The Partners for Change Outcome Management System: A Both/And System for Collaborative Practice

• Author: Jacqueline A. Sparks,Barry L. Duncan
• Published date: 01 September 2018
• Date: 01 September 2018
• DOI: http://doi.org/10.1111/famp.12345

The Partners for Change Outcome Management

System: A Both/And System for Collaborative

Practice

JACQUELINE A. SPARKS*

BARRY L. DUNCAN

†

Systematic client feedback (SCF) is increasingly employed in mental health services

worldwide. While research supports its efficacy over treatment as usual, clinicians, espe-

cially those who highly value relational practices, may be concerned that routine data col-

lection detracts from clinical process. This article describes one SCF system, the Partners

for Change Outcome Management System (PCOMS), along a normative (standardized

measurement) to communicative (conversational) continuum, highlighting PCOMS’ ori-

gins in everyday clinical practice. The authors contend that PCOMS repr esents “both/

and,” providing a valid signal of client progress while facilitating communicative process

particularly prized by family therapists steeped in relational traditions. The article dis-

cusses application of PCOMS in systemic practice and describes how it actual izes time-

honored family therapy approaches. The importance of giving voice to individualized client

experience is emphasized.

Keywords: Systematic Client Feedback; PCOMS ; Partners for Change Outcome

Management System

Fam Proc 57:800–816, 2018

INTRODUCTION

Systematic client feedback (SCF) is increasingly used in varied psychotherapy settings

to provide real-time and pre–post client progress information to therapists, adminis-

trators, and funders. SCF involves the routine collection of consumer feedback to track

improvement, identify at-risk clients, and facilitate adjustment of therapy to prevent

treatment failure. The need for SCF is based on findings that many clients quit therapy

prematurely (Swift & Greenberg, 2012) or have negative outcomes (Reese, Duncan,

Bohanske, Owen, & Minami, 2014). Moreover, clinicians are overly optimistic about their

effectiveness (Walfish, McAlister, O’Donnell, & Lambert, 2012) and are unable to predict

which clients are likely to do poorly (Chapman et al., 2012). SCF systems aim to identify

treatment failures before they occur, allowing time for clinicians to restore therapy to a

positive trajectory.

Evidence that SCF can improve outcome is now well established. Randomized clinical

trials (RCT) and cohort studies indicate significantly better outcomes for feedbac k condi-

tions compared with treatment as usual in individual (Lambert, 2015), couple (Anker,

To read this article in Spanish, please see the article’s Supporting Information on Wiley Online Library

(wileyonlinelibrary.com/journal/famp).

*Department of Human Development and Family Studies, College of Health Sciences, University of Rhode

Island, Kingston, RI.

†

Heart and Soul of Change Project, Jensen Beach, FL.

Correspondence concerning this article should be addressed to Jacqueline A. Sparks, 2 Lower College

Rd., Kingston, RI 02881. E-mail: jsparks@uri.edu

800

Family Process, Vol. 57, No. 3, 2018 ©2018 Family Process Institute

doi: 10.1111/famp.12345

Duncan, & Sparks, 2009; Reese, Toland, Slone, & Norsworthy, 2010), family (Cooper, Ste-

wart, Sparks, & Bunting, 2012), and group therapy (Schuman, Slone, Reese, & Duncan,

2014; Slone, Reese, Mathews-Duvall, & Kodet, 2015). The increasing body of evidence

prompted the American Psychological Association Taskforce on Evidence Based Treat-

ments (2006) to recommend that clinicians routinely collect and utilize client-report data

to inform treatment. Concurring, the American Association for Marriage and Family

Therapy Task Force on Core Competencies advises therapists to solicit and use client feed-

back throughout the therapeutic process (Nelson et al., 2007).

Two SCF systems, the Partners for Change Outcome Management System (PCOMS;

Duncan & Reese, 2015) and the Outcome Questionnaire System (OQ; Lambert, 2015), are

listed by the Substance Abuse and Mental Health Administration in the National Registry

of Evidence-based Programs and Practices. Only PCOMS has demonstrated significant

improvement in outcomes with couples and families. PCOMS (Anker et al., 2009; Duncan

& Sparks, 2002), the evidence-based methodology of using the Outcome Rati ng Scale

(ORS; Miller, Duncan, Brown, Sparks, & Claud 2003) and the Session Rating Scale (SRS;

Duncan, Miller, Sparks, Claud, et al., 2003), directly involves clinicians and clients,

including youth, in an ongoing process of measuring and discussing both progress and the

alliance, the first system to do so.

Systematic client feedback systems with couples and families are in various stages of

development (Sparks & Duncan, in press). In addition to PCOMS, the Systemic Therapy

Inventory of Change (STIC) monitors change from a multisystemic perspective with fami-

lies, couples, and individuals (Pinsof et al., 2015). Contextualized Feedback Systems

(CFS; Bickman, Kelley, Breda, de Andrade, & Riemer, 2011) is a web-based, continuous

quality improvement system designed for use in youth mental health treatment. The Clin-

ical Outcomes in Routine Evaluation (CORE; Barkham et al., 2001) tracks ch ange in gen-

eral psychological services; the Young Person’s Clinical Outcomes in Routine Evaluation

(YP-CORE; Twigg et al., 2009) expands application of the CORE to youth and families.

SCORE (Systemic CORE; Stratton, Bland, Janes, & Lask, 2010) is designed specifically to

document system health and progress over the course of psychotherapy. The OQ System

(Lambert, 2015) also includes the Youth Outcome Questionnaire (YOQ; Dunn, Burlin-

game, Walbridge, Smith, & Crum, 2005), which permits the identification of not-on-track

youth. For many SCF systems, iPads or tablets link to web-based applications providing

progress graphs and alerts for at-risk clients.

Systematic client feedback systems can be considered as falling along a continuum. One

end emphasizes normative measurement, the other, communicative (Duncan & Reese,

2015; Halstead, Youn, & Armijo, 2013). These dimensions are typically viewed as mark-

edly different. The normative end reflects the positivist paradigm’s view that universal

structures underlie human behavior and can be discovered and measured (Sales & Alves,

2012). The communicative end represents constructivist (Neimeyer & Mahoney, 1995)

and social constructionist (Gergen, 1985; McNamee & Gergen, 1992) beliefs that reality is

constructed as people perceive and interact with one another and their environments.

Normative methods thus aim to locate persons within a population via repeated standard-

ized measurement; communicative approaches use personalized instruments to provide

an in-depth understanding of individuals’ specific concerns, goals, and experienc es.

When viewed as strictly normative, SCF can represent the antithesis of why man y cou-

ple and family therapists chose their profession. For these, the interpersonal drama

played out in every session is sacrosanct; reducing it to graphs and red flags on a computer

screen is nothing short of sacrilege. The history of the field of family therapy—from early

communication theorists, to structural and strategic joining, solution-talk, collaborative

conversations, and unfolding client narratives—has focused largely on interactive process.

This communicative bent can be considered at odds with the call to prove the field’s

Fam. Proc., Vol. 57, September, 2018

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