Dissertations / Theses on the topic 'Outcome Questionnaire 45 (OQ)'

The need for psychotherapy outcome research is growing in Japan as the societal demands for psychotherapy have increased in recent years. Although researchers in Japan recognize the importance of integrating clinical practice and empirical research in evaluating psychotherapy outcome, most Japanese studies to date have relied heavily on qualitative case studies (Haebara, 1997; Kanazawa, 2004; Tanno, 2001). With the help of six translators and 116 native Japanese pilot respondents, this study adapted the Outcome Questionnaire (OQ; Lambert et al., 1996), one of the most common quantitative measures of clinical outcome, for use in Japan. The translation of the original OQ into Japanese followed Beaton et al. (2000) to include forward translation, synthesis, back translation, and expert committee meetings. The study produced 4 pre-final versions, 2 pretests, and a pilot. With permission from the original questionnaire developers, a few items were modified to achieve cultural equivalence. The rigorous translation and adaptation processes, evaluated through the Translation Validity Index (Tang & Dixon, 2002) and Content Validity Index (Polit et al., 2007), sought semantic, content, and conceptual equivalence between the English and Japanese versions of the OQ. Study limitations and suggestions for further development of the Japanese OQ are discussed.

Because of the lasting impact that traumatic family events can have on psychological well-being, students who present for services at college counseling centers may be experiencing problems and symptoms associated with earlier trauma. Many college counseling centers utilize the Counseling Concerns Survey developed by the Research Consortium of Counseling and Psychological Services in Higher Education (1991) and the Outcome Questionnaire-45 (OQ-45; Lambert et al., 1996) as intake instruments to assess students who present for counseling. The major components of the Counseling Concerns Survey are the 18-item Family Experiences Questionnaire, which identifies history of family trauma, and the 42-item Presenting Problems List, which assesses students' major areas of distress. The OQ-45 measures symptom severity. While it is generally assumed that family trauma during childhood and adolescence can negatively impact future mental health and well-being, it has been unclear how specific traumatic family experiences reported on the Family Experiences Questionnaire are related to specific presenting problems as listed on the Presenting Problems List or symptom severity as measured by the OQ-45. The purpose of this study was to examine this relationship and to ascertain discernible patterns. Data from the intake instruments of 20,495 students who sought counseling services at a large western U.S. university from 1997 to 2007 was analyzed. Logistic regression of each of the 18 traumatic family history experiences was performed, using the initial OQ-45 score, the 42 Presenting Problems List items, and five Presenting Problems List factors (Draper, Jennings, & Baron, 2003) as "predictors" of the types of trauma the students might have experienced. Results showed that although family trauma of a variety of types was associated with symptom severity and various presenting problems, there did not seem to be an overall discernible pattern. The results suggest that trauma seems to have a diffuse association with presenting problems and symptom severity. However, some family traumas are associated with a greater number of presenting problems, and these traumas were identified.

As pesquisas para padronização de instrumentos de avaliação de resultados terapêuticos têm sido produtivas, uma vez que a aproximação entre a pesquisa e a prática clínica permite ao profissional perceber a importância dessa avaliação de processo e de resultados. Com isto, a necessidade dos psicólogos contarem com instrumentos de avaliação, capazes de auxiliá-los nessa tarefa, tem se mostrado cada vez mais essencial. No entanto, a carência de instrumentos válidos para a realidade brasileira impõe limitações a estes profissionais. O Outcome Questionnaire - OQ-45.2 é um dos instrumentos utilizados para avaliar os ganhos obtidos pelo paciente na psicoterapia, com pesquisas realizadas em vários países. Trata-se de uma escala do tipo Likert de cinco pontos, dividida em três subescalas: desconforto subjetivo (SD), relações interpessoais (IR) e desempenho do papel social (SR). Esta pesquisa teve o objetivo de avaliar as propriedades psicométricas da versão em português do OQ-45.2. A amostra foi composta por 419 participantes adultos, subdivididos em dois grupos, um de pacientes (N = 59) e outro de não pacientes (N = 360), sendo 156 homens e 263 mulheres, com idades variando de 18 a 78 anos. O estudo de precisão do OQ-45.2 foi realizado pelo método de teste-reteste, com intervalo de 7 a 14 dias, e o alfa de Cronbach. Para a escala total a precisão pelo reteste foi de 0,895 e para as subescalas variou de 0,756 a 0,883, indicando estabilidade temporal satisfatória. O alfa de Cronbach para a escala total foi de 0,95, semelhante ao do estudo americano (0,93). Os dados de validade foram obtidos pela correlação entre o resultado global e os das subescalas, por meio da comparação entre grupos contrastantes de pacientes e não pacientes e da validade simultânea com a Escala de Avaliação de Sintomas (EAS-40), o Inventário de Depressão de