Wednesday, February 15, 2012

Accountability and Outcomes in the Counseling Profession

Treatment Outcomes and Accountability

Clients, Counselors, and Third-Party Payers

Clients, are perhaps, the most important stakeholder in treatment outcomes. The common goal in treatment is creating measureable change, without which, there has been little therapeutic value to the intervention. Accountability expects interventions have purpose, positive effect, and measureable outcome. In essence, the treatment must have worth to the client (Erford, 2010).

Knowing which interventions are the most effective is a significant benefit to mental health counselors (Bradley, Sexton, & Smith, 2005). Counselors are bound by moral code to function in the best interest of their clients and apply treatments effective in "promoting the welfare of clients" (Bradley, Sexton, & Smith, 2005, p. 488). In addition to their responsibility to stake holders, counselors must be accountable to third-party payers. Reimbursement may hinge on the payer's determination that "interventions used are research-based, empirically sound, and capable of producing desired outcomes (Erford, 2010, p. 393). These demands will continue to create competitive accountability among mental health counselors (Erford, 2010).

Counselors and the Impact of Counselor Effectiveness

Sexton (1999) claims although "the counselor is probably the most studied object in our research history," these studies may prove that no prototypic counselor exists. The most important factors in counselor effectiveness are "a level of skillfulness..., cognitive complexity..., and ability to relate and relationally match with the clients with whom they are working" (Sexton, 1999, p. 4). Additionally, the ability to properly identify and assess client needs in relation to developing an evidence-based treatment plan is essential.

Significance to Stakeholders and the Profession

Outcomes and Accountability

For the counseling profession to continue as a credible science, stake holders must see measureable change and improved outcomes. If the counseling profession cannot prove its effectiveness, there may be less need for its services. Counselors must be accountable in their provision of empirically proven therapeutic interventions so clients and other stake holders have confidence the service they purchase is valid, valuable, and effective (Erford, 2010). Accountability and acting in the client's best interest is usually synonymous with using interventions based on research and scientific evidence.

Needs Assessment and Program Evaluation

In counseling, needs assessment determines where the greatest needs are, and how to most effectively fill them. To make measureable change, one must first identify where change is needed. This identification is essential to treatment planning and effective intervention, which is ultimately important to stakeholders and for the reputation of the counseling profession (Erford, 2010). If counselors and the counseling profession cannot meet the needs of the populations they serve, they are ineffective and inconsequential. Programs must be held accountable and provide interventions with intended results (Erford, 2010). Without effective program evaluation, there is neither proven worth of the profession nor responsibility to provide effective interventions (Erford, 2010).

The Role and Significance of Research

In Outcomes

Sexton (1999) claims positive outcomes rely on "evidence-based counseling intervention protocols effective with the client problems they were developed to help" (Sexton, 1999). "Outcomes research is vital to the well being of the client, the ethical obligations of the counselor, and the advancement of the field" (Heaves & Erford, 2010, p. 391). It must show effectiveness. Outcomes are pivotal in the personal success of the client as well as all stakeholders, and research is foundational in proving the value of the process and outcome of intervention.

In Accountability

To strengthen their ability to implement therapeutic interventions, counselors must be aware of the proven effectiveness of their applications. Research provides the parameter for accountability and sets standards, without which no measure for comparison exists (Heaves & Erford, 2010). Research enables counselors to provide therapeutic interventions in the best interest of the client and serves as proof of the discipline's value (Erford, 2010).

In Needs Assessment

Needs assessments provide counselors and the profession with real-life information regarding the needs of the populations in which they interact and intervene. Research determines how effectively counselor interventions meet these needs (Erford, 2010). Additionally, research explores needs in relation to interventions and outcomes to determine "the effectiveness of specific models paired with specific problems" (Heaves & Erford, 2010).

In Program Evaluation

Relevant and pertinent research has become increasingly reliable and the gold standard for treatment protocols and program efficiency. Empirically validated success and effectiveness have become the constructs by which programs are measured. Without success relative to the scientifically proven methods of intervention and treatment, programs cannot expect positive evaluation (Astramovich & Coker, 2007).


Astramovich, R. L., & Coker, K. J. (2007). Program Evaluation: The Accountability Bridge Model for Counselors. Journal of Counseling & Development, 85(2), 162-172.

Bradley, L. J., Sexton, T. L., & Smith, H. B. (2005). The American counseling association practice research network: A new research tool. Journal of Counseling & Development, 83(5), 488-491.

Erford, B. T. (2010). Chapter fifteen: accountability in counseling. In Erford, B. (Ed.) Orientation to the Counseling Profession: Advocacy, Ethics, and Essential Professional Foundations (p. 361-389). Upper Saddle River, NJ. Pearson Education, Inc.

Heaves, S.H. & Erford, B. T. (2010). Chapter sixteen: outcome research in counseling. In Erford, B. (Ed.) Orientation to the Counseling Profession: Advocacy, Ethics, and Essential Professional Foundations (p. 390-417). Upper Saddle River, NJ. Pearson Education, Inc.

Sexton, T. L. (1999). Evidence-Based Counseling: Implications for Counseling Practice, Preparation, and Professionalism. ERIC Digest. (pp. 1-6, Rep.). Greensboro, NC: ERIC Clearinghouse on Counseling and Student Services. (ERIC Document Reproduction Service No. ED435948)

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