The future of outcome monitoring among Australian Psychologists

The highly successful program for Medicare subsided sessions with psychologists has had two major shortcomings:

1.     –  The fact the 10 sessions is not enough for many patients

2.     –  The limited evaluation of the effectiveness of these MBS services. 

I’d like to take the time to share my thoughts on the future of Medicare psychology services in Australia, in light of the Productivity Commission’s recommendations.

If mandatory outcome monitoring is to be introduced, as the draft report suggests, I’d propose that psychologists be invited to participate in a program evaluation process that requires collection of outcome data and those who enrol be allowed to provide 20 sessions per calendar. The strategy of linking funding for extra sessions with participation in evaluation has a number of advantages, including creating an incentive for private psychologists to opt into participating in the initial rollout of outcome monitoring while at the same time evaluating the effectiveness of the increased session numbers.

Under the current Better Access model GPs undertake rudimentary and disconnected outcome monitoring, generally by administering a paper copy of the K-10 questionnaire measuring psychological distress. The current process has some serious shortcomings, including that the K-10 data is not systematically transmitted to a central body for evaluation. In addition, outcome monitoring is best done by the treating clinician (e.g. the psychologist) as an intrinsic part of the therapeutic process rather than by a referring party (the GP).

In fact, it is good practice in psychological therapy to administer symptom monitoring scales each session to provide psychologist and client with immediate and objective feedback about their symptoms. A recent paper in Lancet (Delgadillo et al., 2018) found that psychological therapy with continuous symptom monitoring increases the effectiveness of treatment compared to psychological therapy without outcome monitoring and immediate feedback.   

Given the evidence that outcome monitoring within therapy improves outcomes many psychologists are already integrating outcome monitoring into their practice. NovoPsych facilitates this through our software for more than 3000 psychologists.

We suggest that the administration of outcome measures for the proposed trial of 20 sessions of MBS funded psychological therapy be collected by psychologists (rather than the GP). MBS items could be structured such that a requirement be that an outcome measurement tool be administered every psychology session and that the data be digitally transmitted to a central point.

We would suggest the outcome measurement tool be either the Depression Anxiety Stress Scale (DASS-21) or Kessler 10 (K10) given their current wide use and ease of administration. If you’d like our detailed project design please contact Dr Ben Buchanan (details above).

Draft Recommendation 22.5 – Building a Strong Evaluation Culture 
A robust culture of program evaluation should inform the allocation of public funds across the mental health system to ensure that they are deployed most efficiently and effectively.

We note that some professions within the mental health workforce have critical training and expertise in program evaluation and outcome measurement, and there is a grass roots effort, particularly among psychologists, to engage in outcome monitoring through the collection of data. Psychology practices that provide sessions subsidised by Medicare could benefit from policy settings that support evaluation culture.   

Draft Recommendation 25.3 – Strategies to Fill Data Gaps
 Collect the data in a way that imposes the least regulatory burden to ensure data is high-quality and fit-for-purpose– publish the data in ways that are useful to policy makers, service providers and consumers.

It is our experience that practitioners and service providers can be reluctant to collect data given the administrative burden. This is especially true in private practice settings.  For example, a survey of Australian Psychologists found the two reasons most often cited for not collecting outcome data was 1) “Takes too long to administer and score” and 2) “Too much of a burden for clients” (Chung & Buchanan 2018).

We’d therefore recommend that the use of outcome monitoring be incentivised by funding models. For example, allowing private psychologists who routinely collect and report outcome data to provide 20 Medicare rebated sessions per year rather than the current 10.

Draft Finding 25.1 Monitoring and Reporting at the Service Provider Level
Monitoring and reporting at the provider level can improve transparency and accountability, and potentially service quality, through: · publishing data that informs consumer choice and drives self-improvement · benchmarking analyses, where services are able to regularly compare their performance relative to similar services, that prompt discussions and information sharing.

As many NovoPsych users know, increasing number of private psychology practices are engaging in monitoring outcomes. These practices are using outcome data to tender for contracts, provide feedback for professional development and service improvement, and occasionally publishing their results publicly and provided to consumers via a service’s website. These are positive developments that have occurred in the absence of policy incentives. In the future this can be further encouraged by linking extra levels of Medicare funding with the requirement for routine outcome monitoring.  For example, increasing the limit of 10 psychology sessions to 20 per year, provided that the service provider uses an approved outcome monitoring and reporting framework.

