Outcome measures in therapeutic settings within social care: perspectives from management, therapists, supervisors, and clients

The importance of collecting client feedback in social service provision has been increasingly acknowledged over the years. Outcome measures were recently introduced in a therapeutic service in Malta. This thesis explores whether the introduction of outcome measures within a social care organisation helps towards increasing the client's voice in therapy and during clinical case management supervision. It adopts a systemic framework to look at the interconnectedness between the various sub-systems. Data was collected by means of thirty interviews and two focus groups. Initially baseline data was collected via fifteen interviews with therapists, to gain insight into the use of outcome measures in practice. Over the following six-month period, outcome measures were administered more frequently with clients. The results were subsequently discussed during clinical case management supervision. Qualitative data at follow up stage was subsequently gathered from two focus groups which were held with thirteen therapists, as well as interviews with three leaders, with the manager, and with the Chief Executive Officer. Interviews were also held with ten clients in an effort to seek further understanding of their experience using outcome measures as part of service provision. The findings of the study demonstrate that using outcome measures as a therapeutic instrument helps to strengthen the client's voice in therapy as the results of outcome measures helps generate new insight by therapists, by supervisors, and by clients. This study proposes a new tripartite supervision model, wherein the use of outcome measures supports the client's construal to remain at the centre of the supervision process, acting as a triangulated common factor between the therapist, client, and the supervisor. It is recommended that decisions concerning the use of outcome measures should remain at operational level, to overcome resistance to the instruments when perceived as a control mechanism.