Exploring the Acceptability of Electronic Feedback Tools in Mental Health Services

Feedback-informed therapy involves routinely using outcome measurement in psychotherapy to inform therapists of patient progress. Electronic feedback systems automate the collection and scoring of measures. However, these systems vary greatly. Most display feedback data in graphs. But some go further, by comparing scores to population-level norms and clinical cut-offs. Others allow personalised or customisable measures and are integrated within health record systems. Some systems even provide guidance on targeting specific therapy obstacles, called clinical support tools. Uptake of feedback systems within mental health services is low. Implementation barriers include time burden and negative attitudes to measurement. However, no review has explored clinician acceptability of feedback system features.

Part one of this chapter presents a systematic review and narrative synthesis of 23 studies exploring clinician acceptability of electronic feedback system features in adult mental health services. Results found clinicians value features which made data visible and interpretable, allowed personalisation of relevant measures, were integrated into digital health records, and guided clinicians to act on feedback. However, despite appeal, adoption was not guaranteed, suggesting influence of wider barriers or the impact of features in combination.

Part two of this chapter describes a study in which 37 NHS Talking Therapies therapists were provided brief clinical support tools, in the form of videos and worksheets, to use with patients who were identified by the feedback system as not progressing as expected. The aim was to assess how feasible and acceptable these tools were to therapists for the purpose of future study. Therapists felt the tools supported decision-making, clinical confidence, opened up therapeutic conversations, and supported progress, and insight. However, uptake of the tools amongst participating therapists was low, indicating future study may not be worthwhile without addressing highlighted barriers of time burden, lack of support, and improved measurement of engagement with tools.