Benchmarking treatment outcomes via routine outcome monitoring is an extremely valuable process. It can help service providers identify their strengths and weaknesses compared to their peers and modify practices when necessary. Understandably, comparing treatment outcomes through benchmarking can be anxiety producing for providers who may feel their competency is being scrutinized. 

I’d therefore suggest that any attempt to widely implement benchmarking for Medicare-subsidised psychology services delivered in a private setting be lead from within the profession, with an emphasis on self-directed quality improvement.  Education and training for clinicians on outcome monitoring and benchmarking practices is key and care should be taken to empower professionals who participate.

In due course standardized approaches to publishing outcome data for public consumption could be developed, providing more transparently when mental health consumers are making health care choices. In addition, outcome data could be a key component for accreditation standards developed from within the profession for psychology private practices.

The profession of psychology has a flourishing peer supervision culture, where fellow psychologists provide feedback and train each other. Benchmarking augmented with current supervision practices would be a powerful quality improvement practice and could be supported via funding for data-driven supervision training.

We also acknowledge the risk of unintended consequences if benchmarking is rolled out in the wrong way, such as gaming or resistance from service providers. If implemented in partnership with professional groups we think unintended consequences can be successfully minimized.



There is certainly a lot of momentum around outcome monitoring. Many practices are getting ahead of the game by integrating outcome measures into their practice already.  Some people will resist, some will be proactive. Either way, there are interesting times ahead!

Dr Ben Buchanan

NovoPsych Co-founder and Director



Chung, J., & Buchanan, B. (2018). A SelfReport Survey: Australian Clinicians Attitudes Towards Progress Monitoring Measures. Australian Psychologist, 54(1), 3-12

Delgadillo, J., de Jong, K., Lucock, M., Lutz, W., Rubel, J., Gilbody, S., … & O’Hayon, H. (2018). Feedback-informed treatment versus usual psychological treatment for depression and anxiety: a multisite, open-label, cluster randomised controlled trial. The Lancet Psychiatry, 5(7), 564-572.

Assess patient’s mental health remotely via email

The majority of clinicians choose to administer psychometric questionnaires face-to-face in session via the NovoPsych iPad app, however more practices are getting digital and tele-health savvy and administering questionnaires remotely. I want to show you how NovoPsych makes this possible, with features allowing assessments to be sent to your patients via email.

Clients can answer questionnaires on their smartphone or computer at home before your next session, or even before you first meet them. 

With NovoPsych you can:

  • Send a secure email from NovoPsych to your client requesting they complete an assessment (DASS-21 etc.) 
  • Once the client completes the assessment you will be alerted, with results sent directly to you.
  • You can copy an assessment URL so you can send an assessment link to your client via your own messaging system (for example in a welcome email).
  • Have the option to setup automatic emails to be sent to your client on a weekly or monthly basis so you can track symptoms over time. 

How to send an assessment 

1. Login to the NovoPsych platform in your browser (note, these features are not available in the iPad app)
2. Press Email Assessment from the home screen

3. Select a client
4. Choose the assessments you would like to send
5. Press “Copy URL”. The link to the assessment will be ready for you to paste into an email or messaging service.

6. (Optional). If you’d like NovoPsych to send the assessment on your behalf (from the secure NovoPsych email address), you can press “Administer”, which will generate an email with the assessment. You can press “Customise Email” to amend the generic email message. 

With more and more mental health consultations happening remotely this feature helps you measure key outcomes for your patients in a fast and effective way. I hope you find it useful! 

Valuing Questionaire added to NovoPsych

In clinical practice we often get in the routine of administering the same assessments, just because we’re familiar with them. This post will help you get familiar with a new test; the Valuing Questionnaire, which I’ve just added to the NovoPsych library. 

Quick Summary

Used with: Adolescents and Adults
Measures: How consistently someone is living with their values.
Helpful for: Tracking progress in Acceptance and Commitment Therapy (ACT)

Valuing Questionnaire (VQ)

The Valuing Questionnaire (VQ: Smout et al. 2014) is a 10-item self-report scale designed to measure how consistently an individual has been living with their self-determined values and is particularly helpful when administered during a course of ACT.