Beck (BDI II) e o Questionário Geral de Saúde (QSG). As correlações das subescalas com a pontuação total e entre as subescalas foram significantes, mas a subescala SR mostrou correlações menores que as outras. Foram obtidas diferenças estatisticamente significantes (p < 0,001) entre as médias dos dois grupos, o que mostra a sensibilidade da escala para avaliação dos pacientes. O resultado do OQ 45.2 se correlacionou significativamente com os três instrumentos utilizados para o estudo de validade, sendo que as correlações com os escores totais dos instrumentos foram: 0,80 com a EAS-40, 0,83 com o BDI-II e 0,88 com o QSG. Também foram calculadas as correlações entre cada item com o escore total do OQ-45.2, tendo sido encontrados quatro itens com correlações menores do que 0,20. Assim os estudos psicométricos indicaram a adequação da escala para o uso no Brasil, embora ainda seja necessária a confirmação de sua estrutura fatorial e de estudos referentes a mudanças obtidas na psicoterapia
Researches for standardization of therapeutic assessment tools have been productive, since the connection between research and clinical practice allows the professional to realize the importance of the assessment process and results. In this way, the psychologists need of available assessment tools, which can assist them in this task, has become ever more essential. However, the lack of valid instruments to the Brazilian reality imposes limitations to these professionals. The Outcome Questionnaire - OQ-45.2 is one of the instruments used to measure the patients progress in psychotherapy and it was studied in several countries. It is a Likert five points scale, divided into three subscales: Symptom Distress (SD), Interpersonal Relationships (IR) and Social-Role performance (SR). The goal of this research was to assess the psychometric properties of the OQ-45-2 Portuguese version. The sample was composed by 419 adult participants, divided in two groups, one group of patients (N = 59) and the other of non-patients (N = 360), 156 men and 263 women, age ranging from 18 to 78 years. The reliability study of the OQ-45.2 was conducted by the test-retest method, using intervals ranging from 7 to 14 days, and by the Cronbach\'s alpha coefficient. The retest reliability for the total score was 0.895 and for the subscales ranged from 0.756 to 0.883, indicating satisfactory temporal stability. The Cronbach\'s alpha for the total scale was 0.95, similar to the American study (0.93). The validity data were obtained by correlations between the total score and the subscales scores; by comparing contrasting groups of patients and non patients and concurrent validity with the Symptom Assessment Scale (EAS-40) Beck Depression Inventory (BDI II) and the General Health Questionnaire (GHQ). Correlations of the subscales with the total score and subscales scores were significant, but the SR subscale showed lower correlations than others. Differences between the means of two groups were significant statistically (p <0.001), which shows the sensitivity of the scale to assess patients. The results of OQ-45.2 correlated significantly with the three tests used in validity study and correlations between the total scores of the tests were 0.80 with the EAS-40, 0.83 with the BDI-II and 0.88 with the GHQ. Correlations total of total score of OQ-45.2 with each item were also calculated and were found four items correlations lower than 0.20. Therefore, the psychometric studies indicated the appropriateness of the scale for use in Brazil, although it is still necessary the confirmation of its factor structure and studies regarding changes obtained in psychotherapy

In routine outcome monitoring (ROM), the rate and timing of treatment failure alerts has been related to the success of feedback in past randomized clinical trials. In a recent OQ-45 feedback study, Burlingame and colleagues (2018) found that the rates and timing of not-on-track (NOT) progress alerts in group treatment were different than those reported for individual treatment. Using data from 58 different therapy groups and 374 patients, NOT progress alerts occurred at 186% of the rate reported by Shimokawa et al. (2010) when they examined over 6,000 patients receiving individual therapy at the same clinics. Another significant difference was found on the timing of the first NOT progress alerts with group treatment's first alerts occurring two sessions later than individual treatment. The goal of the current study was to use de-identified archival OQ-45 data from patients receiving group and individual treatment at a comparable clinic to determine if these rate and timing differences were replicable. Data from individual therapy (N = 5,493) and group therapy (N = 146) patients' OQ-45 scores show that the present study duplicated the significant difference found in the rate of NOT alerts between these formats. Relative risk of alerting as NOT at least once in group therapy was calculated to be 1.43 compared to individual therapy (group patients are 143% more likely to alert than individual patients). On the other hand, the present study did not find a significant difference in the timing of first alerts between formats. The implication of these results are significant when considering ROM in group therapy. Patients participating in group therapy are much more likely to flag as not-on-track later during the course of treatment when compared to patients in individual therapy.

