Its the biggest update to Feedback Informed Treatment (FIT) in two decades.

In the beginning, all we had were the measures. Clinicians administered the outcome and session rating scales at each session and then compared client scores to the clinical cutoffs (CCO) and reliable change index (RCI) to determine whether care was “on or off track.”

The evolution continued. As data gathered from clinical practice settings accumulated, it became possible to develop “trajectories of change.”

Users of Myoutcomes.com, Fitoutcomes.com, and OpenFIT will instantly recognize the graph pictured below.

Gone were the comparisons to percentile rankings of the normative sample. Instead, the green line represented the least amount of progress the client could make from session to session and still be on track for a successful outcome. Yellow was interderminate and red definately, “off track.”

Since first becoming available, the algorithms that produce the predictive trjectories have been checked and updated every three years or so. The latest review — involving millions of completed cases of care — confimed their ability to inform mental health services provided in diverse settings around the world.

All good. Except, it wasn’t.

Isn’t.

While offering a clear advantage over comparisons to the cutoff scores, percentile rankings, and pre-established change indices, the algorithm-driven, predictive trajectories were still static. Said another way, they did not change following the first visit. True, the initial score was a better predictor of success than a host of factors traditionally considered reliable indicators (e.g., diagnosis, prior treatment history, type and level therapist training). But surely, more accurate assessments of progress would be made if they took into account what happened from visit to visit. Indeed, wasn’t that the whole point of soliciting feedback? Improving the chances of success by adjusting services on an ongoing basis to better fit the individual client?

Enter the SPI, or “Success Probability Index.”

Briefly, the SPI offers an indication of the likelihood of success at each session based on the current and historical pattern of SRS and ORS scores. Importantly, the particular pattern used to generate the index at any given session (e.g., average, slope, change in scores since the prior visit or over the course of care) varies depending on which most accurantely predicts success at the end of care. As can be seen in the screenshot below, despite similar start scores, the different patterns of progress represented in the two graphs result in different predictions. Specifically, the case on the left is on track, while the one on the right (coded in red), is about 16.5% below the average successful client.

In the near future, I’ll publish a “FIT TIP” or two explaining in greater detail both meaning and use of the SPI. In the meantime, take a look at the video produced by Myoutcomes.com — the first system to make the SPI available to their users.

Until next time,

Scott
Director, International Center for Clinical Excellence