Identifying Clients Most in Need of Therapy During COVID-19

COVID-19 has changed how we provide behavioral health services, requiring therapists to limit face-to-face contact with clients and use telehealth methods.


A rotary dial telephone shown in black and white


Phone Check-Ins and the Outcome Rating Scale

In discussions with organizations across the world, many agencies have been doing phone check-ins with clients to see how they are doing and to assess their needs for service. These brief encounters are invaluable to reassure, validate, and support clients in these trying times and harvest resources and resiliencies for the days ahead. Given agency limited resources and reduced staffing, these brief check-ins can also serve to prioritize valuable services to those most in need.

The Outcome Rating Scale (ORS) can really help here. The ORS is an outcome measure and it is a validated screener for client distress. We (DeSantis, Jackson, Duncan, & Reese, 2016) validated the ORS as a screener vs. the PHQ9, the popular depression scale, in a primary care setting. Because the ORS assesses functionality across individual, interpersonal, and social domains, and not just symptoms related to depression and anxiety, the ORS identified significantly more clients in the clinical range. In other words, we found that the ORS casts a wider net in identifying clients with significant distress and who would benefit from services.

Outcome Rating Scale

A Good Read on Client Distress and Prioritizing Services

During these brief check-in calls, administer the ORS via Better Outcomes Now (BON) or the oral version of the ORS, which you can download from this site (click on PCOMS on the main menu, then PCOMS measures, and then agree to the license and enter your email [not used for any purpose other than registering your agreement]). The ORS gives a good read on the client’s perspective of his or her distress in just two minutes.

Once you total the score, you are all set. Recall that the so-called clinical cutoff of the ORS for adults is 25. This just means that those scoring under 25 are scoring more like folks who are seeking behavioral health services and those over 25 are scoring more like those who are not. Said another way, scores under 25 reflect the distress level most often associated with being in service. The lower the score, the higher the distress.  

Those clients, therefore, scoring under the cutoff should be prioritized and scheduled for a regular telehealth or telephone session as soon as possible using the Partners for Change Outcome Management System (PCOMS) to track progress and ensure success. Those clients scoring over the cutoff could stay on “check-in” status and followed up in a month with another ORS. Of course, the ORS does not replace your clinical judgment and if the client is suicidal or homicidal, it wouldn’t matter what the ORS said.

In these bizarre times, it is important that we provide services to those most in need. The ORS is a validated screener that provides a snapshot of the client’s view of distress, enabling a rapid and objective response.


Advantages of Better Outcomes Now

Better Outcomes Now (BON) is designed to allow remote administration of the measures and application of the Partners for Change Outcome Management System (PCOMS) from the client's own device as well as all the functionality that exists in face-to-face discussions, including the graph and progress information. BON will soon include the functionality to remotely administer the PHQ9 and GAD7.

Outcome Measurement Tool | Free Trial | Better Outcomes Now