Quality & Outcome Monitoring

Monitoring Client feedback on progress with the Outcome Rating Scale (ORS) and the alliance or therapeutic relationship with Session Rating Scales (SRS) is a natural fit for any clinicians who strive for a collaborative clinical practice. The ORS and SRS gives Clients a voice in treatment as it allows them to provide immediate feedback on what is working and what is not. 

Example of outcome data table used in review sessions displaying feedback taken from ORS & SRS information, this will help to inform the work and see what's working and what needs to be different so that positive treatment responses can be achieved. 

Example of outcome data table used in review sessions displaying feedback taken from ORS & SRS information, this will help to inform the work and see what's working and what needs to be different so that positive treatment responses can be achieved. 

Outcome Rating Scale (ORS) What is it?

The ORS is a simple, four-item session by session measure designed to assess areas of life functioning known to change as a result of therapeutic intervention:

  1. personal or symptom distress (measuring individual well being)
  2. interpersonal well-being (measuring how well the client is getting along in intimate relationships)
  3. social role (measuring satisfaction with work/school and relationships outside of the home)
  4. overall well being

How is it carried out?

Administered at the start of each session the ORS asks the client to place a mark on each ten centimetre line allocated to each area of functioning. The line value is configured that low estimate to the far left (most negative or 0) and high value to the right (most positive or 10). The ORS rates at a 13 year old reading level, making it feasible for adolescents and adults. There is also an ORS tool for young people, younger than thirteen years of age. 

What's the benefit?

The ORS has many benefits. As a recognised clinical rating scale it has a Reliable Change Index (RCI) that provides a useful guide to help identify when change is clinically significant and can be linked to the work or therapy session rather than chance. On the ORS the RCI = 5 points. So, change that exceeds 5 points and crosses the clinical cut off scores can be considered reliable change.

What does this mean for me?

Put simply, the tool is used so that you and your counsellor or therapist can map your progress across the course of your sessions and provides a reliable and tested indicator as to when you could confidently choose to end sessions (of course you can always choose to end at any time - this just serves as a useful indicator!). You will be asked to complete an ORS sheet at the start of each session. At the session review you will look at the combined scores with your counsellor or therapist which will be displayed in a table format such as above. From this you will be able to see if the work you are doing is working, where improvements are indicated across time, or discuss any unexpected changes and think through what needs to be different within the session. Consider this as a compass or indicator as to how things are progressing both in, and out of your sessions.

What is the Session Rating Scale (SRS)?

The session rating scale is very similar to the ORS, and is administered at the end of the session. The value rating is the same with high scores to the right and low scores to the left, and it looks at process of the session across four different fields:

  1. relationship (measuring how heard, understood and respected you felt)
  2. goals and topics (measuring how much you worked on and talked about what you wanted to work on and talk about)
  3. approach or method (measuring how well the fit of the therapists approach was for you this session)
  4. overall (measuring how you would rate the session in its entirety)

What's the benefit of SRS?

The benefit of the SRS is allowing you to give feedback that can then be discussed with your therapist to ensure that everything is moving in the most effective way possible between the two of you. It allows you to easily voice any concerns, and on the review session this is mapped along side the ORS measures to allow any trends or patterns to be spotted. 

For more information on both ORS and SRS outcome measuring including the use of these tools, or for clinical data and articles about these tools, please visit the creators website by clicking on the link below: