Monitoring Treatment Progress and Providing Feedback is Viewed Favorably but Rarely Used in Practice

  • Amanda Jensen-DossEmail author
  • Emily M. Becker Haimes
  • Ashley M. Smith
  • Aaron R. Lyon
  • Cara C. Lewis
  • Cameo F. Stanick
  • Kristin M. Hawley
Original Article


Numerous trials demonstrate that monitoring client progress and using feedback for clinical decision-making enhances treatment outcomes, but available data suggest these practices are rare in clinical settings and no psychometrically validated measures exist for assessing attitudinal barriers to these practices. This national survey of 504 clinicians collected data on attitudes toward and use of monitoring and feedback. Two new measures were developed and subjected to factor analysis: The monitoring and feedback attitudes scale (MFA), measuring general attitudes toward monitoring and feedback, and the attitudes toward standardized assessment scales-monitoring and feedback (ASA-MF), measuring attitudes toward standardized progress tools. Both measures showed good fit to their final factor solutions, with excellent internal consistency for all subscales. Scores on the MFA subscales (Benefit, Harm) indicated that clinicians hold generally positive attitudes toward monitoring and feedback, but scores on the ASA-MF subscales (Clinical Utility, Treatment Planning, Practicality) were relatively neutral. Providers with cognitive-behavioral theoretical orientations held more positive attitudes. Only 13.9 % of clinicians reported using standardized progress measures at least monthly and 61.5 % never used them. Providers with more positive attitudes reported higher use, providing initial support for the predictive validity of the ASA-MF and MFA. Thus, while clinicians report generally positive attitudes toward monitoring and feedback, routine collection of standardized progress measures remains uncommon. Implications for the dissemination and implementation of monitoring and feedback systems are discussed.


Psychological assessment Attitude measures Evidence based practice Therapists 



This research was supported by an award from the University of Miami’s Provost Resaerch Award program to Dr. Jensen-Doss. Dr. Lewis’ work on this project was supported by the National Institute Of Mental Health of the National Institutes of Health (NIH) under Award Number R01MH103310 and Dr. Lyon’s work by NIH award K08MH095939.

Compliance with Ethical Standards

Conflict of Interest

None of the authors have conflicts of interest to declare.

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of the University of Miami Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

This study was approved for a waiver of signed consent; all participants were provided with a consent statement.

Supplementary material

10488_2016_763_MOESM1_ESM.docx (24 kb)
Supplementary material 1 (DOCX 23 KB)


