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Evaluating treatment program outcome is important in determining program effectiveness. Yet, very few counseling and treatment programs provide outcome data. Reasons for this lack of outcome information range from lack of funding to limited resources like staff time and expertise. Complicating this situation even further is inconsistency regarding the criteria of improvement, different opinions as to what should be measured, and the lack of a universally accepted test. Outcome research has also been lumped together with recidivism prediction, which further confuses this issue. With that being said, it’s not surprising that a standard evaluation instrument that most mental health professionals agree measures treatment (counseling) outcome does not exist.

Of the outcome research being conducted, there are big differences in the methods used. For example, some studies use personality tests; whereas, others interview clients and their significant others. Available records (court, treatment program and adjustment history) review is also widespread.

Some experts believe federal, state and local efforts must be uniform and standardized to obtain comparable data. These experts recommend developing "a standard test" that would be used by everyone throughout the U.S. to evaluate program outcome (A. Wright & Janice Jaworsky, 1998). "Despite lack of consensus among experts on the advantages of standardization of the program evaluation process, all agree outcomes are important" (U.S. Department of Justice, 1998, July 26-29).

Obviously, counseling/treatment outcome measures are complex and will likely always be controversial. There are several questions that must be addressed if any counseling/ treatment program is going to use an outcome test. First, what is the outcome criteria? Are different programs to be compared, inadvertently contrasting one program against another? In contrast, the Pre-Post Inventory compares a client’s posttest scores against their pretest scores. In brief, we are comparing a person upon counseling/treatment completion with the person they were when they were admitted to the program. This comparison focuses upon outcome issues, i.e., did the client get better, stay the same or get worse?

For the outcome measure to be fair, the nature of the counseling/treatment program needs to be clarified. The Pre-Post Inventory is designed for what has traditionally been termed outpatient and inpatient counseling programs. Admittedly, this definition is not exact, yet experienced health care professionals have found it workable. It provides guidance for ruling out extremes, without being overly restrictive.

Another concern has been "what to measure?" The Pre-Post Inventory measures traditional areas of counseling inquiry: Truthfulness, Self-Esteem, Resistance, Distress (anxiety and depression), Alcohol Abuse, Illicit Drug Abuse and Stress Coping Abilities. We postulate improvement (if they were problematic) in each of these psychological traits or symptom clusters with successful counseling.

Another concern involves methodology. The Pre-Post Inventory is designed for objective pretest-posttest outcome comparison. In brief, the pretest serves as the basis for subsequent posttest comparison. Posttest scores are compared to pretest scores. It is assumed that all of the above scale scores will improve in "successful" counseling programs. If one or more areas of inquiry (scales) are not problematic at program intake (pretest), they should not vary that much upon program (posttest) completion.

The Pre-Post Inventory is worded in the present (here-and-now) tense, and history (court, treatment, etc.) items were deleted. The present tense "time reference" enables the same test to be administered at program intake (pretest) and program completion (posttest) intervals. A minimum 30-day pretest-posttest interval is used in the Pre-Post Inventory. History items, if included in a test's scoring, set limits below which a client's score could not drop. History items were deleted so scale scores can vary between staying the same, getting better or becoming worse.

These outcome issues were discussed so that counseling and treatment staff can decide whether or not the Pre-Post Inventory is an outcome test appropriate to their needs. The remainder of this webpage discusses the Pre-Post inventory, shows an example report and presents a validation research study.

References

Ana Wright and Janice Jaworsky (October 1998) The Koch Crime Institute, White Paper Report.

U.S. Department of Justice (1998, July 26-29) the annual Conference on Criminal Justice Research and Evaluation.

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