Values are personal principles someone has chosen to guide their behaviour. Articulation of self-defined values is a core component of ACT-like therapies, and this scale is best used in conjunction with and subsequent to this process in therapy.  The VQ measures “valuing”, which refers to actions one takes to live in accordance with values, rather than simply pleasant outcomes or satisfaction with life.

It measures two constructs:
1. Progress, defined as enactment of values, perseverance, and including clear awareness of what is personally important.

2. Obstruction, which reflects the disruption of valued living due to avoidance of unwanted experience, distraction from values by inattention to values or undue attention to distress.

Here are the 10 questions:

Scoring and Interpretation
Two subscale scores are presented, Progress and Obstruction, which typically have a negative correlation.
Progress (items, 3, 4, 5, 7,9. Range = 0 to 30).
Obstruction (items 1, 2, 6, 8, 10. Range = 0 to 30).

Scores indicative of psychological health are high scores on the Progress scale accompanied by low scores on the Obstruction scale.

As well as raw scores being presented, percentile ranks compared to an undergraduate university sample and a clinical sample are presented. A percentile of 50 on the clinical sample on each subscale represents a typical score for people presenting to outpatient psychology clinics.

When used as a monitoring tool during a course of ACT, successful treatment is indicated by increasing Progress Scores and decreasing Obstruction Scores.

Here is some sample results. The graph shows the scores changing over the course four sessions.

I hope you’ll spend some time getting to know this test, among others. More information on NovoPsych assessments can be found here.

Yours sincerely,
Dr Ben Buchanan
Smout, M., Davies, M., Burns, N., & Christie, A. (2014). Development of the valuing questionnaire (VQ). Journal of Contextual Behavioral Science, 3(3), 164-172.

Outcome measures – Good practice but should they be required?

Dear Colleagues,

I’ve noticed momentum building around Routine Outcome Monitoring. The APS and other groups are all supporting reforms to the Medicare system to include standardised outcome measures.

In order to help psychologists administer psychometric instruments I created the NovoPsych iPad app ( and we now have thousands of psychologists using it. It computes useful metrics, graphs results over time and has dozens of assessments (DASS-21, Spence Children’s Anxiety Scale, CORE-10 etc). If you’re not already involved, you can sign up for free via

– For users of NovoPsych, I hope you might be able to use this thread to provide any feedback about how to make the tool more useful for you?

– For others, I wonder what you make of the recommendations as part of the Medicare review about mandatory Routine Outcome Monitoring? Do you agree that it is a good idea? Are you wary of it? I personally think it *could* be great, provided the requirements don’t add too much of an administrative burden, and streamlined software like NovoPsych can make the process easy. We also need to avoid a “big brother” approach.

All feedback is really useful.

Warm regards,

Dr Ben Buchanan

Productivity Commission Submission from NovoPsych

NovoPsych Productivity Commission Submission

Addressable challenges in the mental health sector

  1. The problem that funding models promote ‘activity-based’ services because the key data measured is activity, not outcomes.
  2. The highly successful Better Access initiative does not have routine outcome monitoring baked into its structure.
  3. The mental health sector has, to date, not had the same emphasis on use of technology to assist in diagnosis and recovery compared to other health fields.
  4. Collaboration between clinician and patient is key, and systems to help individuals understand and monitor their own health and self-management are currently lacking.


NovoPsych is a technology platform designed for mental health clinicians to improve the efficiency and accuracy of mental health assessments, measurement of outcomes, communication between clinicians, and help patients in self-management.

We currently have over 3000 clinicians using the platform, primarily psychologists in private practice, but also work with larger agencies integrating the system into their model of care. The popularity and wide acceptance of our software platform is attributed to the focus on understanding the needs of clinicians, and educating them about the instant and measurable benefits for patients of routine outcome monitoring.

Routine Outcome Monitoring 

Routine outcome monitoring is the regular evaluation of a patient’s treatment response during the course of treatment and provides health care professionals with information relevant to a patient’s progress. This monitoring can improve patient outcomes by enabling clinicians to detect and treat functional and psychological problems that previously may have been missed.

The monitoring is not only useful for clinician and patients themselves, but also provides an opportunity for treatment effectiveness to be evaluated at a systemic level.

Psychologists have specific training in this area on how to interpret outcome measures and understand how to evaluate such measures’ psychometric properties for appropriate use. This is a core skill of psychologists that is under-utilized in the current system.

