In the NHS Outcomes Framework policy , the UK government highlighted the importance of assessing outcomes to enable measurement of the effectiveness of services. For child and adolescent mental health services (CAMHS), the National Service Framework (NSF) suggests that CAMHS interventions should be regularly monitored in order to improve clinical work and inform future service development . The NSF specifically recognises the importance of measuring the patient’s perspective of outcome, including, where possible, the views of the young person, and notes the importance of administrative and clinical support to enable this process.
To support the use of outcome measures, the CAMHS Outcome Research Consortium (CORC; http://www.corc.uk.net) was created to develop a common suite of outcome measures and support services with the collection and analysis of anonymised outcome data. Despite this support, studies have noted little uptake of routine outcome measurement (ROM) within CAMHS in the UK [3, 4], and particularly low rates of repeated use of outcome measures [3, 5–7].
Despite ROM being valued for improving patient monitoring and outcome, aiding goal-setting, encouraging evidence-based practice, increasing patient input and improving clinicians ability to predict outcome in adult services [8–11], there are several factors inhibiting the use of outcome measures. Research has indicated a lack of time, resources, training and feedback from the measures to be fundamental barriers to their use [3, 4], [12, 13]. Additional concerns focus on data misuse, questionnaires being unable to capture complexity of issues and regular monitoring not fitting with all therapeutic approaches [11, 12, 14, 15].
Less research has focused on patient perceptions of ROM. Two studies found that families attending CAMHS felt it was important for their progress to be tracked [16, 17]. Families particularly noted the importance of having feedback from the measures they completed, being able to discuss the data with their clinician, and having brief measures that were holistic and easy to complete.
Since 2011, CORC have been commissioned by the Department of Health to support the analysis of outcome measurements collated through the Children and Young People’s Improving Access to Psychological Therapies (CYP-IAPT; http://www.IAPT.nhs.uk). The CYP-IAPT aspires to improve services for patients by routinely assessing their opinion on the quality and experience of services and specifically advocates the use of session-by-session monitoring to achieve this. Based on the experiences in adult therapeutic studies, the implementation of session-by-session monitoring in CAMHS may improve the completion of follow-up measures, help clinicians detect sudden large improvements  and lead to better patient outcome , however, little is known about the feasibility and acceptability of this system.
We piloted the use of a short electronic 8-item questionnaire, known as SxS (http://www.sdqinfo.org/SxS). Electronic based questionnaires may offer a particularly advantageous way of collecting ROM. Research has shown that electronic measures encourage people to answer more honestly , improve the effectiveness of the assessment , and offer the opportunity to present items in a ‘user friendly’ manner, which has been identified as a key point in improving their use in practice .
SxS is based upon the Strengths and Difficulties Questionnaire (SDQ) impact supplement , but also contains a question about improvement in symptoms and another about hope for the future. The measure is not symptom-specific and there are two versions; one for completion by the young person (11-17-years) and one for their parent/carer. The measure is designed to assess the young person and parent/carer’s perception of their progress since their last clinic appointment. SxS was completed on an iPad in the waiting room, prior to the clinic appointment. Young people and/or their parents/carers participating in the pilot were asked to complete SxS before every clinic session. A report graphing the young person’s progress was automatically generated with the intention of being discussed with the clinician during the appointment.
In order to assess the utility of SxS as a session-by-session measure, we sought to gain perceptions of feasibility and acceptability for healthcare professionals (HCPs), young people and parents, and administrative teams who were involved in the process. In the literature there is a notable absence of clinician and patient opinion on the use of outcome measures and to the best of our knowledge no research has assessed opinions on session-by-session measures within CAMHS.