Author ORCID Identifier

Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation




Educational, School, and Counseling Psychology

First Advisor

Dr. Robert J. Reese


The implementation of the Affordable Care Act (ACA, 2010) has resulted in efforts to make healthcare more affordable and effective. One strategy for making healthcare more affordable and effective is the integration of behavioral health and primary care. In today’s healthcare system, it is estimated that approximately one in three patients seen in a primary care setting meet the criteria for a mental health disorder and another third – while not meeting those criteria – are experiencing psychological symptoms that impair their functioning (Kessler, 2005). Despite the evidence supporting behavioral health services in a primary care setting, treatments tend to be diagnosis specific (Archer et al., 2012; Lemmens, Molema, Versnel, Baan, & deBruin, 2015) and as such do not capture patients’ varied presentations. Patient feedback offers a potential strategy to improve the quality of services provided. Patient feedback is the use of measures administered at each session to assess distress and track progress. There is a robust psychotherapy literature demonstrating the effectiveness of using routine progress monitoring in clinical practice but it has not been evaluated in an integrated care setting. Therefore, the purpose of this study was to evaluate the efficacy of patient feedback in this setting. Preliminary results of this ongoing study revealed there was a moderate feedback effect using both the ORS (d = 0.38) and PHQ-9 (d = 0.12) as the outcome measures. Using the ORS as the outcome measure, patients in the feedback condition demonstrated faster treatment gains, which suggests that they improved faster compared to those patients in the TAU condition. Additionally, patients in the feedback condition incurred significantly more reliable change compared to TAU. However, this result was not replicated when the PHQ-9 was used to measure outcome. Overall, the results suggest that PCOMS may be a potentially useful quality improvement strategy.

Digital Object Identifier (DOI)