Using Progress Feedback to Enhance Treatment Outcomes: A Narrative Review

Kim de Jong; Susan Douglas; Miranda Wolpert; Jaime Delgadillo; Benjamin Aas; Bram Bovendeerd; Ingrid Carlier; Angelo Compare; Julian Edbrooke-Childs; Pauline Janse; Wolfgang Lutz; Christian Moltu; Samuel Nordberg; Stig Poulsen; Julian A Rubel; Günter Schiepek; Viola N L S Schilling; Maartje van Sonsbeek; Michael Barkham

doi:10.1007/s10488-024-01381-3

Using Progress Feedback to Enhance Treatment Outcomes: A Narrative Review

Adm Policy Ment Health. 2024 May 11. doi: 10.1007/s10488-024-01381-3. Online ahead of print.

Authors

Kim de Jong¹, Susan Douglas², Miranda Wolpert³, Jaime Delgadillo⁴, Benjamin Aas^{5

6}, Bram Bovendeerd^{7

8}, Ingrid Carlier⁹, Angelo Compare¹⁰, Julian Edbrooke-Childs¹¹, Pauline Janse¹², Wolfgang Lutz¹³, Christian Moltu^{14

15}, Samuel Nordberg¹⁶, Stig Poulsen¹⁷, Julian A Rubel¹⁸, Günter Schiepek¹⁹, Viola N L S Schilling¹³, Maartje van Sonsbeek¹², Michael Barkham⁴

Affiliations

¹ Clinical Psychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, The Netherlands. KJong@fsw.leidenuniv.nl.
² Department of Leadership, Policy and Organizations, Vanderbilt University, Nashville, TN, USA.
³ Division of Psychology and Language Sciences, Department of Clinical, Education and Health Psychology, University College London, United Kingdom, UK.
⁴ Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK.
⁵ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.
⁶ Faculty of Psychology and Educational Sciences, LMU Munich, Munich, Germany.
⁷ Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands.
⁸ Dimence, Center for mental health care, Deventer, The Netherlands.
⁹ Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands.
¹⁰ Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy.
¹¹ Evidence Based Practice Unit, Anna Freud National Centre for Children and Families, University College London, London, UK.
¹² Pro Persona Research, Renkum, The Netherlands.
¹³ Department of Psychology, University of Trier, Trier, Germany.
¹⁴ District General Hospital of Førde, Førde, Norway.
¹⁵ Department of Health and Caring Science, Western Norway University of Applied Science, Førde, Norway.
¹⁶ Department of Behavioral Health, Reliant Medical Group, Worcester, MA, USA.
¹⁷ Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
¹⁸ Institute of Psychology, University of Osnabrück, Salzburg, Austria.
¹⁹ Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Salzburg, Austria.

PMID: 38733413
DOI: 10.1007/s10488-024-01381-3

Abstract

We face increasing demand for greater access to effective routine mental health services, including telehealth. However, treatment outcomes in routine clinical practice are only about half the size of those reported in controlled trials. Progress feedback, defined as the ongoing monitoring of patients' treatment response with standardized measures, is an evidence-based practice that continues to be under-utilized in routine care. The aim of the current review is to provide a summary of the current evidence base for the use of progress feedback, its mechanisms of action and considerations for successful implementation. We reviewed ten available meta-analyses, which report small to medium overall effect sizes. The results suggest that adding feedback to a wide range of psychological and psychiatric interventions (ranging from primary care to hospitalization and crisis care) tends to enhance the effectiveness of these interventions. The strongest evidence is for patients with common mental health problems compared to those with very severe disorders. Effect sizes for not-on-track cases, a subgroup of cases that are not progressing well, are found to be somewhat stronger, especially when clinical support tools are added to the feedback. Systematic reviews and recent studies suggest potential mechanisms of action for progress feedback include focusing the clinician's attention, altering clinician expectations, providing new information, and enhancing patient-centered communication. Promising approaches to strengthen progress feedback interventions include advanced systems with signaling technology, clinical problem-solving tools, and a broader spectrum of outcome and progress measures. An overview of methodological and implementation challenges is provided, as well as suggestions for addressing these issues in future studies. We conclude that while feedback has modest effects, it is a small and affordable intervention that can potentially improve outcomes in psychological interventions. Further research into mechanisms of action and effective implementation strategies is needed.

Keywords: Measurement-based care; Progress feedback; Routine outcome monitoring.