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Meta-Analysis
. 2018 Aug 20;8(8):CD011729.
doi: 10.1002/14651858.CD011729.pub2.

Client feedback in psychological therapy for children and adolescents with mental health problems

Hanna Bergman  1 , Hege Kornør, Adriani Nikolakopoulou, Ketil Hanssen-Bauer, Karla Soares-Weiser, Thomas K Tollefsen, Arild Bjørndal
Affiliations
Meta-Analysis

Client feedback in psychological therapy for children and adolescents with mental health problems

Hanna Bergman et al. Cochrane Database Syst Rev. .

Abstract

Background: Childhood and adolescent mental health problems are a serious and growing concern worldwide. Research suggests that psychotherapy can have a significant and positive impact on children and adolescents with mental health problems, such as anxiety disorders, depression and conduct disorders. Client feedback tools serve as a method of monitoring clients' progress and providing feedback from clients to therapists during the therapeutic process. These tools may help to enhance clinicians' decision-making by allowing them to adapt their treatment plans as the therapy progresses, resulting in a reduction of treatment failures. Research has shown that client feedback tools have a positive effect on adults' psychotherapy. This review addresses whether feedback tools in child and adolescent therapy could help therapists to better treat their young clients.

Objectives: To assess the effects of client feedback in psychological therapy on child and adolescent mental health outcomes.

Search methods: We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR, Studies and References), the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (1946-), Embase (1974-) and PsycINFO (1967-) to 3 April 2018. We did not apply any restriction on date, language or publication status to the search.

Selection criteria: We included randomised controlled trials (RCTs) that compared client feedback to no client feedback in psychological therapies for children and adolescents.

Data collection and analysis: Two review authors independently assessed references for inclusion eligibility and extracted outcome, risk of bias and study characteristics data into customised forms. We contacted study authors to obtain missing data. We analysed dichotomous data using risk ratios (RRs) and calculated their 95% confidence intervals (CIs). For continuous data, we calculated mean differences (MDs), or standardised mean differences (SMDs) if different scales were used to measure the same outcome. We used a random-effects model for all analyses.

Main results: We included six published RCTs, conducted in the USA (5 RCTs) and Israel (1 RCT), with 1097 children and adolescents (11 to 18 years old), in the review.We are very uncertain about the effect of client feedback on improvement of symptoms, as reported by youth in the short term because we considered evidence to be of very low-certainty due to high risk of bias and very serious inconsistency in the effect estimates from the different studies. Similarly, we are very uncertain about the effect of client feedback on treatment acceptability, due to high risk of bias, imprecision in the results, and indirectness of measuring the outcome (RR 1.08, 95% CI 0.73 to 1.61; 2 studies, 237 participants; very low-certainty).Overall, most studies reported and carried out randomisation and allocation concealment adequately. None of the studies were blinded or attempted to blind participants and personnel and were at high risk of performance bias, and only one study had blind outcome assessors. All of the studies were at high or unclear risk of attrition bias mainly due to poor, non-transparent reporting of participants' flow through the studies.

Authors' conclusions: Due to the paucity of high-quality data and considerable inconsistency in results from different studies, there is currently insufficient evidence to reach any firm conclusions regarding the role of client feedback in psychological therapies for children and adolescents with mental health problems, and further research on this important topic is needed.Future studies should avoid risks of performance, detection and attrition biases, as seen in the studies included in this review. Studies from countries other than the USA are needed, as well as studies including children younger than 10 years.

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Conflict of interest statement

Hanna Bergman worked for Enhance Reviews Ltd. during preparation of this review and was paid for her contribution to this review. Enhance Reviews Ltd. is a private company that performs systematic reviews of literature. Hanna works for Cochrane Response, an evidence consultancy operated by Cochrane.

Hege Kornør is an Associate Editor for the Cochrane Developmental, Psychosocial and Learning Problems Group (CDPLPG).

Adriani Nikolakopoulou has no known conflicts of interest.

Ketil Hanssen‐Bauer has no known conflicts of interest.

