Resources for Living, Inc (RFL) provides a variety of employee Assistance and consultation services, including telephonic counseling services. The organization is results oriented and made a commitment to measure and improve outcomes for their counseling services. 

In early 2002 RFL began to ask their counselors to utilize the Outcome Rating Scale, developed by Scott Miller, Ph.D. and Barry Duncan, Psy.D of the Institute for the Study of Therapeutic Change. The Center provided statistical consultation and analytic services in the development of this very brief, four item measure of outcome. The measure was well suited for RFL, which needed an brief measure that could be administered telephonically.

Counselors were asked to administer the outcome questionnaire at the start of each session, and a second  brief, four item measure at the end of the session to assess the clients perception of the session and the therapeutic alliance. 

Baseline data was collected during the 2nd and 3rd quarters of 2002. The Center utilized this baseline data to calculate the expected trajectory of change for RFL clients. This information was utilized to develop a computer system that permitted the counselors to monitor the trajectory of improvement for each individual client against the normative expectations from RFL's own data. Drs.  Miller and  Duncan provided on site training to the RFL staff about the use of the measures and the importance of paying attention to the clients' ongoing assessment of both subjective distress and the therapeutic alliance. 

Beginning with the 4th quarter of 2002, counselors were able to record  the questionnaire scores on their PCs and receive real time feedback on the trajectory of improvement for the  particular client compared to the average improvement for all other clients in the data base. The goal of course is to help each client  achieve more than "average" improvement, and as a result improve outcome for all clients. 

The results speak for themselves. The following graph shows the upward trend in effect size subsequent to the staff training and implementation of the feedback system. The magnitude of increase in effect size since the 3rd quarter of 2002 well exceeds the .01 level of statistical confidence.