When demand exceeds supply for psychotherapy: evaluation of the client priority rating scale (CPRS) as a triage protocol

Whilst there has been much research conducted on triage in psychiatric inpatient emergency services, there has been very little conducted on triage for traditional outpatient psychotherapy services. Waiting lists for outpatient psychotherapy are common throughout public health services, and how to effectively and fairly determine priority remains a dilemma. This thesis out to investigate a new method of psychotherapy triage using the Client Priority Rating Scale (CPRS). Specifically, the study aimed to evaluate the impact and effectiveness of the CPRS in terms of its reliability, utility and the characteristics of clients prioritised most highly for treatment. The CPRS requires clinicians to make weighted ratings in the domains of Suicidality, Severity of Presenting Problem, Strength of Internal Coping Resources, Availability of Interim Care Options and Possible Negative Impact of Waiting following an initial assessment interview. Scores are then summed and total scores can be used to prioritise waiting times for psychotherapy services. Use of the CPRS was examined in a naturalistic setting with multi-diagnostic clients (n=68) and a standardised controlled setting with depressed clients (n=86). The CPRS was found to have good inter-rater agreement and consistency. As predicted, those with higher CPRS scores were significantly more likely to commence psychotherapy treatment before those with lower scores. CPRS score was found to be significantly related to diagnosis as well as social and psychological functioning such that those with a greater level of psychopathology were more likely to have been assigned higher priority scores. CPRS was also found to be significantly related to working alliance and outcome. In general, clients with lower CPRS scores had better outcomes than those with higher CPRS scores. Overall, the results of this study suggest that the C P R S has utility as a method of triage to determine priority for clients seeking psychotherapy services.