CORC Viewpoint: The single most powerful improvement tool available to children’s mental health services - outcome measurement
The Child Outcomes Research Consortium’s vision is for all children and young people’s wellbeing support to be informed by real-world evidence so that every child thrives. To achieve that, CORC is committed to promoting the meaningful use of evidence to enable more effective, child-centred support, services and systems. Within this context, promoting and supporting the consideration of outcomes is crucial, and is probably the single most powerful improvement tool available to children’s mental health services.
‘No measurement without meaning’
At the heart of CORC’s approach to attempting to measure outcomes is the philosophy that there should be ‘no measurement without meaning’. That is, any measures introduced shouldn’t be used just to ‘tick a box’, to be another process-driven management tool. Instead, at every level of the system there should be a proactive, engaged, thoughtful consideration of the answers to questions such as how can measuring outcomes help? What outcomes is it useful to measure? Which measures are the most appropriate? How will the data be collated and analysed? And, how will the results impact practice? On the face of it, these are straightforward questions to address, but ensuring that everyone, from frontline practitioners to managers and commissioners, can answer them is extremely challenging.
Benefits outweigh the limitations on every level
Outcome measures, such as self or parent report questionnaires, and particularly standardised, psychometric outcome tools, are carefully developed instruments that often take years to create and using them means that you are taking advantage of all the work that has gone into them. At the same time, they are theory dependent and empirically derived and they can never provide a definitive insight into an individual or a population. CORC also acknowledges that no current measures are perfect and that the data they produce always needs to be considered carefully, triangulated with other sources of information (such as clinician judgement), and interpreted cautiously. They can never capture more than a small fraction a child or young person’s experience and what being in treatment has meant to them.
Nevertheless, CORC believes that outcome measures can be invaluable for clinical practice. Research in the US shows that they can help practitioners achieve better outcomes and may increase efficiency, particularly by identifying early those who are not on track (see the Evidence Based Practice Unit’s recent systematic review of the impact of outcome measurement. Feedback from children and young people reinforces the benefits of using measures. Young people say that they can find completing measures easier and less embarrassing than talking to a clinician about difficult issues and that being able to track their own progress can be helpful and potentially empowering.
But while outcome measures are a vital tool for practitioners, outcome measurement is even more important at a service and systems level. We live in a world where there are continual efforts to improve services, involving new interventions, new approaches to delivery and structural changes. The point of all these changes is to achieve better outcomes, but if we only measure processes and don’t measure outcomes we simply don’t know if the changes have made things better, had no impact or made things worse. Without measuring outcomes, particularly in the context where it is hard to find a group to compare young people in the system with, it won’t be possible to judge whether the £1.5bn extra funding the government has committed to children and young people’s mental health over the next five years has had any benefit.
Committed to our cause
These are the reasons why CORC believes that measuring outcomes needs to be the number one priority for children’s mental health services and why we will continue to push for that to be recognised by all those working to support children’s mental health.