While the beneficial effects of psychotherapy have been well documented, the fact remains that 5 to 10 percent of clients get worse while in treatment (Lambert & Ogles, 2004) and a large minority of patients show little response (Hansen, Lambert, & Forman, 2003). The effects of four interventions, aimed at reducing deterioration and enhancing positive outcomes were examined in an Immediate Electronic Feedback sample of 1101 patients whose outcome was contrasted across experimental groups and with two archival groups: the Week-Delayed Feedback group, consisting of archival data from 1374 patients and the treatment-as-usual control group consisting of archival data from 1445 patients. Results indicate that feedback to therapists improved outcome across clients, especially for signal-alarm cases. Therapist feedback effects were enhanced by the use of manually based Clinical Support Tools, but not by providing direct feedback to clients about their progress. There were no significant differences in outcome between the Week-Delayed CST feedback and the 2-Week-Delayed CST feedback groups; however, clients in the Week-Delayed CST feedback condition, attended 3 less sessions, on average, than their 2-Week-Delayed CST feedback counterparts. Furthermore, a significantly greater number of people in the Week-Delayed CST Feedback group ended treatment in the Recovered/Improved classification of the Jacobson/Truax model.

While most clients show improvement in therapy, anomalously, 5% to 10% actually worsen, and a significant minority of clients shows little or no response to therapy. Earlier studies developed clinical support tools (CSTs) designed to provide feedback to therapists about potential problem areas and to improve the likelihood of a positive outcome for clients identified as at-risk for a negative outcome in therapy (Harmon et. al. 2007; Slade, Lambert, Harmon, Smart, & Bailey, 2008; Whipple et al., 2003). While varying from study to study, the CSTs looked at five domains: therapeutic alliance, motivation to change, social support, life events, and perfectionism. More than 100 questions were used to assess these domains. The major goal of this study was to streamline the CST measures to increase efficiency. Toward that end, a new instrument consisting of 37 questions was developed by administering questionnaires to 169 patients at a rural Utah mental health center. In addition, the life events and social support questions were given to 76 students at Brigham Young University and 88 randomly selected residents of Utah County. Using item response analysis and mean scores for each dimension, subscale cut scores were developed for four dimensions: therapeutic alliance, motivation for therapy, social support, and life events. The perfectionism subscale was dropped from the questionnaire because perfectionism was deemed to be too stable to be useful for the intended use of the measure. Cut scores were also developed for each individual question. These subscale and individual item cut scores are intended to help clinicians identify potential problem areas to be explored during the course of therapy.

There is limited research on the use of results-based management (RBM) in schools, therefore this study focussed on developing a sustainable and effective RBM model. The objectives of the study were to identify the obstacles encountered in implementing RBM in primary and secondary schools in the Goromonzi District, identify and describe the steps taken in developing and sustaining an effective RBM model, and to develop a sustainable and effective RBM model suitable for both Zimbabwean primary and secondary schools. A qualitative research method was used since the researcher’s interest was to gain insight into and understanding of school heads’ and teachers’ perceptions, concerns and experiences in their real world conditions when implementing RBM. The study covered ten purposely selected schools in the Goromonzi District. Semi-structured individual and focus group interviews were conducted with the school heads and teachers. To enhance the validity of the findings, this study adhered to ethical principles and techniques. The following salient findings that emerged from the study were that the school heads and teachers had a negative perception of IRBM because a top-down approach was used when it was introduced and the system was not customised since it was merely “imported” from a developed country whose context was different from the Zimbabwean socio-political and economic environment. There was also a serious dearth of financial resources to support the system and this affected the quality of RBM training negatively. The lack of funding also led to the non-payment of incentives for the staff with regard to implementing RBM. It was also indicated that the senior Ministry of Primary and Secondary Education officials showed a lack of commitment and support for RBM. To address the implementation challenges it was indicated that resources had to be mobilised to ensure the capacitation of school heads and teachers and also for incentivising them. Incentivising staff is critical for the successful implementation of RBM. It was also noted that there was a need to develop a results culture in schools and train school heads in change management. It was concluded that a home grown RBM model that was context sensitive to the Zimbabwean situation was required. As envisaged, the study resulted in the development of the three phased Zimbabwe results-based management practical model (ZRBMPM). The first phase addresses RBM implementing challenges and the second phase focusses on incentivising staff to promote the effective implementation of results management. The last phase entails the production of the results. / Educational Leadership and Management / D. Ed. (Education Management)