OMQ / SMQ (ROM) Extensive guide
What are OMQ and SMQ?
The Outcome Measure Questionnaire (OMQ) and the Session Measure Questionnaire (SMQ) are two short and simple questionnaires of five questions each, that are sent before and after each session and can be completed in less than one minute. These questionnaires are outcome feedback measures that gather direct and systematic feedback from clients that can be immediately used in the session and treatment to improve treatment outcomes and client experiences. The OMQ provides insight into the client's well-being and can alert the therapist of sudden changes. The SMQ focuses on assessing the therapeutic alliance.
Added value of outcome feedback
You can monitor therapeutic alliance (therapeutic relationship or working alliance), your style, and how you come across to the client, as the results reflect what your client likes and dislikes during treatment. Continuous monitoring helps to build a strong relationship and this can be used during sessions. As a therapist, it gives you the opportunity to stay well-connected with your client, learn from the feedback, and continue developing yourself. A positive therapeutic alliance is a significant predictor of treatment outcomes (Orlinsky, Rønnestad, & Willutzki, 2004).
Progress - Outcome feedback also provides information about how the client is doing and the progress of the treatment process, allowing for quick adjustments and interventions when there is a stall in progress. Using the measurements directly leads to more motivation, less drop-out, shorter treatment duration, better frequency of sessions, and greater treatment effect (Miller et al., 2006).
When to use OMQ/SMQ
The OMQ and SMQ can be used with children aged 12 and above, adolescents, adults, and the elderly. They can be used in an individual setting, as well as in family- or group therapy.
The questionnaires are systematically filled in, meaning they are completed before and after each session. The OMQ is completed before each session, and the SMQ is completed at the end of each session. The questionnaires are automatically available on the client's app Calendar.
It is best to start sending the questionnaires at intake. The earlier the measurements start, the better the treatment effect can be measured.
How to integrate the OMQ and SMQ in your session and treatment
Ideally, you should review the results of the OMQ and SMQ before the session, or during your flexible time and discuss them during the next session. You can also discuss the results with the coordinating therapist or during supervision.
During the session, you start by discussing the results of the OMQ and SMQ if they are relevant. For the OMQ, you can discuss the score, the trend of the score over time and link it to the topic of the current session or the progress of therapy. For the SMQ, you can ask for positive and/or negative feedback. If there is nothing remarkable in the results, at least mention that you have seen the scores and ask if the client would like to share anything about them. At the end of the session, you can remind the client to fill in the SMQ afterwards, but it also appears automatically as a task on the client's Calendar.
Scheduling and filling out the OMQ and SMQ
Scheduling by the therapist
You can plan an assessment for your clients via:
- the session planner,
- the assessments tool in the toolbar
- the 'Interventions' tab.
Learn more about how to schedule an assessment in this manual.
Completing by the client
The client responds to each statement by swiping across a line. Behind the line is a 7-point scale, which is not visible to the client. A low score (to the left of the line) means “disagree” and a high score (to the right of the line) means “agree”.
If you want to provide more information to your client about the importance and usefulness of completing the assessments, or if your client does not understand how to complete them, you can share the article "Measuring Your Progress" .
Outcome Measure Questionnaire (OMQ)
The Outcome Measure Questionnaire (OMQ) provides insight into the client's well-being and can alert the therapist about sudden changes. The results are transparently discussed in the session to improve collaboration and determine the next steps. The OMQ also provides feedback on the progress or outcome of the treatment.
The OMQ is sent before each session using 5 statements that ask how the client has been doing in the past week.
The way the client can fill out the questions, with an analog scale without numbers, ensures that the client cannot compare their own score with the previous week. The scale is filled out independently of the previous score.
Subscales of the OMQ
- Personal relationships: "I can maintain (important) social contacts".
- Participation: "I am actively occupied with school/work/housework/hobbies".
- Meaning: "I have hope for the future / I find my life has meaning".
- Physical health: "My physical health is doing well".
- Mental health: "My mental health is doing well".