The OQ-45.2 (Outcome Questionnaire-45.2) is a measure of psychological distress that examines patients' emotional states and level of functioning in society. This measure was administered at admission and discharge to inpatients at a level II trauma center with in- and outpatient populations in addition to the BBHI-2 (Brief Battery for Health Improvement-2) and FIM (Functional Independence Measure). Results suggested that patients demonstrated psychological improvements from admission to discharge. In addition, the OQ-45.2 was found to correlate with nearly all subtests of the BBHI-2. Finally, diagnosis, length of stay, and number of psychotherapy sessions were not predictive of improvements on the OQ-45.2 total score, suggesting that this measure can be appropriately used on a heterogeneous medical population.

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Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES
Introduction: The Outcome Questionnaire System (OQ System) is a system developed by the American psychologists Michael Lambert and Gary Burlingame in the early 90s; nowadays it is recognized by the Substance Abuse and Mental Health Administration's National Registry of Evidence-based Programs and Practices (SAMHSA's NREPP). The system is composed by questionnaires for the purpose of obtaining quantitative data on psychotherapeutic treatment in order to evaluate and monitor its outcome (Erekson, Lambert & Eggett, 2015). The results obtained through the application of the questionnaires in the context of psychotherapy helped to verify if the intervention is effective so that, through this feedback, the psychotherapist can prevent withdrawal, modify the therapeutic plan and provide feedback to the patient and the team in order to discuss the clinical case based on quantitative evidence (Nordal, 2012). Among the several questionnaires in the OQ System, the Youth Outcome Questionnaire Self-Report 2.0 (Y-OQ-SR 2.0) was developed to evaluate the psychotherapy of teenagers between 12 and 18 years old (Wells & Burlingame, 2003). The Y-OQ SR 2.0 has 64 items consisting of affirmative first-person phrases and shall be answered on a Likert scale from 0 to 4: 0 (never), 1 (rarely), 2 (sometimes), 3 (often ) and 4 (always). The items are distributed into six factors that evaluate: Intrapersonal Stress; Somatic; Interpersonal Relationships; Critical Items; Social problems; Behavioral Disorders. The questionnaire is non-theoretical and self-applied. Goal: culturally adapt the Y-OQ-SR 2.0 to the Brazilian reality. Method: the study followed the following steps: 1) From the original instrument, two translations into Portuguese were performed by two bilingual translators; 2) Synthesis of the two translations by a third translator overseen by an expert committee; 3) Evaluation of the target audience in order to investigate the understanding of the items; 4) Adjusting the instrument after a consensus among the ideas resulting from the evaluation of the target audience; 5) Back-translation of the Portuguese version into English, by a fourth bilingual translator; 6) Submission of the back-translation to the original authors to ensure that the content has equivalent meaning to the original content; 7) The original authors considered the back-translation appropriate, the Portuguese translation will be used to carry out a pilot study (Borsa et al., 2012; Cassepp-Borges, Balbinotti & Teodoro, 2010; Gjersing, Caplehorn & Clausen, 2010; Takara, 2015). Outcomes: Some terms and words that needed clarification were evaluated by a committee of experts before the synthesis itself. The translation was made by two bilingual translators using the Parallel Blind Technique. The synthesis of the translations was evaluated by the target audience in order to ensure the understanding of the translated items. Five out of these items required review by the committee for a second audience assessment, followed by semantic adjustments. This second evaluation took place satisfactorily, as the target audience understood the phrases and modified words. The final version was submitted to the reverse translation process (Portuguese to English) by a C2 level translator in the Common