Pragmatic Strategies for Assessing Psychotherapy Quality in Practice
Joel Sherrill, Ph.D.
Division of Services and Intervention Research
This initiative is intended to support the development and testing of pragmatic tools and strategies for measuring the quality of psychotherapy delivered in practice settings. While progress has been made at identifying efficacious psychosocial interventions for disorders among youth and adults,1 there is no easy way to assure that a behavioral intervention delivered in practice is consistent with the intervention tested in a research study.
The NIMH Strategic Plan for Research calls for the development of valid and reliable measures of treatment quality and outcomes that can be feasibly applied at the person, clinic, system, and population levels (see Strategy 4.4). Recently, the Institute of Medicine established an ad hoc committee to develop a framework for Developing Evidence-Based Standards for Psychosocial Interventions for Mental Disorders. In their charge and deliberations, the committee emphasized the importance of quality and outcome performance measures. Likewise, implementation of the Mental Health Parity & Addiction Equity Act of 2008 and the Patient Protection and Affordable Care Act of 2010 compel increased attention to quality assessment and accountability.
Pragmatic measures of psychotherapy quality could be used to facilitate therapist training and supervision; such measures could also be used as tools for monitoring quality and implementing quality improvement initiatives. Efficient measures could also facilitate important research in community practice settings (e.g., effectiveness, implementation, and quality-improvement studies). Overall, there is a pressing need for effective and efficient strategies for assessing psychotherapy quality to ultimately ensure the availability of high quality psychosocial interventions.
Fidelity measures used in efficacy studies have limited utility for use in community practice, as they narrowly assess fidelity of specific manualized therapies and involve labor-intensive coding of session content. Thus, research-informed strategies that balance rigor (reliability and validity) with feasibility (taking into account resources and implications for clinical and administrative routines) are needed to ensure patients are receiving high-quality, evidence-based interventions.2 This initiative aims to support the initial development of pragmatic measures that explicitly incorporate end-user perspectives to ensure tools are feasible in community practice; that are strongly associated with patient outcomes; and that are useful for informing practice/policy (e.g., ratings would be useful for monitoring quality and informing quality improvement efforts). The initiative also aims to support research to examine prospectively the feasibility, reliability and validity of the resultant quality assessment measures and strategies, to examine their utility for assessing the quality of psychotherapy in practice settings.
1 See: http://www.nimh.nih.gov/about/director/2012/a-promising-behavioral-treatment-for-tourette-syndrome.shtml
2 Schoenwald SK, Garland AF, Chapman JE, Frazier SL, Sheidow AJ, Southam-Gerow MA. (2011). Toward the effective and efficient measurement of implementation fidelity. Am Policy Ment Health 38(1): 32-43.