The development and implementation of youth mental health outcome measures within measurement feedback systems

  • Ben Kwan

    Student thesis: Doctoral Thesis


    This thesis by published works provides an original contribution to the knowledge
    about mental health outcome measures used with young people aged 12 to 25 years. It
    discusses how such measures can be developed and implemented as a clinical tool in day-today
    practice. The main goal was to develop a routine outcome measure that was suitable for
    youth mental health settings that could be implemented into measurement feedback systems.
    The research aimed to achieve this goal by firstly identifying the gap in existing mental
    health outcome measures used with young people and, secondly, by examining how these
    measures were being used clinically. A further aim of this research was to examine the
    psychometric properties of a new routine outcome measure, MyLifeTracker, in youth mental
    health settings. It aimed to determine developmentally appropriate clinically significant
    change indexes, expected change trajectories, and early warning signals for MyLifeTracker,
    to provide clinicians with clinically useful and evidence-based benchmarks. Lastly, the
    research aimed to explore factors affecting the use of MyLifeTracker in measurement
    feedback systems across youth mental health settings.
    The research used a quantitative methodology comprising four research papers, each
    addressing a specific research aim. The first research paper was a systematic review of
    general mental health outcome measures for young people aged 12 to 25 years. It identified
    how these measures track change and if they had been used in feedback monitoring. The
    second and third papers examined the use of MyLifeTracker by clients receiving support
    from headspace youth mental health services across Australia. The second paper explored the
    reliability, validity, and sensitivity to change of MyLifeTracker for young people, across
    gender and age groups. The third paper determined clinically significant change indexes by
    gender and age groups by comparing participants from headspace services to an Australian
    representative community sample of young people. Expected change trajectories were also
    determined for the clinical group using growth curve modelling. The fourth paper reports
    findings from a survey of 210 clinicians from headspace centres about their use of
    MyLifeTracker, specifically exploring three processes of measurement feedback systems:
    looking at MyLifeTracker before the session, using MyLifeTracker in treatment planning,
    and providing feedback of MyLifeTracker scores to clients.
    The systematic review identified 29 different outcome measures used with young
    people, however, no measures were explicitly designed for this age group. Only two
    measures were found to be used by clinicians in measurement feedback systems in this age
    range. Findings from the review led to the recommendation that measures be explicitly
    designed for this age group that are suitable for routine outcome monitoring. The second
    paper demonstrates that MyLifeTracker provides a psychometrically sound mental health
    outcome measure for routine use with young people. The measure has been incorporated into
    an electronic system for headspace services that routinely tracks session-by-session change
    and produces time-series charts for ease of use and interpretation. The third paper provides
    clinical benchmarks for MyLifeTracker, further supporting the use of the measure in
    measurement feedback systems. Lastly, the fourth paper reports the different levels of use of
    MyLifeTracker in a measurement feedback system and highlights the factors that increase
    clinicians’ use for each process.
    The thesis supports the use of mental health outcome measures to be used not only for
    assessing service effectiveness and quality assurance, but also as a clinical tool to support
    decision making and treatment planning by clinicians and clients. It provides support for brief
    and easy to use measures that are meaningful for clinicians and clients. The clinical benefits
    of measurement feedback systems are becoming more widely known and have become part
    of the agenda for the future progression of psychotherapy. The thesis targets a developmental
    age group that has high rates of clinical deterioration, treatment drop-out and missed appointments,
    and who may be quite responsive to feedback monitoring. The thesis
    concludes by offering a range of targeted strategies that can support the future
    implementation of outcome measurement feedback systems into practice.
    Date of Award2021
    Original languageEnglish
    SupervisorDebra Rickwood (Supervisor) & Tricia Brown (Supervisor)

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