  1. Aarons, G. A. (2004). Mental health provider attitudes toward adoption of evidence-based practice: The evidence-based practice attitude scale (EBPAS). Mental Health Services Research, 6(2), 61–74.CrossRefPubMedPubMedCentralGoogle Scholar
  2. Aarons, G. A., Horowitz, J., Dlugosz, L., & Ehrhart, M. (2012). The role of organizational processes in dissemination and implementation research. Dissemination and Implementation Research in Health: Translating Science to Practice, 128–153.Google Scholar
  3. Aarons, G. A., & Sawitzky, A. C. (2006). Organizational culture and climate and mental health provider attitudes toward evidence-based practice. Psychological Services, 3(1), 61.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior & Human Decision Processes, 50, 179–211.CrossRefGoogle Scholar
  5. APA Presidential Task FORCE on Evidence-Based Practice. (2006). Evidence-based practice in psychology. American Psychologist, 61(4), 271–285.CrossRefGoogle Scholar
  6. Batty, M. J., Moldavsky, M., Foroushani, P. S., Pass, S., Marriott, M., Sayal, K., & Hollis, C. (2013). Implementing routine outcome measures in child and adolescent mental health services: From present to future practice. Child and Adolescent Mental Health, 18(2), 82–87.CrossRefGoogle Scholar
  7. Becker, E. M., & Jensen-Doss, A. (2013). Computer-assisted therapies: Examination of therapist-level barriers to their use. Behavior Therapy, 44(4), 614–624.CrossRefPubMedGoogle Scholar
  8. Bickman, L. (2008). A measurement feedback system (MFS) is necessary to improve mental health outcomes. Journal of the American Academy of Child & Adolescent Psychiatry, 47(10), 1114–1119.CrossRefGoogle Scholar
  9. Bickman, L., Douglas, S. R., De Andrade, A. R. V., Tomlinson, M., Gleacher, A., Olin, S., & Hoagwood, K. (2016). Implementing a measurement feedback system: A tale of two sites. Administration and Policy in Mental Health and Mental Health Services Research, 43(3), 410–425.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Bickman, L., Kelley, S. D., Breda, C., De Andrade, A. R. V., & Riemer, M. (2011). Effects of routine feedback to clinicians on mental health outcomes of youths: Results of a randomized trial. Psychiatric Services, 62(12), 1423–1429.CrossRefPubMedGoogle Scholar
  11. Borntrager, C. F., & Lyon, A. R. (2015). Client progress monitoring and feedback in school-based mental health. Cognitive and Behavioral Practice, 22(1), 74–86.CrossRefPubMedGoogle Scholar
  12. Boswell, J. F., Kraus, D. R., Miller, S. D., & Lambert, M. J. (2015). Implementing routine outcome monitoring in clinical practice: Benefits, challenges, and solutions. Psychotherapy Research, 25(1), 6–19.CrossRefPubMedGoogle Scholar
  13. Chorpita, B. F., Bernstein, A., Daleiden, E. L., & Research Network on Youth Mental Health. (2008). Driving with roadmaps and dashboards: Using information resources to structure the decision models in service organizations. Administration and Policy in Mental Health and Mental Health Services Research, 35(1–2), 114–123.CrossRefPubMedGoogle Scholar
  14. Creed, T. A., Wolk, C. B., Feinberg, B., Evans, A. C., & Beck, A. T. (2016). Beyond the label: Relationship between community therapists’ self-report of a cognitive behavioral therapy orientation and observed skills. Administration and Policy in Mental Health and Mental Health Services Research, 43(1), 36–43.CrossRefPubMedGoogle Scholar
  15. Dillman, D. A., Smyth, J. D., & Christian, L. M. (2009). Internet, mail, and mixed-mode surveys: The tailored design method. (3rd ed.). Hoboken: Wiley.Google Scholar
  16. Dozois, D. J., Mikail, S. F., Alden, L. E., Bieling, P. J., Bourgon, G., Clark, D. A., Drapeau, M., Gallson, D., Greenberg, L., Hunsley, J. (2014). The CPA presidential task force on evidence-based practice of psychological treatments. Canadian Psychology/Psychologie canadienne, 55(3), 153.CrossRefGoogle Scholar
  17. Ebesutani, C., & Shin, S. H. (2014). Knowledge, attitudes, and usage of evidence-based assessment and treatment practices in the Korean mental health system: Current status and future directions. The Korean Journal of Clinical Psychology, 33(4), 891–917.CrossRefGoogle Scholar
  18. Elliott, R., Wagner, J., Sales, C. M. D., Rodgers, B., Alves, P., & Café, M. J. (2016). Psychometrics of the personal questionnaire: A client-generated outcome measure. Psychological Assessment, 28(3), 263–278.CrossRefPubMedGoogle Scholar
