{{Short description|Behavioral Health intervention}} {{Infobox medical intervention|name=Feedback informed treatment|field=[[Behavioral Health]]|uses=Assessing and improving the therapeutic relationship and progress of care}} '''Feedback Informed Treatment''' (FIT) is an [[Evidence-based practice|empirically supported]], pantheoretical approach for evaluating and improving the quality and effectiveness of [[behavioral health]] services, originally developed by psychologist [[Scott D. Miller, Ph.D.|Scott D. Miller]].<ref name="Prescott, D., Maeschalck C., and Miller, S. 2017" /><ref name=":1">{{Cite journal|last=Miller|first=Scott|date=2013|title=The outcome of psychotherapy: Yesterday, Today, and Tomorrow|journal=Psychotherapy|volume=50|issue=1|pages=88–97|doi=10.1037/a0031097|pmid=23505984}}</ref> It involves routinely and formally soliciting feedback from clients regarding the therapeutic relationship and progress of care and using the resulting information to inform and tailor service delivery.<ref name="Prescott, D., Maeschalck C., and Miller, S. 2017">{{Cite book|last=Prescott, D., Maeschalck C., and Miller, S.|title=Feedback Informed Treatment in Clinical Practice: Reaching for Excellence|publisher=American Psychological Association|year=2017|isbn=978-1-4338-2774-7|location=Washington, D.C.}}</ref>

FIT utilizes empirically validated, client-rated measurement tools at each session. Although any validated measures could be used, due to their brevity, the Outcome Rating Scale (ORS)<ref>{{Cite journal|last=Seidel, J. A., Andrews, W. P., Owen, J., Miller, S. D., & Buccino, D. L.|date=2016|title=Preliminary Validation of the Rating of Outcome Scale and Equivalence of Ultra-Brief Measures of Well-Being.|journal=Psychological Assessment|volume=29|issue=1|pages=65–75|doi=10.1037/pas0000311|pmid=27099979|s2cid=5857225}}</ref> and Session Rating Scale (SRS) are commonly employed by FIT Practitioners. The ORS measures the client’s therapeutic progress while asking about their level of distress and functioning. The SRS measures the quality of the [[therapeutic relationship]].<ref name="Prescott, D., Maeschalck C., and Miller, S. 2017"/>

A number of studies and meta-analyses have demonstrated the benefit of routinely monitoring and using client outcome data and feedback to inform care.<ref>{{Cite journal|last=Dulark & Dupre as cited in the Brattland, H., Koksvik, J.M., Burkeland, O., Gråwe, R. W., Klöckner, C., Linaker, O. M., Ryum, T., Wampold, B., Lara-Cabrera, M. L., & Iverson, V. C.|date=2018|title=The effects of Routine Outcome Monitoring (ROM) on therapy outcomes in the course of an implementation process: A randomized clinical trial.|journal=Journal of Counseling Psychology|volume=(65)5|pages=641–652}}</ref> Studies using the ORS and SRS document:

* Improved client outcomes (27%)<ref name=":0">{{Cite journal|last=Miller, S.D., Duncan, B.L., Brown, G.S., Sorrell, R., & Chalk, M.B.|date=2006|title=Using formal client feedback to improve retention and outcome: Making ongoing, real-time assessment feasible|journal=Journal of Brief Therapy|volume=5|issue=1|pages=5–22}}</ref> * Increased client retention * Reduction of deterioration rates (50%)<ref name=":0" /> * Shortening the length of time spent in care

== Relationship to therapist development and deliberate practice == A central question in psychotherapy research is whether therapists improve in effectiveness over the course of their careers.<ref name=":1" /> Studies of therapist effects have repeatedly documented substantial differences among individual therapists in the clinical outcomes their clients achieve.<ref>{{Cite book |last=Wampold |first=B.E. |title=The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work (2nd ed.) |last2=Imel |first2=Z.E. |year=2015 |isbn=978-0805857092}}</ref> A large longitudinal study analyzing outcomes from over 6,500 patients treated by 170 therapists found that patient outcomes did not improve with accumulated therapist experience and showed a small but statistically significant decline over time.<ref>{{Cite journal |last=Goldberg |first=Simon B. |last2=Rousmaniere |first2=Tony |last3=Miller |first3=Scott D. |last4=Whipple |first4=Jason |last5=Nielsen |first5=Stevan Lars |last6=Hoyt |first6=William T. |last7=Wampold |first7=Bruce E. |date=2016 |title=Do psychotherapists improve with time and experience? A longitudinal analysis of outcomes in a clinical setting. |url=https://doi.apa.org/doi/10.1037/cou0000131 |journal=Journal of Counseling Psychology |language=en |volume=63 |issue=1 |pages=1–11 |doi=10.1037/cou0000131 |issn=1939-2168|url-access=subscription }}</ref> However, a companion study at a different agency that had integrated routine outcome monitoring into supervision and deliberate practice of therapeutic skills found small but statistically significant improvements in therapist effectiveness over time.<ref>{{Cite journal |last=Goldberg |first=Simon B. |last2=Babins-Wagner |first2=Robbie |last3=Rousmaniere |first3=Tony |last4=Berzins |first4=Sandy |last5=Hoyt |first5=William T. |last6=Whipple |first6=Jason L. |last7=Miller |first7=Scott D. |last8=Wampold |first8=Bruce E. |date=2016 |title=Creating a climate for therapist improvement: A case study of an agency focused on outcomes and deliberate practice. |url=https://doi.apa.org/doi/10.1037/pst0000060 |journal=Psychotherapy |language=en |volume=53 |issue=3 |pages=367–375 |doi=10.1037/pst0000060 |issn=1939-1536|url-access=subscription }}</ref> A subsequent randomized clinical trial also found that the positive effects of routine outcome monitoring increased as training and supervisory support for its use increased.<ref>{{Cite journal |last=Brattland |first=Heidi |last2=Koksvik |first2=John Morten |last3=Burkeland |first3=Olav |last4=Gråwe |first4=Rolf Wilhelm |last5=Klöckner |first5=Christian |last6=Linaker |first6=Olav Morten |last7=Ryum |first7=Truls |last8=Wampold |first8=Bruce |last9=Lara-Cabrera |first9=Mariela Loreto |last10=Iversen |first10=Valentina Cabral |date=2018 |title=The effects of routine outcome monitoring (ROM) on therapy outcomes in the course of an implementation process: A randomized clinical trial. |url=https://doi.apa.org/doi/10.1037/cou0000286 |journal=Journal of Counseling Psychology |language=en |volume=65 |issue=5 |pages=641–652 |doi=10.1037/cou0000286 |issn=1939-2168|hdl=11250/2560071 |hdl-access=free }}</ref>