European Framework of Reference (CEFR). Finally, the final version was sent to the original authors in order to ensure the equivalence of content with the original version. The final approval of the Brazilian-Portuguese version of the instrument was satisfactory; in other words, no adjustments were required. A committee of experts comprehending adolescent clinical psychologists with fluency in English employed the procedures for operational equivalence and it was concluded that the Y-OQ-SR 2.0 is suitable for the pilot study. Discussion: The evaluation of the target audience was made through stratified focus groups. The group provided discussions about the items to be evaluated, providing both objective data, that were filled by adolescents, and subjective data related to participants' understanding and discussion on terms and words. Once the steps proposed by Borsa et al., 2012, Cassepp-Borges, Balbinotti & Teodoro, 2010, Gjersing, Caplehorn & Clausen, 2010 and Takara, 2015 were successfully achieved, the proposed goal was therefore achieved. The gathering and analysis of data were performed through a rigorous and systematic process to ensure adequate adaptation to the Brazilian reality. The Y-OQ-SR 2.0 is an important tool for adolescent and patient psychotherapists, as it was developed exclusively to assess youth psychotherapy. Its purpose is, therefore, to monitor the psychotherapeutic process (Lambert, 2010) and provide feedback to find out if the psychotherapy is being effective (Lambert, Hansen & Harmon, 2010). The adaptation of the Y-OQ-SR 2.0 to the Brazilian reality will allow the instrument to be released for subsequent studies of evidence of validity.
O Outcome Questionnaire System (OQ System) ? um sistema desenvolvido pelos psic?logos americanos Michael Lambert e Gary Burlingame no in?cio da d?cada de 90 e, atualmente, ? reconhecido no Substance Abuse and Mental Health Administration`s National Registry of Evidence-based Programs and Practices (SAMHSA`sNREPP). O sistema ? composto por question?rios destinados a obter dados quantitativos do tratamento psicoterap?utico com o objetivo de avaliar e monitorar o seu desfecho (Erekson, Lambert & Eggett, 2015). Os resultados obtidos por meio da aplica??o dos question?rios no contexto da psicoterapia auxiliam a verificar se a interven??o est? sendo tanto eficaz quanto efetiva e, por meio desse feedback, o psicoterapeuta pode prevenir desist?ncias, modificar o plano terap?utico e fornecer retorno ao paciente e ? equipe de maneira a discutir o caso cl?nico baseado em evid?ncias quantitativas (Nordal, 2012). Dentre os diferentes question?rios inclu?dos no OQ System, o Youth Outcome Questionnaire Self-Report 2.0 (Y-OQ-SR 2.0) foi desenvolvido para avaliar a psicoterapia de adolescentes entre 12 e 18 anos (Wells & Burlingame, 2003). O Y-OQ SR 2.0 possui 64 itens que consistem em frases afirmativas em primeira pessoa para serem respondidos por meio de uma escala Likert de 0 a 4: 0 (nunca), 1 (raramente), 2 (?s vezes), 3 (frequentemente) e 4 (sempre). Os itens est?o divididos em seis fatores que avaliam: Estresse Intrapessoal; Som?tico; Rela??es Interpessoais; Itens Cr?ticos; Problemas Sociais; Transtornos Comportamentais. O question?rio ? ate?rico e autoaplic?vel. Objetivo: adaptar culturalmente o Y-OQ-SR 2.0 para a realidade brasileira. M?todo: o estudo seguiu as seguintes etapas: 1) A partir do instrumento original, duas tradu??es para o portugu?s foram realizadas por dois tradutores bil?ngues; 2) S?ntese das duas tradu??es por um terceiro tradutor com acompanhamento de um comit? de experts; 3) Avalia??o do p?blico-alvo com objetivo de investigar a compreens?o dos itens; 4) Ajuste do instrumento ap?s um consenso entre as ideias advindas da avalia??o do p?blico-alvo; 5) Retrotradu??o da vers?o em portugu?s para o ingl?s, realizada por um quarto tradutor bil?ngue; 6) Envio da retrotradu??o (vers?o em ingl?s) para os autores originais para assegurar que o conte?do tenha significado equivalente ao conte?do original; 7) Os autores originais consideraram a retrotradu??o adequada, a tradu??o em portugu?s ser? utilizada para a execu??o de um estudo-piloto (Borsa et al., 2012; Cassepp-Borges, Balbinotti & Teodoro, 2010; Gjersing, Caplehorn & Clausen, 2010; Takara, 2015). Resultados: Alguns termos e palavras que necessitaram de esclarecimentos foram avaliados por um comit? de experts antes da s?ntese propriamente dita. A tradu??o foi feita por dois tradutores bil?ngues utilizando a T?cnica Cega Paralela (Parallel Blind Technique). A s?ntese das tradu??es foi avaliada pelo p?blico-alvo para averiguar a compreens?o dos itens traduzidos. Destes itens, cinco necessitaram de revis?o pelo comit? para uma segunda avalia??o do p?blico-alvo seguida de ajustes sem?nticos. Esta segunda avalia??o ocorreu de maneira satisfat?ria, pois o p?blico-alvo compreendeu as frases e palavras modificadas. A vers?o final foi submetida ao processo de tradu??o reversa (portugu?s para o ingl?s) por um tradutor n?vel C2 no Quadro Europeu Comum de Refer?ncia (QECR). Por fim, a vers?o final foi encaminhada aos autores originas com objetivo de assegurar a equival?ncia de conte?do com a vers?o original. A aprova??o final da vers?o para o portugu?s brasileiro do instrumento ocorreu de maneira satisfat?ria, ou seja, n?o foram necess?rios ajustes. Um comit? de experts composto por psic?logos cl?nicos que atuam no atendimento de adolescentes e que possuem flu?ncia em ingl?s empregou os procedimentos para a equival?ncia operacional e foi conclu?do que o Y-OQ-SR 2.0 est? adequado para o estudo-piloto. Discuss?o: a avalia??o do publico-alvo foi feita por meio de grupos focais estratificados. O grupo propiciou discuss?es acerca dos itens a serem avaliados fornecendo dados tanto objetivos que foram preenchidos pelos adolescentes quanto subjetivos relacionados ao entendimento e discuss?o dos participantes acerca dos termos e das palavras. Uma vez que as etapas propostas por Borsa et al., 2012, Cassepp-Borges, Balbinotti & Teodoro, 2010, Gjersing, Caplehorn & Clausen, 2010 e Takara, 2015 foram alcan?adas com ?xito, o objetivo proposto foi, portanto, alcan?ado. As coletas bem como as analyses dos dados ocorreram a partir de um processo rigoroso e sistem?tico de modo a garantir adequada adapta??o para a realidade brasileira. O Y-OQ-SR 2.0 ? um instrumento importante para psicoterapeutas de adolescentes e pacientes, pois ele foi desenvolvido exclusivamente para avaliar a psicoterapia do p?blico juvenil. Sua finalidade ?, portanto, monitorar o processo psicoterap?utico (Lambert, 2010) e fornecer feedbacks para verificar se a psicoterapia est? sendo eficiente (Lambert, Hansen & Harmon, 2010). A adapta??o do Y-OQ-SR 2.0 para a realidade brasileira ir? propiciar que o instrumento seja liberado para estudos subsequentes de evid?ncias de validade.

Managed Mental Health Care (MMHC) began blanketing the United States when cost of care rose exponentially. MMHC is one avenue many employers and insurance companies have chosen to provide employees with mental health treatment at controlled costs. However, not all employers view supplying their employees with mental health treatment beneficial, as they do not know mental health problems can significantly decrease work productivity. Brown and Jones (2005) used the Social Role Scale (SR) of the Severe Outcome Questionnaire (SOQ) to estimate work productivity in employees under the assumption that the scale measures work productivity. The purpose of this study was to move closer to an estimation of the relationship between improved mental health and improved workplace functioning by examining the relationships among a self-report measure of mental health (i.e., the SR), a self-report measure of work productivity (i.e., the Work Productivity and Activity Impairment Scale [WPAI]), and objective measures of work productivity (i.e., the quality and timeliness of institutional records, supervisor ratings, and sick hours used). It was thought that understanding the relationships among these measures might assist in estimating the cost/benefit of investing in psychotherapy. Participants in this study were employees and inpatients at the Utah State Hospital. Statistical analyses indicated the SR did predict two WPAI scales (i.e., Presenteeism and Activity Impairment) for employees. Specific relationships among measures, and suggestions for future research, are discussed.

