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Can CORE assessment data identify those clients less likely to benefit from brief counselling in primary care?
- Authors:
- SAXON David, IVEY Catherine, YOUNG Tracey
- Journal article citation:
- Counselling and Psychotherapy Research, 8(4), December 2008, pp.223-230.
- Publisher:
- Wiley
Studies show that counsellors in primary care see many clients with difficulties of a severity similar to those found in secondary care services. Evidence from both RCTs and studies of routinely collected data indicates that many of these 'clinical' clients benefit from brief counselling intervention. However, little is known about why some benefit while others fail to do so despite completing their counselling contract. This paper considers client characteristics recorded at assessment and aims, using logistic regression analysis, to identify those characteristics predictive of a poor outcome. Results indicate that a number of characteristics are associated with poor outcome; the most important predictors are economic inactivity and aspects of the patient's condition, particularly continuous/recurrent depression, with some differences between genders. However, the models produced were not acceptable in their predictive power. This may be partly due to data quality issues or important characteristics not being available in the data. The paper concludes that being unemployed or on state benefits may be a proxy measure of severity that has an important impact on outcome for all patients, and particularly for males. Some reasons are suggested and areas of future research are identified.
Who drops-out? Do measures of risk to self and to others predict unplanned endings in primary care counselling?
- Authors:
- SAXON David, RICKETTS Tom, HEYWOOD Joanna
- Journal article citation:
- Counselling and Psychotherapy Research, 10(1), March 2010, pp.13-21.
- Publisher:
- Wiley
The unplanned ending of therapy is of concern because it raises questions about the appropriateness of the treatment and it's delivery for some clients. Limited available data indicates that those who drop-out often have more severe symptoms at entry, and have poorer clinical outcomes. This paper, using a large dataset of CORE data collected routinely from the Sheffield Primary Care Psychological Therapy service between 2000 and 2003, employed logistic regression to consider different measures of risk and other client characteristics recorded during assessment to predict drop-out from the service. The findings suggest that younger age, greater psychological distress during assessment or an addiction problem are associated with an unplanned ending. However, no reliable logistic regression model could be produced, possibly due to data quality issues or important characteristics not being available in the data. The authors conclude that counsellors should actively seek to minimise unplanned endings, as amongst them may be the more distressed and risky clients referred to primary care counselling.