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Article Contents: Overview development OQ uses

Quick summary The OQ-45 is a series of questions designed to understand the effectiveness of psychotherapy.

It was developed specifically for monitoring patient well-being on a weekly basis. It generally takes five minutes to complete. Change in scores reflect positive results of treatment vs. untreated (stable) scores. Lambert, M., Hansen, N., & Harmon, S. (2010).

The OQ is also considered a psychological decision making tool: Based on comparing an individual’s progress with similar patients who have undergone treatment. Analogous to a ‘lab test’ in medical treatment, which can supplement and inform clinical decision making, rather than a replacement for the clinician’s judgment.Lambert, M., Hansen, N., & Harmon, S. (2010).

Tracking Change: When a client: 1) begins treatment in the dysfunctional range; 2) changes by 14 or more points on the OQ-45; and 3) passes the OQ-45 cutoff score of 63, The client is regarded as having made clinically significant change. Beckstead et al. (2007)

Ongoing Treatment-Monitoring Systems Monitoring treatment on a consistent basis has several advantages over more limited assessment (such as administering assessments at pre-treatment and post-treatment only).Lambert, Hansen, & Harmon, (2010).

Ongoing Treatment-Monitoring Systems require routine assessment of patient functioning during the course of treatment. (often pre/post assessments, but commonly throughout the duration). These types of assessment require comparisons of patient outcomes to norms from similar patients receiving similar treatments. Goal of feeding patient information back to the practice setting to inform treatment deliver & enhance outcomes. Lambert, Hansen, & Harmon, (2010).

With only 37% of psychologists reporting use of some type of outcome assessment in their practice (ie, BDI, OQ-45, BSI, etc).Hatfield, Ogles, (2004), the OQ-45 can provide more insight to how patients are actually doing.

Researchers found that Client deterioration rates decreased from a base of 21.3% in the controls (no tx feedback) to 17.9% for therapist having weekly client OQ progress information alone to 7.4% for weekly progress feedback combined with Clinical Support Tools (decision tree’s, etc) feedback. These results suggest the potential value of these research-based quality management strategies for individual clients. HarmAon, et al., (2007).

Clinician Judgment of Client Deterioration: 40 therapists familiar with the OQ-45 and its cut-offs for judging deterioration (informed that the base rate for deterioration was likely to be 8%) were only accurate in predicting deterioration in one case out of 550 patients Therapists rarely predicted deterioration. Only 3 (0.01%) of 550 clients were predicted to deteriorate, and only 1 of those predicted to deteriorate had, in actuality, deteriorated at the end of therapy. Therapists failed to identify 39 patients who actually deteriorated during treatment. Actual outcome data indicated that 40 clients (7.3%) deteriorated by the end of therapy. Hannan et al. (2005); Lambert, Hansen, & Harmon, (2010). This data supports the need for the OQ-45 and other treatment monitoring systems that help inform clinical judgement.

Contents of the OQ-45 Conceptualized uses for the OQ-45: 1) To measure current level of distress, 2) an outcome measure administered with treatment interventions, monitoring ongoing treatment response, 3) To accompany computerized decision support tools improving patient care. Lambert, Hansen, & Harmon, (2010).

Specific items used on the measure: Address commonly occurring problems across a wide variety of disorders. Symptoms most likely to occur across patients, regardless of their unique problems. Measures personally and socially relevant characteristics that effect the quality of life of the individual. Are limited so that the length is tolerable to patients and suitable for repeated testing while providing clinicians with data that can be used for decision making. Lambert et al. (2001).

The OQ-45 contains Likert-scale items (range 0-4) created for counseling/psychotherapy process and outcome assessment. It has nine items that are scored in reverse (1, 12, 13, 20, 21, 24, 31, 37, & 43).

5 critical items: 8. I have thoughts of ending my life. 11. After heavy drinking, I need a drink the next morning to get going. 26. I feel annoyed by people who criticize my drinking (or drug use). 32. I have trouble at work/school because of drinking or drug use. 44. I feel angry enough at work/school to do something I might regret.

It gives a Total Score (TOT) and 3 subscales composed of Symptom Distress (SD), Interpersonal Relations (IR), and Social Role (SR).