While state based funded mental health services collect and report on outcome data through the Australian Mental Health Outcomes and Classification Network (AMHOCN) there is no such collection of outcome data being undertaken in MBS funded Better Access services. This was identified as a gap in the initial evaluation of the initiative and considering the significant level of investment in primary mental health care it remains a major gap in the collection of data to inform service planning and the effectiveness of funded services. While many clinicians regularly collect such data using NovoPsych as part of their clinical practice, outcomes measurement is not currently a requirement of the Medicare Benefits Schedule items.

Using Data Analytics to Improve Care

Advances in data analytics and computing power mean that large datasets are an important resource in the decision making process. The best datasets are generally those that are routinely collected by clinicians as a core part of practice– but contain enough detail for researchers and funders to use for valuable secondary analysis.

It is possible to use these datasets to understand trends, patterns and correlations at a large scale and investigate a range of questions much more rapidly and cost-effectively than using methods such as surveys and clinical trials alone. Not only this, datasets can be used to predict with a high degree of accuracy the progression of illness, and therefore what interventions/funding would be optimal.

The wealth of high quality longitudinal data collected by NovoPsych (over 200 million pieces of health information for over 150,000 patients) provides an opportunity to undertake an evaluation of programs and design systems to provide people the best care in a real-time, evidence-based way. Rather than funding models where “one size fits all”, this health data system could be used to provide objective triggers for staged care.

Reducing the strain on Australia’s mental healthcare system requires finding novel approaches to sustainable healthcare delivery. Key to this is investing in a mental healthcare environment that predicts, prevents and delays the onset of chronic and long-term dysfunction, eliminates low-value care and has the capacity to scrutinize and adjust funding in a timely way.

It is urgent that funding systems be person centric, have a degree of precision in the likely outcomes of treatment, and be able to measure the outcome of treatment reliably.

Yours Sincerely,

Dr Ben Buchanan

Co-Founder and Director

A Self‐Report Survey: Australian Clinicians’ Attitudes Towards Progress Monitoring Measures. Australian Psychologist.

Chun, J., Buchanan, B (2018) A Self‐Report Survey: Australian Clinicians’ Attitudes Towards Progress Monitoring Measures. Australian Psychologist.


Research supports an association between regularly administering standardised measures to assess client progress (progress monitoring) and improved treatment outcomes. However, some research suggests clinicians often rely heavily and solely on clinical judgement when making treatment decisions. This study was the first to explore psychologists’ implementation of progress monitoring, within an Australian clinical context.

A self‐report survey investigated Australian psychologists’ (N = 208; gender and age proportional to national representation) attitude, awareness, use, motives, and barriers towards implementing standardised assessment and progress monitoring. The survey comprised of the Attitudes towards Standardised Assessment Scales, and existing literature on progress monitoring implementation.

Ninety‐eight per cent of psychologists were aware of progress monitoring measures, and 69% reported using them in practice. Majority of progress monitoring users rated these measures as very useful (51%) and over one third (39%) used them with most of their clients. Contrary to the hypothesis, a t‐test demonstrated that attitude towards standardised assessment did not differ between progress monitoring users and non‐users. Among the clinicians who have not implemented progress monitoring, time barriers were rated as most important.

This study demonstrates that although awareness of progress monitoring may be widely known, perceived barriers may outweigh the potential benefits for some. It is also concluded that further qualitative research is needed to adequately understand these barriers and their importance. Future interventions may then promote evidence‐based recommendations and focus on the practicality, utility, and workflow difficulties associated with incorporating progress monitoring.

Clinician views of client self-monitoring

Article punished in InPsych Magazine, August 2018. 

The regular use of standardised self-assessment and progress monitoring forms has been associated with improved client treatment outcomes. Research suggests that clinical judgment alone may not be the most accurate and effective method of predicting deterioration in client wellbeing or progress. Progress monitoring forms can be administered at regular intervals during therapy and provide ongoing, individualised and immediate client feedback. Australian researchers surveyed psychologists (N=208) about their attitudes towards using such forms with clients. About half of the psychologists surveyed found such forms useful, and 69 per cent of psychologists were using them with clients. This is in contrast with similar past surveys and with research suggesting that only 12 to 33 per cent of North American psychologists regularly use structured tools with clients. The researchers suggested that in Australia there is increased awareness of their usefulness and emphasis placed on practical- and evidence-based recommendations by government and funding regimes.