Studies have shown a concerning and disproportionate amount of treatment failure and premature termination in youth populations. Routine measurement feedback has been proposed as a means to prevent treatment failure and premature termination for adults and may also improve youth mental health services. However, studies examining helpfulness of measurement feedback systems in youth populations have demonstrated a lack of effects more likely due to poor measurement implementation than to the measurement feedback system itself. Because contexts within the service settings are such crucial factors in whether an innovation is successfully implemented, examining barriers and facilitators in said contexts is a necessary step towards improving implementation for the ultimate purpose of improving youth mental health services. The present study explored barriers and facilitators to the implementation of the Youth Outcome Questionnaire (Y-OQ) and Treatment Support Measure (TSM) in youth routine clinical care. Thirteen staff of varying job titles, experiences, education and opinions towards measures were interviewed using consensual qualitative research (CQR) methods. Results were similar to previous studies, indicating multilevel barriers and facilitators to measurement implementation such as at the organization, staff, client and measure level. Using CQR data analysis, domains, categories and subcategories along with level of frequency are displayed and discussed in further detail. In addition to barriers and facilitators, interviewees provided recommendations for how to improve implementation of measures within their organization. Researchers provide recommendations of continued communication, re-assessment of barriers and facilitators over time and shared responsibility between stakeholders and professionals invested in improving youth mental health services.

Mental health problems are associated with significant losses in work productivity and, consequently, have significant ramifications for business entities and the general economy. Several instruments have been developed to measure productivity-related constructs such as absenteeism and presenteeism. The current study examines the utility of the Outcome Questionnaire-45 (OQ), a commonly used mental health questionnaire, in predicting work productivity. This relationship is explored as a preliminary step in assessing the degree to which changes in mental health brought about by psychotherapy will improve work productivity. Forty-nine participants were recruited from a call center in a small market research firm based in the Western United States. Work productivity was measured using four subscales of the Work Productivity and Activity Impairment (WPAI) questionnaire as well as an objective measure. The OQ and WPAI were administered on a weekly basis over the course of five weeks. Participant characteristic variables and work-time variables were also measured. A mixed models analysis of covariance (ANCOVA) with repeated measures showed that the Social Role (SR) Scale, a subscale of the OQ, was a significant predictor of Presenteeism, Overall Work Impairment, and Activity Impairment subscales. Latent growth modeling (LGM) was used to examine the relationship between the variables while accounting for individual trajectory differences. Although the results suggested that an unconditional model of Overall Work Impairment with SR as a time-varying covariate provided a good fit for the data, standardized regression weights between the variables were not significant. Implications of findings, limitations, and recommendations for future research are discussed.