OQ-45 Factor Structure: Four-factor bilevel structure supports assessing three subscale scores as well as the total score. This reporting system represents overall, general distress (total score) and the unique variance of the individual subscale scores. The relative similarity of loadings for the general distress factor across items means that the OQ can be unit weighted to yield both subscale and general distress scores without any undesirable consequences. Bludworth, J. L., Tracey, T. J. G., & Glidden-Tracey, C. (2010).

Symptom Distress (SD): Research suggests that the most common disorders are anxiety disorders, affective disorders, adjustment disorders and stress related illness. The Symptom Distress subscale is composed of items that have been found to reflect the symptoms of these disorders. A high score indicates that patients are bothered by these symptoms, while low scores indicate either absence or a denial of the symptoms. Symptom scores correlate highly with measures of depression, such as the Beck Depression Inventory. They also correlate highly with measures of anxiety, such as the State-Trait Anxiety Inventory. Content Description: Depression, anxiety, substance abuse Range 0-100 α = .88 1 week test-retest .78 General mean = 26 SD=10 Cutoff for clinical levels = 36 Reliable Change Index (RCI) = 10.

Interpersonal Relations (IR): Interpersonal Relationship items assess such complaints as loneliness, conflicts with others, family and marriage problems. High scores suggest difficulties in those areas, while low scores suggest both the absence of interpersonal problems as well as satisfaction with the quality of intimate relationships. Content Description: friendships, family, marriage, friction, conflict & withdrawal Range 0-44 α = .77 1 week test-retest .74 General mean = 11 SD=6 Cutoff for clinical levels = 15 Reliable Change Index (RCI) = 8   Lambert et al. (2001).

Social Role (SR): The Social Role subscale measures the extent to which difficulties in the social roles of worker, homemaker or student are present. Conflicts at work, overwork, distress and inefficiency in these roles are assessed. High scores indicate difficulty in social roles, while low scores indicate adequate social role adjustment. Additional attention should be given to low scores to determine whether they result from social role satisfaction or from subject unemployment (e.g., the subject arbitrarily marking the items 0 for never or not applicable). Content Description: dissatisfaction, conflict, distress, inadequacy in tasks related to employment, family roles, & leisure life Range 0-36 α = .76 1 week test-retest .76 General mean = 10 SD=4 Cutoff for clinical levels = 12 Reliable Change Index (RCI) = 7  Lambert et al. (2001).

Interpretation Interpreting the OQ-45: Clinicians should consider three elements: 1) the subjects’ answers to certain select items; 2) the total score (TOT); 3) the subscale scores. Lambert et al. (2001).

Clinicians should investigate further if ratings other than 0 (never) are given on these items: Suicidality: Item 8 (I have thoughts of ending my life) Substance Abuse: Items 11 (After heavy drinking, I need a drink the next morning to get going), 26 (I feel annoyed by people who criticize my drinking or drug use), and 32 (I have trouble at work/school because of my drinking or drug use). Potential for Violence: Item 44 (I feel angry at work/school to do something I might regret)

Total score (TOT): A high score (63+) on this subscale suggests that the patient is admitting to a large number of symptoms of distress (mainly anxiety, depression, somatic problems and stress) as well as interpersonal difficulties; difficulties in their social role (such as work) and in their quality of life. In general, lower scores (< 62) suggest that the patient is no more disturbed than the general population. Content Description: Total distress Range 0-180 α = .93 1 week test-retest .82 General mean = 45 SD=19 Cutoff for clinical levels = 63  Reliable Change Index (RCI) = 14 Lambert et al. (2001).

History Developed and Distributed in 1993 by Michael J. Lambert, the OQ-45 is the 3rd most frequently used self report adult patient outcome measure in mental health assessment (Lambert, M., Hansen, N., & Harmon, S. 2010). Forms and Administration Reliability [specific criticisms of reliability, e.g. age] Validity [specific criticisms of validity] Adaptations into other languages

Critiques [not specific to reliability or validity] OQ-45 Critiques and Issues: At one point, there was inconclusive evidence for subscale structural independence: ie, one, two, and three factor solutions were equally possible. structure varies from sample to sample, cannot be replicated, and is often complex and hierarchical. Mueller, Lambert, & Burlingame, (1998); Wampold, (2015)

OQ-45 Empirically: Evidence for Total score and 3 subscales: Symptom Distress (SD), Interpersonal Relations (IR), Social Role (SR). Although there is support for the unique variation associated with the three subscales, it is less clear that they are accurately labeled. Subsequent research needs to focus on understanding what each subscale is uniquely representing via relations with external scales. Bludworth, J. L., Tracey, T. J. G., & Glidden-Tracey, C. (2010).