Scoring of the OMQ
Behind the analog scale that the client sees, there is a 7-point scale. NiceDay will automatically convert the position of the slider to a score on this 7-point scale. These results from each individual questionnaire are visible in the client overview. The scores are also automatically plotted in a graph in the client's 'Data' tab in the therapist portal. There is one graph for the total scores, and two graphs for the subscales. The questions can be turned on and off using checkboxes to get a customised overview.
Interpretation of OMQ
Cut-off scores
There are currently no norms and cut-off scores available for the OMQ. Research is needed to establish cut-off scores for each questionnaire and to make comparisons with outcomes and other questionnaires. These are the current average OMQ scores within the sGGZ population.
We assume that a very low score (1 or 2) on a subscale is an indication that things are not going well in that area. A total score of 10 or lower is also an indication.
It can be assumed that a lower score indicates the possibility of a steep or rapid improvement. The higher the OMQ score at intake, the less progress can be measured during therapy using the OMQ. Additional tests or measurements may be necessary in such cases.
Discussing results with the client
- Very low scores (total <10 or subscale <2)
With an extremely low score on the OMQ (<10), the client clearly indicates that things are not going well and that attention is needed. - Mid-range scores (total around 20 or subscale around 4)
Scores around the mid-range can indicate that the client's suffering is not extremely high, but that they do want something else in their life. It can also mean that the problems have been going on for so long that the person has become used to them. - Very high scores (total >30 or subscale >6)
Very high scores may indicate that the client is doing very well. It can mean that they have a very specific small question, are looking for personal development or growth, or have been directed by someone else.
Comparing consecutive scores
OMQ scores can be compared to each other to examine change over time. When doing so, it is essential to take into account the phase of treatment (beginning/middle/end) and the amount of change. The OMQ has been shown to be sensitive to change, and the test-retest reliability is good. On average, the sGGZ population scores about 4 points higher on the total OMQ score at the end of treatment than before.
The Reliable Change Index (RCI) provides an indication of the change resulting from treatment that cannot be attributed to chance or measurement errors. This represents a "real" improvement. The RCI of the OMQ is 7.46 points. This means that an increase in the total score by 7.46 points can be interpreted as a real improvement with 95% confidence. This does not consider the initial score, as a lower score is expected to show more improvement and a higher score less improvement.
- Too little improvement
You may go back to the beginning: Are the goals clear? How is the therapeutic alliance? Is something being overlooked? - Significant improvement too rapidly
It is important to monitor the client's effort level. Clients should also be warned about the possibility of a drop or setback in the process so that they do not see it as a "failure". - Clear improvement and upward trend levels off into a flat horizontal line on the graph
It may be appropriate to consider reducing the frequency of appointments. The greatest effect at the beginning of therapy has been achieved, and the client needs more time to practice and continue to notice changes. - No improvement over a long period of time and the scores remain flat
It may be time to consider ending therapy before dependency develops. During therapy, you expect to change and if this no longer occurs you can consider ending it. Especially when you see a stable score in combination with a very high SMQ score. - Sudden and significantly different score, f.e. a very low score after a series of consistently increasing scores
There may be an external factor at play that has nothing to do with the therapy session, such as a fight or a problem at work. It is important not to spend the entire session discussing this external factor if it is not related to the therapy session. Spend some time on it, but then return to the treatment goal. - Scores fluctuate continuously and extremely
It may seem as though therapy does not affect the client's well-being. Discuss this with the client, including the therapeutic relationship. It can also occur with clients who fill out the list as a snapshot of how they feel at the moment, rather than writing about how they have felt over the past week. You can inquire about this and clarify the explanation.
Session Measure Questionnaire (SMQ)
The Session Measure Questionnaire (SMQ) is designed to measure the therapeutic alliance. The central question is how the client experienced the video call session and the progress of the treatment so far. The questions are intended to elicit critical feedback to improve the content of the video conversations and the approach. Clients can add a note to each statement to explain their score if they feel the need. The SMQ is sent after each session.
Subscales of the SMQ
- Contact with your therapist: "I felt heard, understood, and supported during the session today."
- Session content: "We have worked on my goals today."
- Way of working: "Digital treatment/coaching fits me."
- Progress: "Writing down events/thoughts which I find important and chatting in between the video call sessions are valuable for my progress."