It is also becoming easier to incorporate self-monitoring tools into practice, with online tools providing access to a variety of forms and in some cases quicker scoring and evaluation methods. Those Australian psychologists using self-monitoring forms believed strongly in their usefulness, particularly for tracking client progress and to determine if changes to treatment were needed.

Contrary to expectations, attitudes towards standardised assessment did not differ between psychologists who were regularly using progress monitoring forms and those who were not. Among those not using forms the main barriers to their use was believing they take too long to administer and score and would be too much of a burden on clients.

Psychologists were more likely to be using self-monitoring forms if they were primarily treating adults and working in private practice. This suggests a need to increase awareness of self-monitoring measures relevant for work with children. The researchers suggest more psychologists might use self-monitoring forms if their perceptions of their usefulness and practicality were enhanced and if they were given suggestions for workflow management.

Chun, J., Buchanan, B (2018) A Self‐Report Survey: Australian Clinicians’ Attitudes Towards Progress Monitoring Measures. Australian Psychologist.

Introducing WebApp

Introducing WebApp


Dear valued NovoPsych users,

I’m writing to let you know of an exciting update NovoPsych has released to make administering psychometric questionnaires easier.  Thousands of psychologists and mental health clinicians are using NovoPsych daily to track client symptoms, with assessments like the:

  • Depression Anxiety Stress Scales (DASS-21 & DASS-42)
  • Kessler Psychological Distress Scale (K10)
  • Generalised Anxiety Disorder Assessment (GAD-7)
  • Spence Children’s Anxiety Scale (SCAS)
  • And many more (see here)

And you’ve always been able to administer these via NovoPsych on an iPad, but I wanted to make that possible even when your iPad isn’t available. Now you can, with the NovoPsych WebApp, available on any smart device! Because the WebApp uses your web browser, you can use it on your laptop, Android, phone, or whatever.

And best of all, if you already have a NovoPsych account there is no cost to start using the WebApp now!

Sign into WebApp with existing account now

With the WebApp, you can send the assessment from your laptop to your client’s phone in under a second, for them to complete in the waiting room, your office, or while they’re at home. Get the results back on your laptop as soon as they’re done. 


Learn more about the WebApp

Please take a moment to watch the three minute video below that I’ve put together. It will show you how NovoPsych reduces paperwork and has helped clinicians better track client outcomes. 


I hope you find it helpful. I’m constantly trying to create a better tool to make your practice more efficient, so feel free to get in touch, give feedback or request a feature.

Yours sincerely,

Dr Ben Buchanan
Co-founder & Director of NovoPsych Pty Ltd
BA (Hons), GradDipPsych, DPsych, MAPS

Start Exploring NovoPsych Now


For North American users

Upgrade your NovoPsych account to BetterMind

Dear North American NovoPsych users,

We write to inform you that the NovoPsych app is transitioning to an upgraded platform called BetterMind by BetterWorld Healthcare, Inc. As a user of NovoPsych in North America you will be able to upgrade to the new BetterMind app for free for the next seven days. Your user account and existing client data can easily be migrated to the upgraded platform.
We thank you for being a NovoPsych user and strongly encourage you to migrate to BetterMind, which will have the following benefits:

  • BetterMind is an enhanced version of NovoPsych, helping you administer a wide range of psychometric tests via your iPad
  • BetterMind has added three more scales, totaling 43 at this time, and as part of the free migration to BetterMind you will enjoy use of the additional scales as well.
  • BetterMind will continue to be expanded, enhanced and fully supported.
  • You can download BetterMind for FREE (if you don’t download within 7 days of receiving this email the normal price is $29.99)

Please be aware that NovoPsych will not be providing technical support to North American users or providing app updates. As an example, the recent iOS 11 update was done for BetterMind but not done for NovoPsych in North America.  This means that the NovoPsych App will not be supported in North America and the App may eventually stop working.  As a result, you are strongly encouraged to transfer your account to BetterMind.

Once again, we thank you for being a NovoPsych user.  We are confident you will continue to enjoy the same benefits and more using the new BetterMind App.

For any enquires please email us at

The NovoPsych Team