FOR CLINICIANS

Instrument Guide

Choosing the right outcome measure is one of the most important decisions in implementing routine outcome monitoring. This guide provides an objective, side-by-side comparison of the most widely validated instruments used in psychotherapy practice and research.

CPS has no financial relationships with any instrument publisher or developer. Our comparisons are based solely on published psychometric data, clinical utility research, and practical implementation considerations.

Instrument comparison

Key properties of validated outcome measures used in routine outcome monitoring.

Instrument	Items	Time	Cost	Internal consistency (α; typical reported ranges)	Notes	Citation
OQ-45	45 items	5-10 min	Licensed (contact publisher)	α≈.93	RCI and CSI validated; three subscales (symptom distress, interpersonal relations, social role)	Lambert et al. (2004)
ORS	4 visual analog scales	<1 min	Licensed (ICCE)	α≈.87-.93	Ultra-brief; part of PCOMS; validated cut score of 25	Miller et al. (2003)
SRS	4 visual analog scales	<1 min	Licensed (same as ORS)	α≈.88-.96	Alliance measure; validated against WAI; complements ORS in PCOMS	Duncan et al. (2003)
CORE-OM	34 items	5-10 min	Free for clinical use	α≈.94	Four domains; widely used in UK/European services; risk subscale	Evans et al. (2002)
PHQ-9	9 items	2-3 min	Free (public domain)	α≈.86-.89	Depression-specific; DSM criteria mapping; suicidality screen (Item 9)	Kroenke et al. (2001)
GAD-7	7 items	1-2 min	Free (public domain)	α≈.89-.92	Anxiety-specific; good GAD sensitivity/specificity	Spitzer et al. (2006)
NEQ	32 items (20+12 attribution)	5-10 min	Contact developers	α≈.95	Captures negative/adverse effects with attribution	Rozental et al. (2019)

OQ-45

Items: 45 items
Time: 5-10 min
Cost: Licensed (contact publisher)
Internal consistency (α): α≈.93
Notes: RCI and CSI validated; three subscales (symptom distress, interpersonal relations, social role)
Citation: Lambert et al. (2004)

ORS

Items: 4 visual analog scales
Time: <1 min
Cost: Licensed (ICCE)
Internal consistency (α): α≈.87-.93
Notes: Ultra-brief; part of PCOMS; validated cut score of 25
Citation: Miller et al. (2003)

SRS

Items: 4 visual analog scales
Time: <1 min
Cost: Licensed (same as ORS)
Internal consistency (α): α≈.88-.96
Notes: Alliance measure; validated against WAI; complements ORS in PCOMS
Citation: Duncan et al. (2003)

CORE-OM

Items: 34 items
Time: 5-10 min
Cost: Free for clinical use
Internal consistency (α): α≈.94
Notes: Four domains; widely used in UK/European services; risk subscale
Citation: Evans et al. (2002)

PHQ-9

Items: 9 items
Time: 2-3 min
Cost: Free (public domain)
Internal consistency (α): α≈.86-.89
Notes: Depression-specific; DSM criteria mapping; suicidality screen (Item 9)
Citation: Kroenke et al. (2001)

GAD-7

Items: 7 items
Time: 1-2 min
Cost: Free (public domain)
Internal consistency (α): α≈.89-.92
Notes: Anxiety-specific; good GAD sensitivity/specificity
Citation: Spitzer et al. (2006)

NEQ

Items: 32 items (20+12 attribution)
Time: 5-10 min
Cost: Contact developers
Internal consistency (α): α≈.95
Notes: Captures negative/adverse effects with attribution
Citation: Rozental et al. (2019)

Psychometric properties reported here are from published validation studies and may vary across populations and clinical settings.

How to choose

Consider these factors when selecting an outcome measure for your practice.

Practice setting

High-volume clinics benefit from ultra-brief measures (ORS/SRS, PHQ-9). Private practice can accommodate longer instruments (OQ-45, CORE-OM).

Client population

Depression-focused: PHQ-9. Anxiety-focused: GAD-7. Transdiagnostic: OQ-45 or CORE-OM. Alliance monitoring: SRS.

Budget

PHQ-9 and GAD-7 are public domain (free). CORE-OM is free for routine clinical use. OQ-45 and ORS/SRS require licensing.

Administration frequency

Session-by-session: ORS/SRS (ultra-brief). Weekly or biweekly: PHQ-9, GAD-7. Periodic: OQ-45, CORE-OM.

Adverse effects detection

Only the NEQ specifically measures negative therapy effects. The OQ-45 can detect deterioration via RCI.

Research base

OQ-45 has the most extensive feedback research base. PCOMS (ORS/SRS) has growing RCT evidence.

Getting started with ROM

Resources to help you implement routine outcome monitoring in your practice.

Coming Soon

Free Starter Kit

Checklists, quick-start guide, workflow template, and client-facing materials — bundled into a single kit. Coming soon.

Learn more Coming Soon

CE Courses

Earn continuing education credits through evidence-based courses on outcome monitoring, feedback-informed treatment, and client safety.

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Evidence Summaries

Read clinician-focused summaries of the research behind routine outcome monitoring, deterioration rates, and feedback systems.

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Important notes on instrument selection

•Psychometric properties reported here are from published validation studies and may vary across populations and clinical settings.
•Some instruments require licensing. Always verify current licensing terms directly with the publisher before use.
•No single instrument is best for all settings. The right choice depends on your practice context, client population, budget, and clinical goals.
•Consider combining a general outcome measure (e.g., OQ-45, CORE-OM) with an alliance measure (SRS) for the most comprehensive feedback system.

Not an Endorsement

Inclusion of an instrument in this guide does not constitute an endorsement by the Center for Psychotherapy Safety. CPS has no financial relationships with any instrument publisher, developer, or licensing body.

This guide is for educational purposes only. Clinicians are responsible for evaluating instrument suitability for their specific practice setting and ensuring compliance with all applicable licensing requirements.