Child and Adolescent Psychiatry

378 Chapter 43

services can see who they benefit most and least. This may lead to them
concentrating more of their resources on what they do best, or it may lead
to their trying new approaches for the sorts of problems that have not
responded well in the past. Either way, changing practice in response to
outcome monitoring increases the chance of the service doing more good
this year than last year. It is this capacity for improvement that justifies
investing scarce resources (time, money, energy) in monitoring outcome
(see Box 43.1). A service can save money in the short term by ignoring
outcome, but in the longer term it would thereby lose opportunities to
change for the better.

Box 43.1Regular outcome monitoring increases costs in the short

term but favours the growth of effectiveness over the longer term

With feedback from

outcome monitoring

No feedback from

outcome monitoring

Time

Cost effectiveness

Subject review

Wolpert M. (2008) Organization of services for children and adoles-
cents with mental health problems.In: Rutter Met al.(eds)Rutter’s
Child and Adolescent Psychiatry, 5th edn. Wiley-Blackwell, Chichester,
pp. 1156–1166.

Further reading

Bickman LA (1996) Continuum of care: More is not always better.Ameri-
can Psychologist 51 , 689–701.
Goodman R. (1997a) Child mental health: Who is responsible? An overex-
tended remit.BMJ 314 , 813–814.