Practice-Based Evidence in Psychotherapy in Ecuador

Study Overview
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Brief Summary
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This is a naturalistic study implementing a routine outcome monitoring system to track clients' change and outcomes at the Centro de Psicología Aplicada (CPA) of the Universidad de Las Américas in Quito, Ecuador

Detailed Description
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This is an exploratory and descriptive naturalistic longitudinal project. The general objective of this study is to systematically examine the progress and outcomes of psychological interventions provided at the Centro de Psicología Aplicada (CPA) of the Universidad de Las Américas by routinely monitoring outcomes through an standardized system. Characteristics of the participants and the received interventions will be recorded through the use of assessment forms filled by therapists before and after therapy, and clients will complete outcome measures on psychological distress, life satisfaction, ambivalence in psychotherapy, family functioning, therapeutic alliance, and satisfaction with the treatment received. This is the first project in Ecuador to propose a system for routine outcome monitoring in psychotherapy. It could contribute to develop normative trajectories of change and expected recovery curves in the future and to improve the quality of psychological treatments.

Official Title
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Practice-Based Evidence in Ecuador: Routine Outcome Monitoring in Psychotherapy for Common Mental Health Problems

Conditions
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Psychological Distress

Intervention / Treatment
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* Other: Psychological Intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Be 11 years of age or older. Have sufficient ability to communicate in Spanish. Undergo psychological treatment at the CPA. Exclusion Criteria: Present substantial cognitive deficits that do not allow the development of the evaluation.

Ages Eligible for Study
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Minimum Age: 11 Years
Maximum Age: 100 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Helpseeking Ecuadorian adult and adolescent clients<br>The participants will be adolescent (11-17 years) and adult (>18 years) clients presenting with common non-severe mental health problems who seek mental health services at the Centro de Psicología Aplicada. The CPA is an outpatient psychological service where students of the last semesters of the Clinical Psychology degree develop and practice their psychological care skills as co-therapists of professional clinical psychologists. | Other: Psychological Intervention<br>* The CPA provides outpatient psychological services to individuals: children, adolescents and adults, couples and families. At the CPA, care is carried out through the co-therapy model, which involves the participation of a professional clinical psychologist and a trainee. Psychotherapists with diverse theoretical and clinical backgrounds (mainly psychodynamic, cognitive, systemic and integrative), but a common constructivist approach, work in the center. The following elements are transversal in their practice: therapeutic alliance, healing environment, and a collaborative procedure between the client, the psychotherapist and the trainee co-therapist.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) | The CORE-OM (Evans et al., 2002) is a 34-item self-report instrument designed for use in heterogeneous services and based on a pan-theoretic core of psychological distress, including subjective well-being, problems, risk, and functioning. Items are scored on a scale from 0 (never) to 4 (always or almost always). Higher scores indicate greater psychological distress. This instrument is suitable as an initial assessment tool and as an outcome measure. The Spanish versionof this measure will be used. This version was translated by Feixas et al. (2012) and has shown good psychometric properties in Spain (Trujillo et al. 2016) and Ecuador (Paz et al. 2020). | CORE-OM is administered to adult clients at baseline and immediately after treatment completion | 
| Change in Clinical Outcomes in Routine Evaluation-10 (CORE-10) | The CORE-10 (Barkham et al., 2013) is a generic, short, and easy-to-use assessment measure. Its items were drawn from the CORE-OM. The CORE-10 is an instrument that has shown good psychometric properties (Barkham et al., 2013) and is practical for use on a session-by-session basis with people presenting with psychological distress in mental health settings. Its Spanish version will be used (Feixas et al., 2012). | CORE-10 is administered to adult clients at the second week and then routinely every week until treatment completion | 
| Change in Young Person's-Clinical Outcomes in Routine Evaluation (YP-CORE) | The YP-CORE is a brief self-report instrument capable of detecting psychological distress in adolescents, generated by a wide range of problems, while providing information about the person's general functioning (Twigg et al., 2009). It has 10 items, which must be answered on a 5-point scale (0 to 4). Its Spanish version will be used. The YP-CORE was translated to Spanish by Feixas et al. (2018) and showed adequate psychometric properties. In the present study, we will use a version of this measure adapted for Ecuador and Latin America whose psychometric properties are being explored. | YP-CORE is administered to adolescent clients at baseline and then routinely every week until treatment completion | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Life Satisfaction Scale | It is a 10-point scale that asks respondents to rate their degree of satisfaction with life in the present. It will be presented in Spanish. | Life Satisfaction Scale is administered to all clients at baseline and immediately after treatment completion | 
| Change in Ambivalence in Psychotherapy Questionnaire (APQ) | It is a 9-item scale that measures the level of ambivalence towards change perceived by the consultants. It includes two subscales, demoralization and oscillation, and an overall score of ambivalence towards change (Oliveira et al., 2020). Both the original version (Oliveira et al., 2020) and the Spanish version (Montesano et al., submitted for publication) have demonstrated good psychometric properties, including good convergent and divergent validity. In this study the Spanish version will be used. | APQ is administered to adult clients at baseline and then routinely every four weeks | 
| Change in Systemic Clinical Outcome and Routine Evaluation-15 (SCORE-15) | It is a 15-item questionnaire with a scale of 1 to 5, where 1 means strongly disagree and 5 means strongly agree. It was designed to be completed by family members, aged 12 years or older (Stratton et al., 2010). It has three dimensions: strengths, difficulties and communication. Lower scores correspond to better family functioning. In addition, the SCORE-15 has two scales ranging from 1 to 10 on which participants rate the perceived effectiveness of the therapeutic intervention and the perceived severity of the difficulty leading to treatment. In the present study, we will use the Spanish version of this measure which has shown adequate reliability and validity in a Spanish sample (Rivas & Pereira, 2016). | SCORE-15 is administered to all clients at baseline, at four weeks and immediately after treatment completion | 
| Satisfaction with the Treatment Received Scale (CRES-4) | The CRES-4 scale has 4 items: one question on satisfaction, one on the level of resolution of the main problem, one on the emotional state before the start of treatment and one question on the emotional state when completing the questionnaire (Feixas et al., 2012). These questions allow interpretations to be made about the perceived change in their emotional state, satisfaction and resolution of the problem. In this study, the Spanish version of this measure will be used (Feixas et al., 2012). | CRES-4 is administered to all clients immediately after treatment completion | 
| Change in Therapeutic Alliance Scale | It is a 10-point one-item measure that evaluates therapeutic alliance. Clients are asked to state, in general, how connected they feel to their therapist and if they have talked about what the clients were interested in addressing in therapy. It will be presented in Spanish. | Therapeutic Alliance Scale is administered to all clients immediately after the first intervention and then routinely every week until treatment completion | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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routine outcome monitoring, practice-based evidence, psychotherapy, change, outcome, psychological distress