  19. Frauenhoffer, D., Ross, M. J., Gfeller, J., Searight, H. R., & Piotrowski, C. (1998). Psychological test usage among licensed mental health practitioners: A multidisciplinary survey. Journal of Psychological Practice, 4(1), 28–33.Google Scholar
  20. Garland, A. F., Bickman, L., & Chorpita, B. F. (2010). Change what? Identifying quality improvement targets by investigating usual mental health care. Administration and Policy in Mental Health and Mental Health Services Research, 37(1–2), 15–26.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Garland, A. F., Brookman-Frazee, L., Hurlburt, M. S., Accurso, E. C., Zoffness, R. J., Haine-Schlagel, R., & Ganger, W. (2010). Mental health care for children with disruptive behavior problems: A view inside therapists’ offices. Psychiatric Services, 61(8), 788–795.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Gilbody, S. M., House, A. O., & Sheldon, T. A. (2002). Psychiatrists in the UK do not use outcomes measures: National survey. British Journal of Psychiatry, 180(2), 101–103.CrossRefPubMedGoogle Scholar
  23. Gleacher, A. A., Olin, S. S., Nadeem, E., Pollock, M., Ringle, V., Bickman, L., Douglas, S., Hoagwood, K., et al. (2016).. Administration and Policy in Mental Health and Mental Health Services Research, 43, 426–440.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Hall, C., Moldavsky, M., Taylor, J., Sayal, K., Marriott, M., Batty, M., Pass, S., Hollis, C., et al. (2014). Implementation of routine outcome measurement in child and adolescent mental health services in the United Kingdom: A critical perspective. European Child & Adolescent Psychiatry, 23(4), 239–242.CrossRefGoogle Scholar
  25. Hatfield, D. R., & Ogles, B. M. (2004). The use of outcome measures by psychologists in clinical practice. Professional Psychology: Research and Practice, 35(5), 485–491.CrossRefGoogle Scholar
  26. Hatfield, D. R., & Ogles, B. M. (2007). Why some clinicians use outcome measures and others do not. Administration and Policy in Mental Health and Mental Health Services Research, 34(3), 283–291.CrossRefPubMedGoogle Scholar
  27. Hawley, K. M., Cook, J. R., & Jensen-Doss, A. (2009). Do noncontingent incentives increase survey response rates among mental health providers? A randomized trial comparison. Administration and Policy in Mental Health, 36(5), 343–348.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Herschell, A. D., Lindhiem, O. J., Kogan, J. N., Celedonia, K. L., & Stein, B. D. (2014). Evaluation of an implementation initiative for embedding dialectical behavior therapy in community settings. Evaluation and program planning, 43, 55–63.CrossRefPubMedGoogle Scholar
  29. Higa-McMillan, C. K., Powell, C. K. i. K., Daleiden, E. L., & Mueller, C. W. (2011). Pursuing an evidence-based culture through contextualized feedback: Aligning youth outcomes and practices. Professional Psychology: Research and Practice, 42(2), 137–144.CrossRefGoogle Scholar
  30. Hu, L. t., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55.CrossRefGoogle Scholar
  31. Ionita, G., & Fitzpatrick, M. (2014). Bringing science to clinical practice: A Canadian survey of psychological practice and usage of progress monitoring measures. Canadian Psychology/Psychologie Canadienne, 55(3), 187–196.CrossRefGoogle Scholar
  32. Jensen-Doss, A., & Hawley, K. M. (2010). Understanding barriers to evidence-based assessment: Clinician attitudes toward standardized assessment tools. Journal of Clinical Child & Adolescent Psychology, 39(6), 885–896.CrossRefGoogle Scholar
  33. Jensen-Doss, A., & Hawley, K. M. (2011). Understanding clinicians’ diagnostic practices: Attitudes toward the utility of diagnosis and standardized diagnostic tools. Administration and Policy in Mental Health and Mental Health Services Research, 38(6), 476–485.CrossRefPubMedGoogle Scholar
  34. Jensen-Doss, A., Hawley, K. M., Lopez, M., & Osterberg, L. D. (2009). Using evidence-based treatments: The experiences of youth providers working under a mandate. Professional Psychology: Research and Practice, 40(4), 417.CrossRefGoogle Scholar
  35. Johnston, C., & Gowers, S. (2005). Routine outcome measurement: a survey of UK child and adolescent mental health services. Child and Adolescent Mental Health, 10(3), 133–139.CrossRefGoogle Scholar
  36. Koerner, K., & Castonguay, L. G. (2015). Practice-oriented research: What it takes to do collaborative research in private practice. Psychotherapy Research, 25(1), 67–83.CrossRefPubMedGoogle Scholar
