In line with the evidence-based paradigm, routine outcome monitoring and clinical feedback systems are now being recommended and implemented in youth mental health services. However, what constitutes a good outcome for young service users is not fully understood. In order to successfully monitor outcomes that are clinically and personally relevant for the service user that are to benefit from these systems, we need to gain more knowledge of what young service users value as meaningful outcomes of youth mental health services.
To contribute knowledge into what constitutes “good outcomes” from the experiences of adolescent service users in public mental health systems.
A qualitative in-depth study of the experiences and reflections from 22 adolescents aged 14–19 years, currently or recently being in public mental health services. The data material was analyzed using a systematic step-wise consensual qualitative research framework for team-based analysis.
An overarching theme of outcome as having developed a stronger autonomy and safer identity emerged from the analysis, with the subsequent five constituent themes, named from the words of the adolescent clients: (1) I’ve discovered and given names to my emotions, (2) I’ve started to become the person that I truly am, (3) I’ve dared to open up and feel connected to others, (4) I’ve started saying yes where I used to say no, and, (5) I’ve learned how to cope with challenges in life.
“Good outcomes” in youth mental health services should be understood as recovery oriented, sensitive to developmental phases, and based on the personal goals and values of each adolescent client.
Edbrooke-Childs J, Wolpert M, Deighton J. Using patient reported outcome measures to improve service effectiveness. Adm Policy Ment Health Ment Health Serv. 2016. https://doi.org/10.1007/s10488-014-0600-2.
Green C, et al. What young people say about outcomes and feedback tools. In: Law D, Wolpert M, editors. Guide to using outcomes and feedback tools with children, young people and families. UK: Press CAMHS; 2014.
Connolly MB, Strupp HH. Cluster analysis of patient reported outcomes. Psychother Res. 1996;6:11. CrossRef
Binder PE, Holgersen H, Nielsen GH. What is a “good outcome” in psychotherapy? A qualitative exploration of former patients’ point of view. Psychother Res. 2010. https://doi.org/10.1080/10503300903376338.
Klein MJ, Elliott R. Client accounts of personal change in process—experiential psychotherapy: a methodologically pluralistic approach. Psychother Res. 2006. https://doi.org/10.1080/10503300500090993.
Beresford P, Branfield F. Developing inclusive partnerships: user-defined outcomes, networking and knowledge. Health Soc Care Community. 2006. https://doi.org/10.1111/j.1365-2524.2006.00654.x. PubMed
van Deventer C, McInerney P, Cooke R. Patients’ involvement in improvement initiatives: a qualitative systematic review. JBI Database Syst Rev Implement Rep. 2015. https://doi.org/10.11124/jbisrir-2015-1452.
Gibson K, Cartwright C. Young clients’ narratives of the purpose and outcome of counselling. Br J Guid Couns. 2014. https://doi.org/10.1080/03069885.2014.925084.
Bergmans Y, et al. The perspectives of young adults on recovery from repeated suicide-related behavior. Crisis. 2009. https://doi.org/10.1027/0227-5910.30.3.120. PubMed
Lambert MJ. The efficacy and effectiveness of psychotherapy. In: Lambert MJ, editor. Bergin and Garfield´s handbook of psychotherapy and behavior change. New Jersey: Wiley; 2013. p. 169–218.
Block AM, Greeno CG. Examining outpatient treatment dropout in adolescents: a literature review. Child Adolesc Soc Work J. 2011. https://doi.org/10.1007/s10560-011-0237-x.
Kazdin AE. Developing effective treatments. In: Kazdin AE, editor. Psychotherapy for children and adolescents: directions for research and practice. Oxford: Oxford University Press; 2000. p. 131–57. CrossRef
Barbour RS. Doing focus groups. The SAGE qualitative research kit. London: Sage Publications Ltd; 2007. CrossRef
Barbour RS, Kitzinger J. Developing focus group research: politics, theory and practice. London: Sage; 1999. CrossRef
Kitzinger J, Barbour RS. Introduction: the challenge and promise of focus groups. In: Barbour RS, Kitzinger J, editors. Developing focus group research: politics, theory and practice. London: Sage; 1999.
Kvale S, Brinkmann S. InterViews: learning the craft of qualitative research interviewing. London: Sage; 2009.
Binder PE, Holgersen H, Moltu C. Staying close and reflexive: an explorative and reflexive approach to qualitative research on psychotherapy. Nordic Psychol. 2012. https://doi.org/10.1080/19012276.2012.726815.
Hill C. Consensual qualitative research. A practical resource for investigating social science phenomena. Washington, DC: American Psychological Association; 2012.
Slade M. Personal recovery and mental ilness: a guide for mental health professionals. New York: Cambridge University Press; 2009. CrossRef
Anthony WA. Recovery from mental illness: the guiding vision of mental health service system in the 1990s. Psychosoc Rehabilit J. 1993;16:11–23. CrossRef
Hall CL, et al. The use of routine outcome measures in two child and adolescent mental health services: a completed audit cycle. BMC Psychiatry. 2013. https://doi.org/10.1186/1471-244X-13-270.
Mellor-Clark J, et al. Leading horses to water: lessons from a decade of helping psychological therapy services use routine outcome measurement to improve practice. Adm Policy in Ment Health Ment Serv Res. 2016. https://doi.org/10.1007/s10488-014-0587-8.
Batty MJ, et al. Implement ing routine outcome measures in child and adolescent mental health services: from present to future practice. Child Adolesc Ment Health. 2013. https://doi.org/10.1111/j.1475-3588.2012.00658.x.
Sharples E, et al. A qualitative exploration of attitudes towards the use of outcome measures in child and adolescent mental health services. Clin Child Psychol. 2017. https://doi.org/10.1177/1359104516652929.
Edbrooke-Childs J, et al. Patient reported outcome measures in child and adolescent mental health services: associations between clinician demographic characteristics, attitudes and efficacy. Child Adolesc Ment Health. 2016. https://doi.org/10.1111/camh.12189.
Kroger J. Identity development: Adolescence through adulthood. 2nd ed. Thousand Oaks: Sage; 2007.
McAdams DP, McLean KC. Narrative identity. Curr Dir Psychol Sci. 2013. https://doi.org/10.1177/0963721413475622.
Allen JP. The attachment system in adolescence. In: Cassidy J, Shaver PR, editors. Handbook of attachment: Theory, research, and clinical applications, 2nd edn. New York: Guilford Press; 2008. p. 419–435.
Berzonsky MD. Identitiy processing style, self-construction, and personal epistemic assumptions: a social-cognitive perspective. Eur J Dev Psychol. 2004. https://doi.org/10.1080/17405620444000120.
Graham P. The end of adolescence. Oxford: Oxford University Press; 2004.
Tondora J, et al. Partnering for recovery in mental health: a practical guide to person-centered planning. Hoboken: Wiley; 2014. CrossRef
- What are “good outcomes” for adolescents in public mental health settings?
Kristina O. Lavik
- BioMed Central