Benchmarking outcomes in a public behavioral health setting: feedback as a quality improvement strategy

The purpose of this study was to evaluate the effectiveness of a large public behavioral health (PBH) agency serving only clients at or below the federal poverty level that had implemented continuous outcome feedback as a quality improvement strategy.

The authors investigated the post treatment outcomes of 5,168 individuals seeking treatment for a broad range of diagnoses who completed at least 2 psychotherapy sessions. The Outcome Rating Scale (ORS; Duncan, 2011; Miller & Duncan, 2004) was used to measure outcomes. Clients had a mean age of 36.7 years and were predominantly female (60.7%) and White (67.8%), with 17.7% being Hispanic, 9.3% being African American, and 2.8% being Native American. Forty-six percent were diagnosed with depression, mood, and anxiety disorders; 18.8% were diagnosed with substance abuse disorders; and 14.4% were diagnosed with bipolar disorder and schizophrenia. A subset of clients with a primary diagnosis of a depressive disorder was compared to treatment efficacy benchmarks derived from clinical trials of major depression. Given that the PBH agency had also implemented an outcome management system, the total sample was also compared to benchmarks derived from clinical trials of continuous outcome feedback.

Treatment effect sizes of psychotherapy delivered at the PBH agency were comparable to effect size estimates of clinical trials of depression and feedback. Observed effect sizes were smaller, however, when compared to feedback benchmarks that used the ORS.

Services to the poor and disabled can be effective, and continuous outcome feedback may be a viable means both to improve outcomes and to narrow the gap between research and practice.