Alternative Versions Cross-cultural research See also References

Wikipedia pages to link to: https://en.wikipedia.org/wiki/Partners_for_Change_Outcome_Management_System https://en.wikipedia.org/wiki/Michael_J._Lambert https://en.wikipedia.org/wiki/Customer_service https://en.wikipedia.org/wiki/Symptom_Checklist_90 https://en.wikipedia.org/wiki/Psychometrics#Instruments_and_procedures https://en.wikipedia.org/wiki/Behavioral_health_outcomes_management https://en.wikipedia.org/wiki/PHQ-9 https://en.wikipedia.org/wiki/Youth_Outcome_Questionnaire https://en.wiktionary.org/wiki/self_report https://en.wikipedia.org/wiki/Brigham_Young_University https://en.wikipedia.org/wiki/Social_issue

Websites to link to: https://www.oqmeasures.com/ https://psycnet.apa.org/fulltext/2014-44018-012.html

Lambert, M., Hansen, N., & Harmon, S. (2010). Outcome Questionnaire System (The OQ System) Development and Practical Applications in Healthcare Settings. In M. Barkham, G. Hardy, & J. Mellor-Clark (Eds.), Developing and Delivering Practice-Based Evidence : A Guide for the Psychological Therapies (pp. 142-154). West Sussex, UK: Wiley-Blackwell.

Lambert, M. J., Hansen, N. B., Umpress, V., Lunnen, K., Okiishi, J., Burlingame, G. M., & Reisinger, C. W. (2001). Administration and scoring manual for the OQ-45. Orem, UT: American Professional Credentialing Services.

Bludworth, J. L., Tracey, T. J. G., & Glidden-Tracey, C. (2010). The bilevel structure of the Outcome Questionnaire–45. Psychological Assessment, 22(2), 350–355. https://doi.org/10.1037/a0019187

Mueller, R. M., Lambert, M. J., & Burlingame, G. M. (1998). Construct validity of the Outcome Questionnaire: A confirmatory factor analysis. Journal of Personality Assessment, 70(2), 248–262. https://doi.org/10.1207/s15327752jpa7002pass:

Harmon, S. C., Lambert, M. J., Smart, D. M., Hawkins, E., Nielsen, S. L., Slade, K., & Lutz, W. (2007). Enhancing outcome for potential treatment failures: Therapist-client feedback and clinical support tools. Psychotherapy Research, 17(4), 379–392. https://doi.org/10.1080/10503300600702331

Hannan, C., Lambert, M. J., Harmon, C., Nielsen, S. L., Smart, D. W., Shimokawa, K., & Sutton, S. W. (2005). A Lab Test and Algorithms for Identifying Clients at Risk for Treatment Failure. Journal of Clinical Psychology, 61(2), 155–163. https://doi.org/10.1002/jclp.20108

OQ®-45.2. (n.d.). Retrieved October 10, 2018, from https://www.oqmeasures.com/oq-45-2/

Beckstead, D. J., Hatch, A. L., Lambert, M. J., Eggett, D. L., Goates, M. K., & Vermeersch, D. A. (2003). Clinical significance of the Outcome Questionnaire (OQ-452). The Behavior Analyst Today, 4(1), 86–97. https://doi.org/10.1037/h0100015

Wampold, B. E. (2015). Routine outcome monitoring: Coming of age—With the usual developmental challenges. Psychotherapy, 52(4), 458–462. https://doi.org/10.1037/pst0000037

Hatfield, D. R., & Ogles, B. M. (2004). The Use of Outcome Measures by Psychologists in Clinical Practice. Professional Psychology: Research and Practice, 35(5), 485–491. https://doi.org/10.1037/0735-7028.35.5.485