.png)
Best Practices for Measurement-Based Care: Early Risk Detection Using ORS and SRS
- Cindy Hansen
- Dec 31, 2025
- 4 min read
Updated: Jan 3
Why Therapy Outcome Monitoring Systems Matters
In today’s fast-paced clinical world, practitioners and directors need Therapy Outcome Monitoring Systems (TOMS) that do more than check boxes—they need systems that drive real change. Research shows that early detection of “on track” or “off track” cases can make all the difference in treatment success.
The Dual-Measure Advantage: ORS/SRS + PHQ-9
Here’s the game-changer: Combine the power of common factors tools (ORS/SRS) with a symptom-based PROM (like the PHQ-9) for a 360° view of client progress.
ORS & SRS: Quick check-ins at every session or weekly, capturing well-being, alliance, and functional gains.
PHQ-9: Strategic snapshots at intake, midpoint, end of care, and six-month follow-up, tracking depressive symptoms and supporting clinical decisions.
Result: Actionable, real-time data that empowers you to intervene early, personalize care, and demonstrate measurable outcomes.
How to Bring This to Life in Your Practice
Ready to get started? Here’s how:
Start Every Session with ORS/SRS: Just one minute at the beginning and one minute at the end —clients rate their well-being and the therapeutic relationship.
Pro Tip: Use these scores to open up honest conversations and build trust.
Schedule PHQ-9 Checkpoints: Integrate the PHQ-9 at intake, midway, discharge, and follow-up.
Did You Know? Early changes in ORS/SRS often predict outcomes before symptom measures catch up!
Review and Respond by Session 3: If ORS/SRS scores plateau or drop, flag the case for review. Adjust the plan early for maximum impact.
Make It a Team Sport: Share feedback in supervision and team huddles. Celebrate wins, troubleshoot challenges, and foster a culture of learning.
Balance Data with Context: Always interpret scores within the client’s cultural and personal context. Invite feedback and adapt your approach for equity and inclusion.
Equity in Action: Cultural Considerations
Great care is equitable care.
Use culturally validated versions of ORS/SRS and PHQ-9 whenever possible.
Interpret scores with awareness of language, values, and lived experience.
Engage in ongoing training on cultural competence and equity.
Invite client feedback—adjust tools and approaches to ensure everyone feels seen and respected.
When you prioritize equity, you ensure outcome monitoring supports all clients, not just some.
At-a-Glance: Monitoring Framework
Tool | Frequency |
ORS & SRS | Every session or weekly |
PHQ-9 | Intake, midpoint, end of care, 6-month follow-up |
Benefits of Measurement-Based Care for Therapists and Directors
By adopting measurement-based care, therapists and clinical directors gain early risk detection for timely intervention, personalized data-informed care for every client, stronger engagement, and a culture of learning and continuous improvement. These benefits translate into measurable outcome improvements and enhanced well-being for clients and teams.
Future Trends in Measurement-Based Care
Measurement-based care is rapidly evolving, with several trends poised to shape its future in clinical practice:
Integration of Digital Health Tools: The adoption of mobile apps and telehealth platforms is making it easier for clinicians and clients to complete outcome measures remotely, track progress in real time, and receive automated feedback between sessions.
Artificial Intelligence and Predictive Analytics: AI-driven tools are beginning to analyze large datasets from outcome measures, helping clinicians identify risk patterns, personalize interventions, and predict treatment trajectories with greater accuracy.
Personalized and Adaptive Measurement: Future systems will increasingly tailor outcome monitoring to individual client needs, cultural backgrounds, and presenting problems, ensuring that data collection is both relevant and equitable.
Interoperability with Electronic Health Records (EHRs): Seamless integration of measurement-based care tools with EHRs will streamline workflow, improve data accessibility, and support coordinated care across multidisciplinary teams.
Focus on Equity and Inclusion: There is growing emphasis on developing and validating outcome measures that are culturally responsive and accessible to diverse populations, reducing disparities in mental health care.
Real-Time Data Visualization: Enhanced dashboards and visual analytics will empower clinicians and directors to quickly interpret trends, share insights with teams, and make data-driven decisions.
By staying informed about these trends, practitioners and clinical directors can ensure their approach to measurement-based care remains innovative, effective, and responsive to the changing landscape of mental health services.
Ready to Transform Your Practice?
Join a community of innovators in feedback informed treatment.
Explore research and training options at https://www.holisticresearchcanada.ca/training
Practitioner Testimonial
"In my journey implementing FIT, Cindy has been a fantastic coach. Her enthusiasm and knowledge is so inspiring."— Gun-Eva (Andersson) Andersson Långdahl, PHUG AB/owner/Legitimerad Psykolog, Specialist klinisk och pedagogisk Psykologi
References
• Anker, M. G., Duncan, B. L., & Sparks, J. A. (2009). Using client feedback to improve couple therapy outcomes: A randomized clinical trial in a naturalistic setting. Journal of Consulting and Clinical Psychology, 77(4), 693–704. https://doi.org/10.1037/a0016062
• Bringhurst, D. L., Watson, C. W., Miller, S. D., & Duncan, B. L. (2006). The reliability and validity of the Outcome Rating Scale: A replication study of a brief clinical measure. Journal of Brief Therapy, 5(1), 23–30.
• Duncan, B. L., Reese, R. J., & DeSantis, L. (2021). Measurement-Based Care in Integrated Health Care: A Randomized Clinical Trial. Families, Systems, & Health, 39(2), 259–268. https://doi.org/10.1037/fsh0000608
• Haas, E., Hill, R., Lambert, M. J., & Morrell, B. (2002). Do early responders to psychotherapy maintain treatment gains? Journal of Clinical Psychology, 58(9), 1157–1172. https://doi.org/10.1002/jclp.10044
• Keum, B. T., Miller, M. J., & Inkelas, K. K. (2018). Testing the factor structure and measurement invariance of the PHQ-9 across racially diverse U.S. college students. Psychological Assessment, 30(8), 1096–1106. https://doi.org/10.1037/pas0000550
• Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: A new depression diagnostic and severity measure. Psychiatric Annals, 32(9), 509–515.
• Löwe, B., Kroenke, K., Herzog, W., & Gräfe, K. (2004). Measuring depression outcome with a brief self-report instrument: Sensitivity to change of the PHQ-9. Journal of Affective Disorders, 81(1), 61–66. https://doi.org/10.1016/S0165-0327(03)00198-8
• Miller, S. D., Duncan, B. L., Brown, J., Sparks, J., & Claud, D. (2003). The Outcome Rating Scale: A preliminary study of the reliability, validity, and feasibility of a brief visual analog measure. Journal of Brief Therapy, 2(2), 91–100.
• Reese, R. J., Duncan, B. L., Bohanske, R. T., Owen, J. J., & Minami, T. (2011). Benchmarking outcomes in a public behavioral health setting: Feedback as a quality improvement strategy. Psychotherapy Research, 21(6), 676–693. https://doi.org/10.1080/10503307.2011.586505
Where's the acknowledgment that the Feedback-Informed Treatment (FIT) and its core tools, the Outcome Rating Scale (ORS) and Session Rating Scale (SRS), were developed by psychologist Dr. Scott D. Miller and colleagues at the International Center for Clinical Excellence (ICCE)? Original authors should be given proper credit.