The triumphs and tribulations of creating a Monitoring and Feedback System in a standard UK NHS secondary care setting

In the UK, routine monitoring and feedback to therapists regarding client progress represents a promising but neglected opportunity to improve therapeutic outcome…until now. This paper describes the first UK implementation of a Monitoring and Feedback System (MFS) in routine clinical practice, gives direct insight into encountered barriers and recommends solutions, to inspire and inform future adoption of similar systems. A methodology for the development and application of an MFS in an Adult Psychological Therapies service is presented. The service offers various therapies for clients defined as severe and complex. The backbone of the present MFS was two brief distress measures, which consenting clients completed before each therapy session, and one post session measure assessing helpfulness, alliance and stage of therapy. Therapists received feedback after each client’s fourth session. A three month pilot phase preceded official implementation, representing an opportunity to hone a functional, transportable protocol with minimal disruption to routine practise. Qualitative and quantitative data on compliance, user acceptability and logistics is presented. The study was approved by the REC. Feedback from therapists and clients shaped the eventual protocol and the pilot was punctuated by numerous interventions to enhance utilisation. Consequently, early establishment of structured, reflexive communication opportunities for therapists and clients is recommended. Ease of administration predicted utilisation, which was factored into recruitment and data collection. Client feedback identified social desirability issues, which further influenced data collection. Training and communication initiatives included a therapist manual and a weekly web based communication forum. Feasibility issues including confidentiality, case tracking and feedback mechanisms are discussed. Although continuous systematic quality control is necessary, our experiences suggest it is feasible to implement an MFS in standard UK secondary care. A pilot phase in which protocols can be reconfigured according to the idiosyncratic realities of the site, therapists and clients is advocated. Continued development may lead to improved client outcomes, a fresh proactive approach to treatment outcome and ultimately alterations to routine service delivery, building a crucial bridge between research and practice