The Clinical Support Tools (CST) was developed to help therapists organize and target potential problems that might account for negative outcomes in psychotherapy. The core of CST feedback is The Assessment for Signal Clients (ASC). The purpose of this study was to describe and identify patterns of problems that typically characterize off-track cases. A cluster analysis of 107 off-track clients revealed three client types: those whose problems were characterized by alliance and motivational difficulties; those characterized by social support and life event difficulties; and those whose problems had an indistinguishable pattern. Loglinear modeling showed that if patients had less therapeutic alliance problems they were also less likely to have motivational problems. Findings were also consistent with the cluster analysis, which showed that a relatively higher percentage of not-on-track participants received signal alerts for the social support items and scale. Individuals whose progress goes off-track appear to have their greatest difficulty with social support, losses, and therapy task agreement.

This two-article dissertation examined the impact of enhanced educational dialogue, in terms of periodic email feedback on course progress and an invitation to participate in a discussion board, on student achievement and course satisfaction in an introductory statistics course offered in an independent study setting. Participants in the study were students enrolled in the year-long online course. They were randomly assigned to different types and levels of educational dialogue and their completion status, final exam scores, average quiz scores, and course satisfaction ratings were compared after controlling for the following covariates of interest: age, gender, high school GPA, Math ACT, learner autonomy, attitude on the usefulness of statistics, and confidence in learning statistics. The different types and levels of educational dialogue used in this study were: email reminders only, discussion board only, email and discussion board, and no email or discussion board. Successful completion of introductory statistics courses in online learning environments can be predicted by student's attitude toward statistics and learner autonomy, in addition to the conventional measures of mathematics aptitude (ACT Math score) and effort as measured by High School GPA; however, there is a scarcity of psychometrically sound and brief measures of these constructs. The first article developed and validated the following scales as measures of attitude toward statistics and learner autonomy: perceived value of statistics (4 items), confidence in learning statistics (4 items), and learner autonomy (3 items). These abbreviated scales are shown to have content and discriminant validity. They can be used by statistics education researchers with confidence. The second article used MANCOVA and logistic regression to analyze the data collected from the randomized controlled experiment. The MANCOVA results show that students who have higher confidence in learning statistics have higher final exam scores and higher course satisfaction at the 5% level of significance. In addition, students assigned to the email group have the highest average quiz scores. Logistic regression results show that older students and those who have high confidence in learning statistics are more likely to complete the course. Overall, the completion rate for this study is significantly higher than the previous sections of the course. One of the implications of this study is that basic course progress feedback to students with minimal teacher-student interaction may have a beneficial impact on student achievement in online courses.

Researchers have found evidence that when clinicians use an evidence-based feedback system that uses Clinical Support Tools (CST) for not-on-track clients, deterioration rates fall and success rates improve (Shimokawa et al., 2010). Despite multiple studies finding evidence in support of using the CST, there has been a discrepancy between effect sizes (i.e., d = 0.5; Simon et al., 2012). As such, further replicate of these past studies is needed to discover if small effect sizes still persist and if so, what possible variables may contribute to inconsistent findings. For the current study, it was predicted that the use of the CST would result in significantly lower OQ-45 scores at treatment termination after controlling for the intake OQ-45 score. Additionally, previous research indicated that the combined intervention of the progress feedback plus CST would significantly reduce deterioration rates with those NOT. Out of 1,122 participants, 172 were randomly assigned to one of two conditions: The CST feedback group (n = 71) and the no CST feedback group (n = 101). There was not a significant difference in the mean OQ-45 scores for the CST feedback group (M = 2.39, SD = 20.95) and the no CST feedback group (M = 4.17, SD = 19.74). The results of this study raise questions about how regularly the therapists were monitoring their clients' progress feedback and whether the CST are effective. Additionally, the author evaluates the timing of when the CST were administered to clients and when therapists reviewed the feedback.