Core outcomes in psychosexual therapy: A feasibility study of the CORE-OM

The routine use of an outcome measure in sexual and relationship therapy could help provide the basis for building practice-based-evidence in this area as well as providing information that funders of services are increasingly requiring. The Clinical
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  See discussions, stats, and author profiles for this publication at: Core outcomes in psychosexual therapy: Afeasibility study of the CORE-OM  Article   in  Sexual and Relationship Therapy · February 2006 DOI: 10.1080/14681990500281414 CITATIONS 3 READS 71 2 authors:Some of the authors of this publication are also working on these related projects: Recovering Quality of Life: ReQoL   View projectLarge-scale clinical and cost-effectiveness trials: CADET, OCTET, REEACT, REEACT2   View projectPeter BranneyLeeds Beckett University 34   PUBLICATIONS   138   CITATIONS   SEE PROFILE Michael BarkhamThe University of Sheffield 284   PUBLICATIONS   8,871   CITATIONS   SEE PROFILE All content following this page was uploaded by Michael Barkham on 22 September 2014. The user has requested enhancement of the downloaded file. All in-text references underlined in blue are added to the srcinal documentand are linked to publications on ResearchGate, letting you access and read them immediately.  ORIGINAL RESEARCH Core outcomes in psychosexualtherapy: A feasibility study of theCORE-OM PETER BRANNEY 1 & MICHAEL BARKHAM 2 1 Institute of Psychological Sciences, University of Leeds, Leeds LS2 9JT, UK,  2 Professor of Clinical and Counselling Psychology, Director of Psychological Therapies Research Centre,University of Leeds, Leeds LS2 9JT, UK  ABSTRACT  The routine use of an outcome measure in sexual and relationship therapy could help provide the basis for building practice-based-evidence in this area as well as providing information that  funders of services are increasingly requiring. The Clinical Outcome in Routine Evaluation-Outcome Measure (CORE-OM)assesses core domains of well-being and is part of a system widely used in theevaluation of the psychological therapies in the UK. The present study sought to establish whether the psychometric properties of the CORE-OM are reproducible in a psychosexual population. Data are presented from nine females and five males who completed the CORE-OM during pre-therapy assessment at a psychosexual clinic and compared with the normative data. The results show that theCORE-OM has acceptable reliability and that the CORE-OM scores for this sample fall between thenorms for non-clinical and clinical samples. Scores for all the domains on the CORE-OM were alsohigher than those for the non-clinical samples. The small sample size militated against over interpretation but the CORE-OM looked a plausible candidate measure with this client group. KEYWORDS:  CORE-OM; psychosexual therapy; outcome measure; psychometric properties Introduction ‘‘Certainly the 1990s will be referred to in mental health services history as thedecade of outcomes. In part because of tightened resources, the past few yearshave included increased responsibility or accountability for many types of health-related services. As a result of this focus, educational, medical, andmental health services in particular now are more closely scrutinized andmanaged using the collection of outcome data than at any time in recenthistory.’’ (Ogles  et al. , 2002, p. 1) Correspondence to: Peter Branney, Institute of Psychological Sciences, University of Leeds, Leeds.LS2 9JT. E-mail: Received 28 February 2005; Accepted 6 July 2005. Sexual and Relationship Therapy Vol 21, No. 1, February 2006  ISSN 1468-1994 print/ISSN 1468-1749 online/06/010015-12 ª  British Association for Sexual and Relationship Therapy DOI: 10.1080/14681990500281414  In the new millennium the desire for outcomes has not abated. Managed careorganizations have ‘‘rekindled the need for evidence-based practice’’ (Lambert  et al. ,2003, p. 5). The National Health Service (NHS) in the United Kingdom is a classicexample, with a 1998 white paper,  A First Class Service: Quality in the new NHS  (Department of Health, 1998) renewing the vigour for ‘quality’. They noted that ‘‘inthe history of the NHS there has never been any coherent assessment of whichtreatments work best for whom’’ (p. 6). Yet they were working to correct that, havingalready commissioned the work constituting the now classic text,  What Works for Whom?   (Roth & Fonagy, 1996, 2004). Demonstrating their commitment to suchwork, they conducted another systematic research review only five years later(Department of Health, 2001). Essentially, these substantial pieces of work arereviews of the evidence from which practice decisions can be made, hence evidence-based practice. Yet there is a chasm between the world of research, from where wegenerally get evidence, and the all too real world of health care. The NHS aims totackle the ‘‘the take up of research on clinical and cost-effectiveness’’ afterrecognizing that currently it ‘‘is uneven and unsystematic’’ (Department of Health,1997, #1.22). It is not enough for practitioners to make decisions on the bestavailable research; they must also show that what they do works, is effective, that they are providing a service of ‘quality’. As Kazdin notes in a foreword to Roth & Fonagy (1996), treatments of established efficacy should be used with mechanisms forsystematically monitoring their effectiveness in everyday practice.Health professionals, therefore, are increasingly required to provide informationon ‘outcomes’. Predictably, the NHS not only requires health services to provideroutine data on outcomes but they now publish them annually (already in their fifthyear; Healthcare Commission, 2004). Many managed care organizations aredemanding information, tying them in with payment and even instigating‘‘evaluative procedures in order to make certain that therapy does not extendbeyond what they deem as the basic necessary length’’ (Lambert  et al.,  2004, p. 10).This is also filtering through to research funding, with a UK Mental Health NationalServices Framework highlighting the evaluation of ‘‘effectiveness and cost-effectiveness under usual services conditions of psychological and psychosocialinterventions’’ as a research priority (Department of Health, 1999, p. 22).It is this very desire for routine clinical outcomes that is going to reap someexciting results for both researchers and practitioners. Researchers have for a longtime worked with outcomes, developing and improving measures of them. Now thatpractitioners are feeling the pressure to use them there is a need to combine effortsand use the same outcome measure. The Department of Health noted that clinicalpractice and research links should be ‘‘established and maintained by using outcomemeasures’’ (1996, p. 62) and Mellor-Clark   et al.  (1999) argue that collaborating withthe same outcome measures will enable the comparison of service data with clinicaltrials.It is this activity, the use of common outcome measures in research and practice,which is quite possibly one of the more ingenious initiations to build an evidencebase. Careful selection of outcome measures will enable a clinical practice to not only provide their purchaser with the appropriate information on quality. It may also16  P. Branney & M. Barkham  enable them to make comparisons between their services and research and possibly even other services. The point of connection is the use of a common outcomemeasure or measures with the potential most creatively realized when research andpractice collaborate, establishing and broadening the evidence base with practice-based evidence. Fully accomplished this could give us an evidence–practice cycle(practice-based-evidence-based-practice; see Figure 1; Barkham & Mellor-Clark,2003). Consequently, the selection and development of outcome measures is crucial.The Clinical Outcome in Routine Evaluation-Outcome Measure (CORE-OM)has been specifically designed to bridge the research-practice divide (Barkham  et al. ,1998, 2001, 2005; Evans  et al. , 2002). The CORE-OM is part of a standardised auditand outcome evaluation package for the psychotherapy services–the CORE System– and, therefore, psychotherapy research (Mellor-Clark   et al. , 1999, 2001). Moregenerally, this approach aims to develop the collection of practice-based evidence(research done in usual service conditions) with reliable and valid measures (toolsthat are of research standards), which in turn can be used to develop evidence-basedpractice (practice decisions based on what research shows to be the best answer). Inaddition, the tools are applicable across the spectrum of psychotherapy models (e.g.cognitive-behavioural, psychodynamic).The CORE-OM comprises 34 items measuring general well-being, specifically tapping subjective well-being, symptoms (anxiety, depression, physical, and trauma),functioning (general, close and social relationships), and risk (to self and others). Ithas demonstrated reliability and validity across large samples from primary andsecondary health care (Barkham  et al. , 2005) and a general population version hasbeen widely used in student surveys (Sinclair  et al. , 2005).The CORE-OM is now used regularly in the practice of UK psychotherapy andmany of those aligned to sexual and relationship therapy will have come across it.Indeed, problems in sexual functioning may manifest themselves in changes in well-being and, if so, the CORE-OM could be a useful tool for researchers andpractitioners working in sexual and relationship therapy. For example, erectiledysfunction has been found by a number of surveys to be associated with lower self-esteem (Impotence Association, 1997) and reduced quality of life (Fugi-Meyer  et al. , F IGURE  1. Evidence-based-practice-based-evidence cycle. CORE-OM in PST   17  1997; Impotence Association, 1997; Litwin  et al. , 1998) even when controlling forage and geographical location (Jonier  et al. , 1995).Consequently, there is pressure for sexual and relationship therapists andresearchers to work towards evidence-based-practice. Evidence is to include practice-based-evidence, which is to be collected as part of routine working practices. TheCORE-OMoffersclinicianstheopportunitiesofawell-established,shortpsychometricmeasure that also comes as part of a system for analysis of service outcomes.Nevertheless,itisunclearifchangesinsexualfunctioningwouldbeapparentinthecoreconstructs it measures. Therefore, we shall report on a feasibility study of the CORE-OMinapsychosexualclinicalpractice.ThisstudyaimedtoexaminetheCORE-OM’svalidity and reliability, and utility for routine-clinical practice in PST. Method The psychosexual clinic Over a two-month period (August–September 2003) all new clients ( n ¼ 14) to apsychosexual clinic serving a large northern urban population in the UK were invitedby their clinical nurse practitioner (Sandra Coburn) to complete the CORE-OM. Thefocus was on pre-therapy only. Consequently, only new patients were invited into theproject and they were only required to complete the CORE-OM at the assessmentstage, i.e. before therapy started. There were five females and nine males (see Table I)with a number of dysfunctions; following the ICD-10 classification system there werefour cases of premature ejaculation (F52.4), four failure of genital response (F52.2),three vaginismus (F52.5), one dyspareunia (F52.6), one sexual aversion (F52.1), andtwo unspecified sexual dysfunctions (F52.9). Dyspareunia and sexual aversion werecomorbid in a single female. T ABLE  I. Characteristics of non-clinical, psychotherapy, and psychosexual samples.Sample Type of sample  n Female n  (%)Male n  (%)GendernotknownAgerange(years)25th, 50th,75th centilesNon-clinical( n ¼ 1106)University 691 304 (44) 381 (55) 6 17–43 19, 20, 23University (test–retestsample)55 46 (84) 8 (15) 1 20–45 20, 21, 23Sample of convenience360 251 (70) 109 (30) 0 14–45 18, 20, 23Clinical( n ¼ 890)23 sites (samplesize 10–96,mea n ¼ 42)890 530 (60) 344 (39) 16 16–78 26, 34, 45Psychosexual( n ¼ 14)1 site 14 5 (36) 9 (64) 0 20–56 28, 42, 49 18  P. Branney & M. Barkham


Mar 18, 2018
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