Karla Soares‐Weiser was the director of Enhance Reviews Ltd. during preparation of this review. Enhance Reviews Ltd. is a private company that performs systematic reviews of literature. Karla is employed by Cochrane as Deputy Editor in Chief.

Thomas K Tollefsen has no known conflicts of interest.

Arild Bjørndal is CEO of an organisation that teaches one of the methods to practitioners.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 1 Client feedback versus no client feedback, outcome: 1.2 Improvement, various scales: short‐term (youth report).
5
5
Forest plot of comparison: 1 Client feedback versus no client feedback, outcome: 1.5 Treatment acceptability: dropouts from treatment.
6
6
Forest plot of comparison: 1 Client feedback versus no client feedback, outcome: 1.6 Treatment acceptability: planned sessions not held.
1.1
1.1. Analysis
Comparison 1 Client feedback versus no client feedback, Outcome 1 Improvement, dichotomous: number of participants with clinical improvement.
1.2
1.2. Analysis
Comparison 1 Client feedback versus no client feedback, Outcome 2 Improvement, various scales: short‐term (youth report).
1.3
1.3. Analysis
Comparison 1 Client feedback versus no client feedback, Outcome 3 Improvement, various scales: short‐term (parent, therapist, teacher report).
1.4
1.4. Analysis
Comparison 1 Client feedback versus no client feedback, Outcome 4 Improvement: Ohio Scales‐Problem Severity, medium‐term.
1.5
1.5. Analysis
Comparison 1 Client feedback versus no client feedback, Outcome 5 Treatment acceptability: dropouts from treatment.
1.6
1.6. Analysis
Comparison 1 Client feedback versus no client feedback, Outcome 6 Treatment acceptability: planned sessions not held.
1.7
1.7. Analysis
Comparison 1 Client feedback versus no client feedback, Outcome 7 Therapeutic alliance: youth‐rated, short‐term.
1.8
1.8. Analysis
Comparison 1 Client feedback versus no client feedback, Outcome 8 Duration of treatment (weeks).
1.9
1.9. Analysis
Comparison 1 Client feedback versus no client feedback, Outcome 9 Client satisfaction: Goal Attainment Scaling (GAS), parent report, medium‐term.
1.10
1.10. Analysis
Comparison 1 Client feedback versus no client feedback, Outcome 10 Subgroup analysis: type of therapy ‐ improvement, various scales: short‐term (youth report).
1.11
1.11. Analysis
Comparison 1 Client feedback versus no client feedback, Outcome 11 Subgroup analysis: number of sessions ‐ improvement: various scales (youth report), short‐term.
1.12
1.12. Analysis
Comparison 1 Client feedback versus no client feedback, Outcome 12 Subgroup analysis: number of sessions ‐ treatment acceptability: dropouts from treatment.
1.13
1.13. Analysis
Comparison 1 Client feedback versus no client feedback, Outcome 13 Subgroup analysis: number of sessions ‐ treatment acceptability: planned sessions not held.
1.14
1.14. Analysis
Comparison 1 Client feedback versus no client feedback, Outcome 14 Subgroup analysis: feedback by client or parent ‐ treatment acceptability: dropouts from treatment.
1.15
1.15. Analysis
Comparison 1 Client feedback versus no client feedback, Outcome 15 Subgroup analysis: feedback by client or parent ‐ treatment acceptability: planned sessions not held.
1.16
1.16. Analysis
Comparison 1 Client feedback versus no client feedback, Outcome 16 Subgroup analysis: frequency of feedback ‐ improvement: various scales (youth report), short‐term.
1.17
1.17. Analysis
Comparison 1 Client feedback versus no client feedback, Outcome 17 Subgroup analysis: frequency of feedback ‐ treatment acceptability: dropouts from treatment.
1.18
1.18. Analysis
Comparison 1 Client feedback versus no client feedback, Outcome 18 Subgroup analysis: frequency of feedback ‐ treatment acceptability: planned sessions not held.
See this image and copyright information in PMC

Comment in

References

References to studies included in this review

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NCT01873742 {published data only}
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NCT02023736 {published data only}
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