Session Rating Scale (SRS)
Introduction
The Session Rating Scale (SRS) is a four-item, simple and transparent tool designed to track individuals’ perceptions of the therapeutic relationship. The four dimensions are presented in visual analog format, and represent a relationship scale, goals and topics scale, an approach/method scale, and a total perception of session scale. The SRS is provided to youth at the end of each clinical session to obtain real-time feedback. It is based on encouraging young people to identify any concerns with clinical alliance and the therapeutic process, so that service providers may adjust to better fit youth’s expectations. It has good reliability and validity.
Why are we asking youth to complete this questionnaire?
Young people’s ratings of alliance with service providers are strongly correlated with outcome, and tracking alliance actually helps improve the service provider bond. Moreover, a collaborative relationship is valued at YWHO, thus young people’s perceptions are imperative to consider. Young people may not say anything even if they take exception to a part of the session; The SRS permits an opportunity for youth to provide their perspectives and for service providers to address youth concerns immediately. The SRS is easy to integrate, encouraging a partnership between young people and service providers to monitor and strengthen the alliance.
Responding to youth asking why they are being asked to complete this questionnaire:
At the end each session, we ask you to fill out an additional form. It’s very short, and helps the service provider know how the session went - kind of like taking the “temperature” of the visit. Research shows that your experience of the work together with your service provider during the visit is a good predictor of whether there’s successful treatment outcomes. So it is important that we ask you for your perception of how each session went, in terms of the approach, topics covered, relationships with the service provider, and just overall. Then, the service provider can respond to your views, and working on the therapeutic alliance becomes a joint endeavour.
Clinical questionnaire:
At the hub, when youth are provided the questionnaire on an iPad (or possibly in hard copy form), they receive the following instructions:
When do youth respond to these questions?
Young people are asked to complete this form after each of their clinical visits at the hub.
What if youth don't understand a question?
If a young person requires assistance with an item due to developmental, cognitive, language, or other issues, try to provide these supports:
- Read all items aloud exactly as printed word for word, at an appropriate pace;
- If there is some misunderstanding, repeat the item;
- Determine which word is confusing and define the word, but try not to reword the question (it may alter the meaning of the question, as well as the response); and
- Do not suggest answers.
Scoring/results:
How can I go over results with youth?
Scoring is automatically calculated on the YWHO Data Collection platform, not by the service provider. This is done by simply summing the marks made by the youth (measured to the nearest centimetre) on each of the four lines. If the youth has not completed all questions, the platform will not automatically generate a score.
- Scores are attached to each of the youth’s four ratings where 0 = very negative perception of an aspect of the therapeutic alliance and 10 = very positive perception of an aspect of the therapeutic alliance
- Scores are added up and can range from a total low of 0 to a maximum of 40
- Based on a total possible score of 40, any score lower than 36 overall (or 9 on any scale), could be a source of concern, and service providers are encouraged to open a dialogue with youth.
- Scores of 34 or below always warrant discussion, as such young people are at greater risk for drop out/poor treatment outcome. It is the absence of positive alliance qualities that is strongly correlated with outcome, so it is critical that negative feelings about the session be spoken about openly with youth.
- There is no progress tracker, although past single scores can be viewed for each youth to provide information over time.
Please remember that this rating tool does not operate in isolation. Please take into account findings from verbal feedback, other questionnaires, and use your clinical judgment and discussions with youth and their families to make the most appropriate decisions regarding interventions and therapeutic alliance at your specific YWHO site.
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