Wednesday, October 24, 2012
Analyzing the Outcome Questionnaire - 45.2
The contemporary demands of managed care often require counselors to measure effectiveness and efficiency of their services (Lambert, Gregersen, & Burlingame, 2005). In a response to that quest, the authors of the Outcome Questionnaire 45.2 (OQ-45.2) designed this 45 item instrument as a baseline and ongoing screening tool to help psychological professionals determine and track treatment progress (Lambert, Gregersen, & Burlingame, 2005).
Evaluation of the Outcome Questionnaire-45.2
Evidence for Validity
Convergent validity was based on ten other instruments (including the Beck Depression Inventory) that measure the same or similar constructs (Hanson & Merker, 2005). The three subscale correlation coefficients were between .44 and .92, and for the total score were .54 to .88. However, deficient evidence of discriminant validity raises doubts about overall validity of the OQ-45.2 (Hanson & Merker, 2005). Correlations between scores of the OQ-45.2 and clinician-generated Global Assessment of Functioning and Structured Clinical Interviews for DSM-IV Disorders formed a basis of comparison for concurrent validity (Hanson & Merker, 2005). The correlations were .78 and .87, respectively. Construct validity was measured with a test that determines sensitivity to change and differences between pretest and posttest scores were significant (Pfeiffer, 2005).
Reliability estimates were based on two samples. One was 157 undergraduate students comprised of 103 women and 54 men, 90% of whom were of European American background (Hanson & Merker, 2005). The second group consisted of 298 inpatient and outpatient clients from an employee assistance program, for which no additional gender, age, or ethnic information is provided (Hanson & Merker, 2005). Internal consistency estimates were between .70 and .93. Estimates of test-retest reliability were between .78 and .84 with three weeks between tests. In a different sample, with ten weeks between tests, stability coefficients were between .82 in pretest and .66 in posttest. The standard error of measurement was .93 (Pfeiffer, 2005).
Types of Scores Provided
The OQ-45.2 has 45 items that contribute to the total score and three subscales that measure three different areas of functioning in the client's life. The subscales include Symptom Distress (SD), Interpersonal Relations (IR), and Social Role (SR) (Pfeiffer, 2005). The total score is a comprehensive indication of mental health (Hanson & Merker, 2005). Twenty-five items are contained in the SD subscale, which measures subjective distress related to adjustment, mood and anxiety disorders, substance abuse, and stress-related illnesses (Hanson & Merker, 2005). The IR subscale contains 11 items related to satisfaction versus difficulty with interpersonal relations (Hanson & Merker, 2005). The SR subscale contains 9 items that measure distress, dissatisfaction, and conflict related to family, employment, and social life roles (Pfeiffer, 2005). The OQ-45.2 provides a total score as well as the three separate subscale scores. Higher scores suggest dysfunction in one or more of the subscales (Pfeiffer, 2005).
Benefits and Limitations
Benefits. The strengths of the OQ-45.2 include its brevity and easy administration, scoring, interpretation and versatility in practice and in research. It is cost effective and has intrinsic value in its ability to identify potential therapeutic failures (Hanson and Merker, 2005). Most of the items on the OQ-45.2 are highly sensitive to change; its cut scores are based on empirical evidence and it utilizes a Reliable Change Index that measures improvement, deterioration, and recovery. A final and significant benefit is the reliability and validity of its total score as an indication of mental health. (Hanson & Merker, 2005).
Limitations. Similar to other questionnaires and self-reports, the OQ-45.2 is susceptible to faking. The lack of norming information contained in the manual is distressing, and without additional information concerning the genders, ages, races, and ethnicities of participants, it is impossible to know whether the normative samples are representative for the intended populations (Hanson & Merker, 2005). This instrument should be utilized cautiously with diverse populations (Gregersen, Nebeker, Seely, & Lambert, 2005).
Uses in Counseling
The OQ-45.2 was designed to measure the subjective experiences of clients to provide counselors with a more accurate perspective on clients' experiences, symptoms, and self-perceived ability to function (Hanson & Merker, 2005; Pfeiffer, 2005). As a baseline screening tool, this outcome assessment can provide comparisons between initial intake and future therapy sessions (Pfeiffer, 2005). Additionally, the OQ-45.2 can monitor client progress and provide definitive evidence of change as frequently as is appropriate (Pfeiffer, 2005). It can assist in case conceptualization and ongoing treatment decisions and recommendations (Hanson & Merker, 2005). As a key monitoring device for progress, the OQ-45.2 can identify clients who may be at impending risk for failure in treatment (Pfeiffer, 2005). The authors warn, however, this instrument is not designed for making psychiatric diagnoses (Pfeiffer, 2005).
Assessing outcomes in therapy has become a routine measure that helps increase the quality and effectiveness of treatment (Lambert, Gregersen, & Burlingame, 2005). Although it has limitations, this instrument is versatile and reasonably reliable and valid for use in the counseling profession.
Hanson, W. E., & Merker, B. M. (2005). Review of the OQ-45.2 (Outcome Questionnaire). In
R. A. Spies & B.S. Plake (Eds.), The sixteenth mental measurements yearbook. Lincoln, NE: Buros Institute of Mental Measurements. Retrieved from http://web.ebscohost.com.ezp.waldenulibrary.org/
Pfeiffer, S. I. (2005). Review of the OQ-45.2 (Outcome Questionnaire). In R. A. Spies & B.S. Plake (Eds.), The sixteenth mental measurements yearbook. Lincoln, NE: Buros Institute of Mental Measurements. Retrieved from http://web.ebscohost.com.ezp.waldenulibrary.org/
Gregersen, A. T., Nebeker, R. S., Seely, K. I., & Lambert, M. J. (2005). Social validation of the outcome questionnaire: An assessment of Asian and Pacific Islander college students. Journal of Multicultural Counseling and Development, 33(4), 194-206.
Lambert, M. J., Gregersen, A. T., & Burlingame, G. M. (2004). The outcome questionnaire. In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcome assessment (pp. 191-234). Mahwah, NJ: Erlbaum.