- Daily life: "I can apply things I learn in treatment in my daily life."
Scoring SMQ
Behind the analog scale that the client sees, a 7-point scale is integrated. NiceDay will automatically convert the location of the slider to a score on this 7-point scale. The results of each individual questionnaire are visible in the client's overview, including any attached notes. Additionally, the scores of each questionnaire are automatically plotted on a graph in the client's 'Data' tab of the clinician portal. This graph shows the total scores, as well as the subscales, which can be turned on and off using checkboxes to provide a clear overview.
Interpretation SMQ
Each question is a subscale and is scored on a scale from 1 to 7. The total scores of the SMQ range from a minimum of 5 (5x1) to a maximum of 35 (5x7). The midpoint of a subscale is 4, and the midpoint of the total scale is 20.
For the SMQ, the lower the score, the lower the client's satisfaction with their treatment, the conversation, and the therapist. Conversely, the higher the score, the higher the satisfaction. The SMQ helps to tailor the treatment to the client's needs and situation. It also helps to identify problems in the therapeutic alliance, such as ruptures or breaks, at an early stage and provides the opportunity to address them to give the treatment the best possible chance of success. Changes in treatment engagement are also observed.
These results should be discussed with your supervising clinician or clinical supervisor, especially if the connection between the client and therapist does not seem to be going smoothly. The information can help you decide whether to adapt your therapeutic approach to the client's needs or to transfer the treatment to a colleague.
Cut-off scores
There are currently no norms or cut-off scores available for the SMQ. Research is needed to establish cut-off scores for each questionnaire. These are current average SMQ scores within the mental health care population. It shows, among other things, that the SMQ score is generally very high and remains relatively stable during the treatment process.
Discussing with the client
As a therapist, it is important to be open to the feedback given by the client. Therefore, create an honest and safe atmosphere in which a client can provide feedback. If a client is unsure what feedback to give, you can ask follow-up questions using the following prompts:
- What should I do more or less next time?
- I want to make sure I am meeting your needs, how can I best do that?
- What can I improve on?
- What did you find helpful in this conversation? What did you find less helpful?
- Can you suggest something I should or should not do with other clients?
- Did we cover everything today that you wanted to discuss?
- Very low score on the SMQ?
Take the time to address this in the next session. Use part of the session to explore this further. This can prevent a crack from becoming a break or the client from dropping out of treatment. - Fluctuations in SMQ scores?
This can affect treatment outcomes and indicates fluctuations in the therapeutic alliance. Discuss this with the client. - Always a maximum SMQ score?
If the client gives a maximum score on the SMQ from the start of treatment, it may indicate socially desirable responses. Emphasize the importance of feedback for treatment and discuss this openly with the client if necessary.
Ending treatment
As long as there is meaningful progress and change in therapy as measured by the OMQ, you can continue the treatment. If there is little to no further progress, it is important to evaluate the continuation of therapy together with the client.
In the last session, you discuss the OMQ score progression throughout the treatment and reflect on the progress.
Appendix
https://www.vgct.nl/stream/kmn34887f
https://www.oplossingsgerichte-therapie.nl/cdoi
https://www.psyq.nl/over-psyq/behandelresultaten/roqua
Duncan, B.L. (2010). On becoming a better therapist. Washington: American Psychological Association.
Duncan, B.L. et. al (eds) (2010). The heart and soul of change second edition: delivering what works in therapy. Washington: American psychological Association.
Miller, S.D. & Duncan, B.L. (2004). The Partners for Change Outcome Management System. Wiley InterScience.
Miller, S.D., Duncan, B.L., Brown, J., Sorrel, R., Chalk, M.B.(2006). Using formal feedback client feedback to improve retention and outcome: making ongoing, real-time assessment feasible. Institute for the study of Therapeutic Change, Chicago.
Orlinsky, D. E., Rønnestad, M. H., & Willutzki, U. (2003). Fifty years of process-outcome research: Continuity and change. In M. J. Lambert (Ed.), Bergin and Garfield’s handbook of psychotherapy and behavior change (5th ed., p. 307-390). New York: Wiley.