SAMMANFATTNING

Under 2006 påbörjades arbetet med att nationellt höja kvaliteten på praktiskt socialt arbete. Socialstyrelsen gav då ut nya råd och riktlinjer för hur socialtjänsten kan stärka och utveckla sitt behandlingsarbete. Utifrån detta blir det allt vanligare att mer strukturerade manualer och behandlingsinstrument införs i arbetet. Ett sådant instrument är Youth Outcome Questionnaire, som under hösten 2007 implementeras i en kommunal behandlingsverksamhet i Örebro. Syftet med studien är att undersöka hindrande och möjliggörande faktorer som omgärdar implementeringen av ett behandlingsinstrument i en behandlingsverksamhet för ungdomar på institution. Syftet preciseras genom följande frågeställningar: Hur följdes det behandlingsarbetet upp innan implementeringen av instrumentet? Vad har föranlett att enheten beslutat att införa det nya behandlingsinstrumentet Y-OQ 2.0? Vilka möjliggörande eller hindrande faktorer har föregått implementeringsarbetet av instrumentet? Vilka negativa eller positiva faktorer framkommer i det praktiska handhavandet och tillämpningen av instrumentet? Studien har en kvalitativ ansats och bygger på semistrukturerade intervjuer med sex personer ur personalgruppen i den aktuella verksamheten. Tolkningsramen utgörs i huvudsak av implementeringsteori. Resultatet visar att personalen har en positiv inställning till arbetet med instrumentet. Man har inte tidigare arbetat utifrån strukturerade utvärderingsmetoder i form av instrument eller manualer och en majoritet av respondenterna ser behovet av utvärdering i verksamheten. Hindrande faktorer under implementeringen visar sig främst i att man upplever utbildningen som något bristfällig och att man inte heller fått någon handledning kring instrumentet. Detta har lett till osäkerhet kring användandet av detta liksom hur man ska använda de resultat som framkommer, vilket också visar på de praktiska svårigheter detta medfört. De möjliggörande faktorerna handlar till stor del om personalens positiva attityd och vilja att använda sig av det nya verktyget. I diskussionen förs resonemang kring implementeringens effekter på behandlingsverksamheten och instrumentets tillämpningsområde inom behandlingsarbetet.

Nyckelord: Implementering, implementeringsteori, behandlingsinstrument, Youth Outcome Questionnaire (Y-OQ 2.0), institutionsbehandling

This study examines psychotherapy response in connection to treatment duration and maintenance of treatment gains. The dose-effect perspective (Howard et al. 1986) first proposed applying medical terminology to investigate a level of exposure to a dose of psychotherapy (in number of sessions) where individuals can expect to receive sufficient benefit (i.e., 48 -- 58% of clients can be expected to sufficiently benefit from therapy by 8 sessions). The proponents of the Good Enough Level (Barkham et at. 2006) argued that mere exposure to therapy is not an effective measure for client benefit, but rather that client responses to therapy vary. They contend that instead of recommendations for attending a certain number of sessions (dose-effect) that individuals who attend psychotherapy will discontinue attending therapy when they have obtained sufficient benefit (good enough level). Archival data of university students who previously attended individual therapy were obtained and subjects were contacted via email to take a survey and follow up measure of general well being. Those individuals who completed the Outcome Questionnaire-45 were selected for the study and their treatment response was analyzed in connection to treatment duration measured in number of sessions attended. 288 met criteria for the current study, consisting of 197 women and 91 men ranging in age from 17 to 52 (M= 21). Conclusions obtained from this study indicate that treatment duration is not a factor in subjects having positive outcomes to psychotherapy. Additionally, there was not a significant difference among subjects who were able to maintain treatment gains and the number of session attended in treatment. These results offer support for the Good Enough Level model of treatment response suggesting that individuals respond to therapy differently and discontinue when they have received sufficient benefit. Implications for these findings are discussed along with limitations of the current study.

The Outcome Questionnaire (OQ-45; Lambert et al., 1996) has been widely employed as a psychotherapy outcome monitoring measure following research findings that support various aspects of its validity and sensitivity to change. Despite its broad usage in both clinical and research settings, some of its psychometric properties are not definite. The three subscales of the OQ-45 are designed to measure three distinct, but related, aspects of psychological functioning. However, neither the one- nor three-factor models have been supported by previous research. Likewise, the results of the current study supported neither of those factor structures. It was suspected that heterogeneity in data might have led to the lack of the confirmatory factor analysis model fit. Therefore, factor mixture modeling (FMM), a combination of confirmatory factor analysis and latent class analysis, was employed to investigate potential heterogeneity of the data. Among the series of factor mixture models with varying numbers of classes that were fitted, the two-class, unconditional FMM based on the revised three-factor solution was decided to best describe the data under analysis. Although three covariates of clinical status, sex, and race were selected as known sources of heterogeneity and incorporated into the FMMs (i.e., conditional model), the findings were contradictory to expectations. The implications of these findings in counseling were discussed in terms of aggregating OQ-45 scores and its score interpretation. Furthermore, this study demonstrates the process involved and dilemmas encountered in choosing the best fitting FMM. There is currently no criterion for assessing individual model fit. Instead, models’ fit are compared using various information criteria (IC). And, as was found in the current study, these ICs are frequently contradictory. Thus, the process of identifying the best fitting model cannot rest solely on fit indices but must also depend on interpretation of models and consideration of the ultimate use of the results. In the current study, consideration of transition matrices and the pattern of latent means across classes contributed as much to model selection as fit index interpretation.
