The Evidence-Based Practice (EBP) movement has gained considerable influence in the healthcare industry, including psychotherapy. The American Psychological Association's (APA) official stance on EBP encouraged clinicians to used standardized outcome measures in routine practice in order to establish the efficacy of their interventions. Routine Outcome Measurement (ROM) systems were designed specifically to accomplish this purpose, and have been shown to improve client outcomes and provide valuable aggregate data that contributes to empirical literature. Despite this research and the endorsement of the APA's official EBP stance, these measures have not been widely adopted by clinicians. Several studies have found that clinicians find the measures impractical and lacking in clinical relevance. In order to accommodate these clinician concerns, while still maintaining the major features of ROM, the Clinically Adaptive Multidimensional Outcome Survey (CAMOS) was developed. The CAMOS employs a unique system that allows clinicians to be able to tailor the measure to the needs of their client, while still maintaining a core of standardized items. The present study attempted to identify a short form of McBride's measurement model, in order to determine which items would form this standardized core. The study found evidence for the validity and reliability of the CAMOS short form. With this evidence, the short form can serve as the basis for the CAMOS's unique tailoring system. It is hoped that the novel features of the CAMOS can help accomplish the APA's goals in relation to EBP.

<p>This thesis focuses on routine outcome measurement in occupational therapy; specifically the use of the Canadian Occupational Performance Measure (COPM) in inpatient geriatric rehabilitation.</p> <p>The purpose of the first study (Chapters two and three) was to: 1) determine if routine COPM use was associated with improved functional outcome; 2) gather therapist perceptions on routine COPM use; and, 3) propose a template for summarizing COPM data. A cohort study with a therapist participant survey measured the difference in Functional Independence Measure (FIM^™) change scores between an experimental group (n = 45) that implemented the routine use of the COPM for evaluation/planning and a historical “usual care” comparison group (n = 58). Using generalized linear modeling, it was found that both groups had significant changes in FIM^™scores over time (p <. 05). Differences between groups were not significant. Therapists perceived that the COPM facilitated treatment but experienced challenges in routine use. Therapists placed more importance on individual than group data.</p> <p>The second study (Chapter four) determined if routine use of the COPM was associated with changes in five domains of practice: focus of care on occupation, knowledge of client perspective, clinical decision-making, clinician ability to articulate outcomes, and documentation. Twenty-four occupational therapists on eight geriatric rehabilitation units completed a before-and-after study with a repeated baseline. Domains of practice during three months of standard care (no COPM) were compared using Chart Stimulated Recall and chart audit as outcome measures to three months of intervention (COPM). Mean practice scores indicated a significant effect for time (p < .0001) but no effect based on the frequency of COPM use. Chart audit indicated that COPM use resulted in more occupation-focused issue identification.</p> <p>This thesis challenges assumptions regarding the value of measurement and contains the first study to demonstrate that routine outcome measure use affects occupational therapy practice.</p> / Doctor of Philosophy (PhD)