  37. Kotte, A., Hill, K. A., Mah, A. C., Korathu-Larson, P. A., Au, J. R., Izmirian, S., … Higa-McMillan, C. K., et al. (2016). Facilitators and barriers of implementing a measurement feedback system in public youth mental health. Administration and Policy in Mental Health and Mental Health Services Research, 1–18.Google Scholar
  38. Lambert, M. J., Whipple, J. L., Hawkins, E. J., Vermeersch, D. A., Nielsen, S. L., & Smart, D. W. (2003). Is it time for clinicians to routinely track patient outcome? A meta-analysis. Clinical Psychology: Science and Practice, 10(3), 288–301.Google Scholar
  39. Landes, S. J., Carlson, E. B., Ruzek, J. I., Wang, D., Hugo, E., DeGaetano, N., … Lindley, S. E., et al. (2015). Provider-driven development of a measurement feedback system to enhance measurement-based care in va mental health. Cognitive and Behavioral Practice, 22(1), 87–100.CrossRefGoogle Scholar
  40. Little, R. J. (1988). A test of missing completely at random for multivariate data with missing values. Journal of the American Statistical Association, 83(404), 1198–1202.Google Scholar
  41. Lyon, A. R., Dorsey, S., Pullmann, M., Silbaugh-Cowdin, J., & Berliner, L. (2015). Clinician use of standardized assessments following a common elements psychotherapy training and consultation program. Administration and Policy in Mental Health and Mental Health Services Research, 42(1), 47–60.CrossRefPubMedPubMedCentralGoogle Scholar
  42. Lyon, A. R., Ludwig, K., Wasse, J. K., Bergstrom, A., Hendrix, E., & McCauley, E. (2016). Determinants and functions of standardized assessment use among school mental health clinicians: A mixed methods evaluation. Administration and Policy in Mental Health and Mental Health Services Research, 43(1), 122–134.CrossRefPubMedPubMedCentralGoogle Scholar
  43. Martinez, R. G., Lewis, C. C., & Weiner, B. J. (2014). Instrumentation issues in implementation science. Implementation Science, 9, 118.Google Scholar
  44. Meehan, T., McCombes, S., Hatzipetrou, L., & Catchpoole, R. (2006). Introduction of routine outcome measures: Staff reactions and issues for consideration. Journal of Psychiatric and Mental Health Nursing, 13(5), 581–587.CrossRefPubMedGoogle Scholar
  45. Muthén, L., & Muthén, B. (1998–2011). Mplus user’s guide (6th ed.). Los Angeles, CA: Muthén & Muthén.Google Scholar
  46. Overington, L., Fitzpatrick, M., Hunsley, J., & Drapeau, M. (2015). Trainees’ experiences using progress monitoring measures. Training and Education in Professional Psychology, 9(3), 202–209.CrossRefGoogle Scholar
  47. Palmiter, D. J. Jr. (2004). A survey of the assessment practices of child and adolescent clinicians. American Journal of Orthopsychiatry, 74(2), 122–128.CrossRefPubMedGoogle Scholar
  48. Persons, J. B. (2006). Case formulation–driven psychotherapy. Clinical Psychology: Science and Practice, 13(2), 167–170.Google Scholar
  49. Reese, R. J., Norsworthy, L. A., & Rowlands, S. R. (2009). Does a continuous feedback system improve psychotherapy outcome? Psychotherapy: Theory, Research, Practice, Training, 46(4), 418–431.CrossRefGoogle Scholar
  50. Unsworth, G., Cowie, H., & Green, A. (2012). Therapists’ and clients’ perceptions of routine outcome measurement in the NHS: A qualitative study. Counselling and Psychotherapy Research, 12(1), 71–80.CrossRefGoogle Scholar
  51. Ventimiglia, J. A., Marschke, J., Carmichael, P., & Loew, R. (2000). How do clinicians evaluate their practice effectiveness? A survey of clinical social workers. Smith College Studies in Social Work, 70(2), 287–306.CrossRefGoogle Scholar
  52. Weisz, J. R., Chorpita, B. F., Frye, A., Ng, M. Y., Lau, N., Bearman, S. K., Ugueto, A. M., Langer, D. A., Hoagwood, K. E., et al. (2011). Youth top problems: Using idiographic, consumer-guided assessment to identify treatment needs and to track change during psychotherapy. Journal of Consulting and Clinical Psychology, 79(3), 369.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Amanda Jensen-Doss
    • 1
    Email author
  • Emily M. Becker Haimes
    • 1
  • Ashley M. Smith
    • 1
  • Aaron R. Lyon
    • 2
  • Cara C. Lewis
    • 2
    • 3
  • Cameo F. Stanick
    • 4
  • Kristin M. Hawley
    • 5
  1. 1.Child Division, Department of PsychologyUniversity of MiamiCoral GablesUSA
  2. 2.University of WashingtonSeattleUSA
  3. 3.Indiana UniversityBloomingtonUSA
  4. 4.University of MontanaMissoulaUSA
  5. 5.University of MissouriColumbiaUSA

Personalised recommendations