Improving the Usefulness of the Outcome Questionnaire (OQ) in the Treatment of Mental Health

The Outcome Questionnaire (OQ) is a mental health assessment tool used to measure patient progress in therapy. The OQ generates a numerical score based on responses and compiles statistical data to monitor mental health distress between current and previous patient appointments. The Utah Department of Human Services and Substance Abuse Mental Health requires the use of the OQ at local mental health authorities (LMHAs). Clinicians have reported that OQ scores can be problematic: a patient's affect often does not reflect the score, thereby leading to inaccurate treatment and increasing the likelihood of adverse outcomes. This project aims to improve the accuracy of assessment using the OQ in the screening of mental health symptoms. The objectives for this DNP scholarly project are to: (a) identify clinician and system contributors or barriers that impact the evaluation of OQ screening accuracy; (b) collaborate with LMHA clinicians on safety strategies to improve the usefulness of the OQ; and (c) disseminate the findings of the project to LMHA clinicians and executive-level department administrators. The literature review indicated that a clinician's assessment is still critical in evaluating patients, and assessment tools give clinicians another method to evaluate a patient's status. OQ validity and effectiveness are crucial to ensuring that our current practice is safe. Overconfidence in a clinician's skills can lead to reading the patient's therapeutic success inaccurately. Treatment provided for patients with ineffective evaluation of their current state could result in adverse outcomes. Tracking and analyzing feedback helps the clinician analyze previous sessions and the patient response to treatment. The patient's current state of treatment and frequency of sessions can affect his or her OQ score and presentation. Implementation and evaluation of the project involved the following : (a) inquiring why Utah requires LMHA use of the OQ; (b) creating a pre- and postquestionnaire to identify mental health clinicians' perception of the validity and reliability of the OQ; (c) disseminating the prequestionnaire to 11 mental health providers at an LMHA; (d) reviewing and analyzing the questionnaire results; (e) developing an educational presentation regarding the validity and proper use of the OQ for the 11 mental health provider participants; (f) implementing a post-questionnaire intervention with 9 participants after the educational presentation; (g) comparing data from the pre- and postquestionnaire interventions and compiling the results; and (h) presenting the results to LMHA clinicians and executive-level administrators for review, and discussing implications and future directions with the clinicians. The majority of clinicians have never received formal training on the OQ, but they generally view the OQ as a valid instrument. The questionnaire results demonstrated that education on the OQ improved the clinicians' perception that the OQ will help their clinical practice and adequately reflect patients' functioning, and eased their fears the OQ might reflect poorly on them. Patients not screened properly with mental health screening tools have an increased risk of adverse outcomes in therapy. Utah law requires LMHA clinicians to use the OQ, but they believed it did not display accurate safety assessment results. Safety--using screening tools effectively--and mental health care are necessary to avoid adverse outcomes. Educating clinicians about the benefits of the OQ will enhance its usefulness.