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L'efficacité de la psychothérapie est maintenant bien établie depuis la fin des années 1970. Toutefois, l'évaluation du progrès en thérapie et du succès ou de l'échec d'interventions thérapeutiques a rencontré plusieurs difficultés méthodologiques, notamment au niveau de l'utilisation d'instruments peu appropriés quant à leur validité et leur fidélité. Une équipe de recherche de Brigham Young University dirigée par Michael J. Lambert s'est intéressée à cette problématique. Lambert et Burlingame (1996) ont développé un questionnaire connu sous le nom de « Outcome Questionnaire » (OQ-45.2) visant à mesurer l'efficacité thérapeutique. Le QQ-45.2 est une mesure unique, rapide et auto-administrée facile à corriger et à interpréter. Il comporte 45 items répartis en trois sous-échelles se rapportant aux trois dimensions fondamentales de la santé mentale proposées par Lambert et Burlingame (1996). Ces sous-échelles se nomment : Symptômes intrapsychiques de détresse (Symptom Distress), Relations interpersonnelles (Interpersonal Relations) et Performance dans les rôles sociaux (Social Roles). Le OQ-45.2 est peu coûteux, sensible aux changements et compatible avec plusieurs mesures reconnues en santé mentale. Jusqu'à tout récemment, aucun instrument de mesure unique de l'efficacité thérapeutique n'était disponible en français. Ce questionnaire a été traduit par Flynn, Aubry, Guindon, Tardif, Viau et Gallant (2003) sous le nom de Mesure d'impact (MI-45). Hormis l'étude de Flyrm et al. (2003), aucune autre étude à ce jour ne s'est penchée sur l'examen des qualités psychométriques de cette traduction. La présente étude comporte trois objectifs : (1) évaluer la cohérence interne de la MI-45 et de ses sous-échelles, (2) déterminer la validité de construit de la MI-45 et (3) examiner la structure factorielle de la version francophone de la MI-45 auprès d'un échantillon clinique et non clinique. Au total, 374 participants dont 126 clients (95 femmes et 31 hommes) ayant recours à des services de psychothérapie et 248 étudiants (183 femmes et 65 hommes) inscrits à un programme de premier cycle à l'Université du Québec à Chicoutimi ont participé à l'étude. Les participants ont répondu à un questionnaire incluant la version francophone de la MI-45, un questionnaire sociodémographique, différentes échelles mesurant à la fois la présence de symptômes en lien avec le stress psychologique, la dépression et l'anxiété, ainsi que la présence d'indicateurs de bien-être psychologique dont l'estime de soi, l'actualisation du potentiel, la satisfaction de vie et le sens à la vie. Dans l'ensemble, les résultats révèlent que la MI-45 possède une cohérence interne satisfaisante et des qualités psychométriques comparables à celles obtenues pour la version originale anglaise ainsi que pour la traduction francophone de Flynn et al. (2003). La cohérence interne de la MI-45 a été mesurée à l'aide de l'alpha de Cronbach qui s'est révélé tant pour l'échantillon clinique que non clinique similaire à ceux obtenus par Lambert et al. (1996). L'évaluation de la validité de construit a été mesurée à l'aide de coefficients de corrélation de Pearson lesquels se sont révélés similaire à ceux obtenus par Lambert et al. (1996). Les résultats de l'analyse factorielle exploratoire appuient le modèle théorique à trois sous-échelles proposé par Mueller, Lambert et Burlingame (1996). Cependant, une différence subsiste dans la composition des sous-échelles, dans la mesure où certains items ne se retrouvent pas dans leurs sous-échelles originales. Bien que le modèle à trois facteurs soit supporté sur le plan théorique, il apparaît préférable d'utiliser la solution à un facteur afin de respecter les résultats obtenus lors de F analyse factorielle originale. Finalement, l'ensemble des résultats obtenus sont discutés sur la base de leurs implications cliniques, des forces et limites de la recherche et des pistes de recherche fixture.