Measurement for this initial six-month period followed this sequence: A standard suite of measurements was administered at session one, session 6 and session 12; ORS and SRS assessments occurred at every treatment session for identified patients (IP) only. During this initial six-month period, counselors only received training in the use of the ORS and SRS as instruments to be added to the standard suite of outcome measures. In the second six-month period, training in the client-directed outcome-informed approach to therapy was provided to all the counselors. The training components included the following: (1) 16 hours of formal introduction to theory of change according to the Duncan and Miller framework; (2) in-depth training on the use of ORS and SRS for obtaining client feedback and monitoring progress in therapy; (3) assessment of counselors' levels of understanding...

Six counselors were involved in the entire study, and one new counselor was added for treatment of the second cohort.
Results

Data were analyzed through repeated measures using an Analysis of Variance (ANOVA). Outcome measures of behaviors, impairments, symptoms, and social functioning of the children and adolescents participating in the study were obtained through administration of the HoNOSCA. For the HoNOSCA, the means of the treatment groups (Treatment as Usual or TAU and Client-Directed Outcome-Informed or CDOI) were compared for three sources of variation: Treatment, interaction, and time. A significant effect was found for Treatment (F (1,201) = 206, p