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each session. Each has its benefits: (1) helps make sure you are not missing
anything major, (2) makes you honest about whether you are doing any
good (and also provides your bosses and commissioners with evidence
on how effective you are), and (3) enables you to modify treatment as
you go along, for the reasons suggested above. There may be resistance
among clinicians to doing such monitoring but in our view it is essential
as a means of developing better outcomes for children and weeding out
ineffective therapies. If it is not undertaken, there is a risk that the self-
interest of therapist will win out over the children’s interests – rather than
give what works best for children, clinicians might ignore this in favour of
what they feel most comfortable with, were trained in twenty years ago,
know how to do, get most money for, find quickest, or are told by their
organisation to do.
To be practicable, measures need to be short, easy to enter onto a
database, and fed back to the team at regular intervals. They probably
should include, at initial assessment and termination, a broad overall
screen (for example, the SDQ) an index of impairment or function (for
example, the CGAS), and a scale for the severity of the main condition;
the last can be used for session by session monitoring. While it is good to
have the clinician’s view, there is a risk that this alone may not be accurate
as they may wish to make their results look better than they are, so the
young person (if old enough) and family need to complete measures too.
Details of such a system can be obtained by visiting the website of the
Clinical Outcomes Research Consortium (http://www.corc.uk.net), which
also allows services to see how they compare with others.
Subject review
Weisz J, Bearman SK. (2008) Psychological treatments: overview and
critical issues for the field.In: Rutter Met al.(eds)Rutter’s Child and
Adolescent Psychiatry, 5th edn. Wiley-Blackwell, Chichester, pp. 251–268.
Further reading
Carr A. (2009)What Works with Children, Adolescents and Adults?AReviewof
the Effectiveness of Psychotherapy. Routledge, London.
Fonagy Pet al. (2005)What Works for Whom?A Critical Review of Treatments
for Children and Adolescents. Guilford Press, London.
Henggeler SWet al. (1997) Multisystemic therapy with violent and chronic
juvenile offenders and their families: The role of treatment fidelity in
successful dissemination.Journal of Consulting and Clinical Psychology 65 ,
821–833.
McCord J. (1992) The Cambridge-Somerville study: A pioneering
longitudinal-experimental study of delinquency prevention.In:McCord
J, Tremblay RE (eds.)Preventing Antisocial Behavior: Interventions from Birth