Therapists’ use of Routine Outcome Monitoring (ROM) in Clinical Practice: A Qualitative Multiple Case Study

Abstract

Routine outcome monitoring (ROM) has been shown to have a significant effect on clinical outcome. However, the process behind the effect of ROM intervention is not well understood. In this qualitative dissertation study, the process of experienced users of ROM was explored. A multiple case study design was used to obtain a detailed descriptive understanding of six purposefully sampled clinicians’ ROM process. Data were collected using semi-structured interviews and analyzed using an iterative and thematic approach to identify cross-case themes that speak to a descriptive understanding of the process. The results showed that participants used ROM with nearly every client and every session. Participants viewed ROM as a tool for facilitating client engagement. They described how ROM encouraged collaboration between clinician and client as well as providing opportunities for in-depth conversations about therapy progress and therapeutic process. In interpreting ROM scores, participants framed client’s scores based on previous scores and personal context. Participants discussed factors facilitating the implementation of ROM such as organizational adoption, electronic feedback tools, and client acceptability. They also discussed barriers to ROM implementation such as time and resource burden, lack of feedback culture, and client demand characteristics. Findings are discussed in the context of wider empirical literature on ROM process. Future directions for research are outlined and the clinical implications are stated.