Ultra-brief measures of outcome, while they capture limited detail, make the collection of session by session progress data very feasible. If you’re looking for a measure with the lightest possible measurement load, then the Outcome Rating Scale is well worth considering.
There is a trade off in measurement between capturing detail about the impact of problems on clients and the time it takes to collect that detail. The more we ask for in standard measures of outcome the longer it takes for clients to complete them.
Detail can be helpful in rounding out the picture we gain from clients at assessment. Using longer measures at the start and end of therapy is relatively feasible. But when we start to use measures on a more regular or sessional basis longer measures it can start to feel burdensome for both therapist and client alike.
It was the experience of using the 45 item Outcome Questionnaire 45.2 (OQ-45.2) in routine practice that led Scott Miller and Barry Duncan to develop, with others, the Outcome Rating Scale (ORS).
The Outcome Rating Scale
4 item ultra-brief measure of severity in previous week for key areas of life functioning
Designed as a brief measure suitable for session by session use
10 cm visual analog scale giving a scoring range between 1 – 10
Suitable for adults and young people 13 and upwards
13–17-year olds = 28
18 and over = 25
Having used the OQ45.2 in a range of settings and experienced a range of complaints from both practitioners and clients alike about the its length and the time required to complete it, as well as the content, they set about the task of developing an ultra-brief measure of outcome that could be easily used on a session by session basis and thereby considerably reduce the overall burden of measurement.
What is it?
As outlined in the paper detailing its initial psychometric properties, [i] the Outcome Rating Scale (ORS) is an ultra-brief measure designed to assess the degree of severity of clients’ experience in a number of key areas of life functioning.
The items on the ORS were adapted from the three areas of client functioning assessed by the OQ-45.2; namely, individual, interpersonal and social role functioning. As stated in the paper changes in these areas are widely considered to be valid indicators of successful treatment outcome.
The ORS is designed to be accessible for people with a reading age of 13, making it suitable for adolescents and adults. The Child Outcome Rating Scale (CORS) was developed for use with children between 6 – 12 and features simpler language and the use of smiley and frowny faces to assist children in completing the scales.
What does it measure?
Specifically, the four scales on the measure ask clients to rate how well they are doing in the following four areas:
Individually (Personal wellbeing)
Interpersonally (Family, close relationships)
Socially (Work, school, friendships)
Overall (General sense of wellbeing)
Scoring the measure
The four dimensions of functioning in the ORS are presented as four visual analogue scales (as shown in the main image above) which are 10cm lines. Clients are instructed to place a mark on each line that corresponds with their experience in the past week.
Marks to the left represent lower levels of functioning in that area, and marks to the right represent higher levels. This should be explained clearly to clients as the instructions on the measure alone may cause confusion for some clients. This is more clearly shown in the screenshot below of the ORS embedded within the Pragmatic Tracker software.
Scoring can be done simply by using a ruler against each scale starting at 0. If the client’s mark is at 2.8cm then the score is 2.8 for that scale. Scores can be written at the right of each scale and added together to derive a total score for all items. The highest score possible is 40.
What do the numbers mean?
Unlike the CORE Outcome Measure and the GAD-7, which I’ve previously profiled, lower scores indicate poorer functioning. The clinical cut-offs for the ORS and the CORS are age dependent and are as follows:
13 – 17-year-old = 28
18 and over = 25
CORS (12 and under)
Child Self Reporting = 32
Carer Reporting on Child = 28
If used as a session by session measure the clients scores at each session can be plotted on a graph showing the client’s progress. A simple paper-based chart with the relevant cut-off will suffice if using paper measures.
A progress chart using the ORS within Pragmatic Tracker is shown below. The irregular line shows the client’s score improving over the course of four sessions to the point at which they are above the adult cut-off point of 25 (bear in mind higher scores are indicative of improvement).
Copyright, cost and where to get it
A license for individual practitioners to use the paper and pencil version of the ORS is available free of charge from Scott Miller here. Organisational licenses dependent on the number of providers within the organisation can also be purchased.
No electronic or digital use of the scales is permitted, however, a range of providers have been licensed to build in the ORS to software and further details are available here
How to choose a therapy outcome measure
Introducing measures into working with clients
Made to measure: CORE
Made to measure: GAD-7
[i] Miller, S. D., Duncan, B.L., Brown, J., Sparks, J., & Claud, D. (2003). The Outcome Rating Scale: A preliminary study of the reliability, validity, and feasibility of a brief visual analog measure. Journal of Brief Therapy, 2, 91-100.
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2 replies on “Made to measure: The Outcome Rating Scale”
Thanks for another interesting article. I have used the ORS through one of the EAP’s that I work for and have often wondered about it’s background.
Picking up on the comments that you and Graeme made in relation to objectivity in outcome measuring. It was interesting to discover that there is a clinical cut off in the ORS, which implies a degree of objectivity which I have not observed.
My experience has been that some clients will continue to score themselves quite low, even when their verbal appraisal of their situation is improving. The idea in their heads must be that there is still a long way to go before things are at the best they can be.
As I want any outcome measure to be useful in therapy, I have asked some clients about their scores after they have given them and through this conversation they have then re-assessed their thoughts and increased the score. Which adds to my idea that it is a particularly subjective measure and while it can be useful with the individual, I often wonder what the EAP think when they see the results.
Thanks for the comments David!
It’s sometimes difficult to understand how it is that we or others may approach the completion of measure items, isn’t it. I think you make an excellent point, therefore, about following up on what may seem like discrepancies between the numbers and the narrative. As to what EAP’s think about the data I really do wonder if most have any idea at all what to do with it. I use three different measures with three different EAP’s and I’ve never had any feedback on how I might be doing. I suspect the measures are doing the electronic equivalent of gathering dust in the corner!