert, Michael J. (2013-07-26). "Implementing routine outcome monitoring in clinical practice: Benefits, challenges, and solutions" . Psychotherapy Research. 25 (1): 6–19. doi:10.1080/10503307.2013.817696. ISSN   1050-3307. PMID   23885809.
8. Solstad, Stig Magne; Cooper, Mick; Sundet, Rolf; Moltu, Christian (2023-11-22). "Effects and experiences of idiographic patient-reported outcome measures for feedback in psychotherapy: A systematic review and secondary analysis of the empirical literature". Psychotherapy Research. 35 (1): 125–138. doi: 10.1080/10503307.2023.2283528 . ISSN   1050-3307. PMID   37990817.
9. Carlier, I. V.; Meuldijk, D.; Van Vliet, I. M.; Van Fenema, E.; Van Der Wee, N. J.; Zitman, F. G. (2012). "Routine outcome monitoring and feedback on physical or mental health status: Evidence and theory". Journal of Evaluation in Clinical Practice. 18 (1): 104–110. doi:10.1111/j.1365-2753.2010.01543.x. PMID   20846319.
10. Carlier, Ingrid V.E.; Meuldijk, Denise; Van Vliet, Irene M.; Van Fenema, Esther; Van der Wee, Nic J.A.; Zitman, Frans G. (2012). "Routine outcome monitoring and feedback on physical or mental health status: evidence and theory" . Journal of Evaluation in Clinical Practice. 18 (1): 104–110. doi:10.1111/j.1365-2753.2010.01543.x. ISSN   1356-1294. PMID   20846319.
11. Beck, Aaron T.; Steer, R. A.; Brown, G. (1996). "Beck Depression Inventory–II" . PsycTESTS Dataset. doi:10.1037/t00742-000 . Retrieved 2025-02-14.
12. Richter, Paul; Werner, Joachim; Heerlein, Andrés; Kraus, Alfred; Sauer, Heinrich (1998). "On the Validity of the Beck Depression Inventory" . Psychopathology. 31 (3): 160–168. doi:10.1159/000066239. ISSN   0254-4962. PMID   9636945.
13. https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/beck-depression
14. Derogatis, Leonard R. (2000), "SCL-90-R." , Encyclopedia of psychology, Vol. 7., New York: Oxford University Press, pp. 192–193, doi:10.1037/10522-079, ISBN   1-55798-656-8 , retrieved 2025-02-14
15. Gomez, Rapson; Stavropoulos, Vasileios; Zarate, Daniel; Palikara, Olympia (2021-03-12). Cerniglia, Luca (ed.). "Symptom Checklist-90-Revised: A structural examination in relation to family functioning". PLOS ONE. 16 (3): e0247902. Bibcode:2021PLoSO..1647902G. doi: 10.1371/journal.pone.0247902 . ISSN   1932-6203. PMC   7954339 . PMID   33711019.
16. Horowitz, Leonard M.; Rosenberg, Saul E.; Baer, Barbara A.; Ureño, Gilbert; Villaseñor, Valerie S. (1988). "Inventory of interpersonal problems: Psychometric properties and clinical applications". Journal of Consulting and Clinical Psychology. 56 (6): 885–892. doi:10.1037/0022-006X.56.6.885. PMID   3204198.
17. Horowitz, Leonard M.; Rosenberg, Saul E.; Baer, Barbara A.; Ureño, Gilbert (1988). "Inventory of interpersonal problems: Psychometric properties and clinical applications". Journal of Consulting and Clinical Psychology. 56 (6): 885–892. doi:10.1037/0022-006X.56.6.885. PMID   3204198.
18. Stern, Barry L.; Kim, Yookyung; Trull, Timothy J.; Scarpa, Angela; Pilkonis, Paul (2000). "Inventory of Interpersonal Problems Personality Disorder Scales: Operating Characteristics and Confirmatory Factor Analysis in Nonclinical Samples" . Journal of Personality Assessment. 74 (3): 459–471. doi:10.1207/S15327752JPA7403_9. PMID   10900572.
19. Renner, Fritz; Jarrett, Robin B.; Vittengl, Jeffrey R.; Barrett, Marna S.; Clark, Lee Anna; Thase, Michael E. (2012). "Interpersonal problems as predictors of therapeutic alliance and symptom improvement in cognitive therapy for depression". Journal of Affective Disorders. 138 (3): 458–467. doi:10.1016/j.jad.2011.12.044. PMC   3306447 . PMID   22306232.
20. Lambert, Michael J.; Hansen, Nathan B.; Finch, Arthur E. (2001). "Patient-focused research: Using patient outcome data to enhance treatment effects" . Journal of Consulting and Clinical Psychology. 69 (2): 159–172. doi:10.1037/0022-006X.69.2.159. ISSN   1939-2117. PMID   11393594.
21. Whipple, Jason L.; Lambert, Michael J.; Vermeersch, David A.; Smart, David W.; Nielsen, Stevan L.; Hawkins, Eric J. (2003). "Improving the effects of psychotherapy: The use of early identification of treatment and problem-solving strategies in routine practice" . Journal of Counseling Psychology. 50 (1): 59–68. doi:10.1037/0022-0167.50.1.59.
22. https://psycnet.apa.org/record/2025-73823-001
23. Li, Xu; Carney, Jalen J.; Rousmaniere, Tony; Fineman, Ben; Vaz, Alexandre (2025-01-27). "The "magic" of looking at that score: A multilevel investigation of therapist review of client symptom measures and client clinical outcome" . Journal of Counseling Psychology. 72 (2): 192–200. doi:10.1037/cou0000781. ISSN   1939-2168. PMID   39869719.
24. "CORE Measurement Tools (CORE-10)".
25. Barkham, Michael; Mellor-Clark, John; Connell, Janice; Cahill, Jane (2006). "A core approach to practice-based evidence: A brief history of the origins and applications of the CORE-OM and CORE System" . Counselling and Psychotherapy Research. 6 (1): 3–15. doi:10.1080/14733140600581218.
26. Barkham Chris Evans Frank Margison, Michael (1998). "The rationale for developing and outcome batteriesfor routine use in service settings and psychotherapy outcome research implementing core" . Journal of Mental Health. 7 (1): 35–47. doi:10.1080/09638239818328. ISSN   0963-8237.
27. Zeldovich, Marina; Alexandrowicz, Rainer W. (2019). "Comparing outcomes: The Clinical Outcome in Routine Evaluation from an international point of view". International Journal of Methods in Psychiatric Research. 28 (3): e1774. doi:10.1002/mpr.1774. ISSN   1049-8931. PMC   6849827 . PMID   30779267.