Change Metrics refers to an outcome measure’s ability to use a Reliable Change Index (RCI) and cutoff score to define standards for clinically significant change achieved during mental health treatment (i.e. classifying patient change as—recovered, improved, no change or deterioration).


Reliable Change Index is the amount by which a client’s total score must increase (deterioration) or decrease (improvement) to be considered clinically significant. Changes in the total score that are less then the RCI are not statistically relevant (i.e. no change). Following is a table of the RCI’s for each Measure.

Measure RCI 
 OQ®-45.2  14
 OQ®-30.2  10
 Y-OQ® 2.01  13
 Y-OQ® SR 2.0  18
 Y-OQ® 30.2  10
 S-OQ® 2.0  18


(Examples of items measured in the sub scales)

Symptom Distress (SD)

  • Anxiety disorders
  • Affective disorders
  • Stress related iIllnesses

Interpersonal Relations (IR)

  • Loneliness
  • Conflict with others
  • Family difficulties

Social Role Performance (SR)

  • Conflicts at work
  • Relationships
  • Interaction with parents, adults, and peers


(Examples of items measured in the sub scales)

Intrapersonal Distress (ID)

  • Anxiety
  • Depression
  • Self-harm

Somatic (S)

  • Headaches
  • Dizziness
  • Pain or weakness in joints

Interpersonal Relations (IR)

  • Attitude towards others
  • Communication and interaction with friends
  • Aggressiveness, arguing, and defiance.

Critical Items (CI)

  • Paranoia
  • Hallucination
  • Delusions, suicide, eating disorder issues.

Social Problems (SP)

  • Truancy
  • Sexual problems
  • Substance abuse

Behavioral Dysfunction (BD)

  • Times of inattention
  • Hyperactivity
  • Impulsivity


You can have a staff read it to the client but training and supervision are necessary to ensure that we do not introduce bias into the answers.  It is important if someone does not understand what you asked them to clarify the question if they have not gotten the point. Some of the questions are intentionally vague and a subjective response is desired, ie., the clients perception of what is being asked.  How you phrase a question is very critical to creating an atmosphere where the client wants to present the most accurate impression of how they are doing.


Some clients and especially ones with a borderline personality disorder will have score profiles that are up and down and giving lots of alerts.  It is important to pay attention to these changes but only red alerts are cause for particular attention.  One way to use the instrument is to point out these swings and probe to see what has changed or happened with emphasis on exploring what was occurring when improvement occurred. Multiple red warnings increase the likelihood that a patient will have a negative outcome if the warnings are not attended to by the clinician.


You can track overall change, looking at the total score.  You can track specific symptoms or behaviors using subscale scores. The OQ, administered and scored in the waiting room, also offers the opportunity to see a detailed snapshot of how a client is doing before the session starts.  This includes a set of critical items that may require immediate attention.


The OQ® Analyst software will tell you if the client is making reliable improvement, possible improvement, no change, possible worsening, or reliable worsening.  Furthermore, it will recommend general next steps such as continuing things as they are, considering discharge, treatment plan review, or intensive and immediate intervention.  Your best interpretive tool, though is talking with your clients about their own scores and what they mean.


For adult clients you will see a total score, critical items, and subscale scores on interpersonal distress, social relationships, and social role functioning.  For children and adolescents, you will see a total score, critical items, and subscale scores on intrapersonal distress, somatic symptoms, interpersonal relations, social problems, and behavioral dysfunction.


The therapist should take the opportunity to explain to the patient, parent, or guardian that the OQ is a routine questionnaire that monitors the patient’s sense of well being, just like a lab test.

  • The patient, parent, or guardian should be informed that completing the OQ is encouraged, but voluntary.
  • Patients should be told that completing the OQ is becoming a routine part of treatment for all psychotherapy patients and that they are not being singled out.
  • The clinician can describe how reviewing the scores together can be both interesting and helpful.
  • Experience with the instrument shows that the attitude, and of patients toward completing the measures, and ultimately their willingness to do so is highly dependent on therapists’ positive or negative attitudes.
  • Few patients reject the measures if clinicians suggest they will be valuable and helpful to the patient.


The OQ provides a very early, statistically validated read on how the client is doing and whether they are having the desired or expected response to treatment.

  • Results can be used to provide encouragement for clients who are doing well and to have a focused discussion about what is working and what is not if clients are not having the expected or desired improvement.
  • The subscale scores can be used to identify and target particularly problematic areas as a focus of treatment.
  • Client responses to particular items can draw provider attention to areas that need investigation during the current session.
  • The results allow the provider and client to jointly monitor the client’s progress from a shared point of reference, allowing the client to participate more fully in assuring that their treatment is as effective and efficient as possible.