These findings contributed to growing interest in integrating client outcome data into [[clinical supervision]] and training. Miller and Hubble argued that clinical mastery begins with establishing a baseline of one's own effectiveness through outcome data, then using that baseline to pinpoint specific areas of deficit and design targeted practice activities accordingly.<ref>{{Cite journal |last=Miller |first=S.D. |last2=Hubble |first2=M.A. |year=2011 |title=The road to mastery |url=https://www.psychotherapynetworker.org/article/road-mastery/ |journal=Psychotherapy Networker |volume=35 |issue=2 |pages=22-31}}</ref> In graduate training contexts, this framework can be applied by having trainees collect and review outcome data on their own caseloads under supervision, using the data to set individualized learning goals, and structuring practice activities around identified growth areas. This approach transforms routine clinical work into a vehicle for deliberate skill development rather than mere accumulation of hours. Researchers have described strategies for using outcome monitoring in supervision, including training students to obtain and use objective client feedback and identifying patterns across clients to guide supervisee development.<ref>{{Cite journal |last=Swift |first=Joshua K. |last2=Callahan |first2=Jennifer L. |last3=Rousmaniere |first3=Tony G. |last4=Whipple |first4=Jason L. |last5=Dexter |first5=Kyle |last6=Wrape |first6=Elizabeth R. |date=2015 |title=Using client outcome monitoring as a tool for supervision. |url=https://doi.apa.org/doi/10.1037/a0037659 |journal=Psychotherapy |language=en |volume=52 |issue=2 |pages=180–184 |doi=10.1037/a0037659 |issn=1939-1536|url-access=subscription }}</ref> Broader frameworks have proposed using FIT data as the basis for a cyclical process of therapist development, in which outcome and alliance measures identify areas for improvement that then become the focus of structured skill practice.<ref>{{Cite book |last=Miller |first=Scott D. |title=Better results: using deliberate practice to improve therapeutic effectiveness |last2=Hubble |first2=Mark A. |last3=Chow |first3=Daryl |date=2020 |publisher=American Psychological Association |others=American Psychological Association |isbn=978-1-4338-3190-4 |location=Washington, DC}}</ref> In this approach, tools such as the ORS and SRS serve not only as clinical decision aids but also as a performance measurement system for ongoing professional development. Some graduate training programs integrate FIT and [[Practice (learning method)|deliberate practice]] into their curricula. One example of this integration is the Sentio University Marriage and Family Therapy program, a nonprofit graduate institution in Los Angeles, California. Sentio's curriculum is built around the "Clinic-to-Classroom" method,<ref>{{Cite journal |last=Rousmaniere |first=T |last2=Vaz |first2=A |year=2025 |title=Sentio's clinic-to-classroom method: Bridging deliberate practice and clinical training. |url=https://societyforpsychotherapy.org/sentios-clinic-to-classroom-methodbridging-deliberate-practice-and-clinical-training/ |journal=Psychotherapy Bulletin |volume=60 |issue=2 |pages=79-84}}</ref> in which real FIT data from the program's integrated training clinic are brought directly into the classroom to inform deliberate practice skills training.<ref>{{Cite web |title=Feedback-Informed Treatment in Marriage and Family Therapy Programs: A Research Overview |url=https://sentio.org/feedback-informed-treatment |access-date=2026-03-22 |website=Sentio University |language=en-US}}</ref>

== Further reading == * Prescott, D. Maeschalck, C & Miller, S.D. (eds.) (2017). ''Feedback Informed Treatment in Clinical Practice.'' Washington, D.C.: American Psychological Association Press. {{ISBN|978-1-4338-2774-7}}.

* Miller, S.D., Hubble, M.A. & Chow, D. (2021). ''Better Results: Using [[Practice (learning method)|Deliberate Practice]] to Improve Therapeutic Effectiveness.'' Washington, D.C.: American Psychological Association Press. {{ISBN|978-1-4338-3344-1}}.

== External links == * [https://www.iccexcellence.com International Center for Clinical Excellence]{{Dead link|date=April 2024 |bot=InternetArchiveBot |fix-attempted=yes }} * [http://centerforclinicalexcellence.com/wp-content/uploads/2021/05/FIT-Publications.xlsm FIT Research Studies] * [https://sentio.org/feedback-informed-treatment Sentio Marriage and Family Therapy Program in California]

== References ==

{{Reflist}}

[[Category:Treatment of mental disorders]] [[Category:Feedback]]

{{mental-disorder-stub}}