Why Are Some Cases Not on Track? An Item Analysis of the Assessment for Signal Cases During Inpatient Psychotherapy

Thomas Probst, Danube University Krems
Maria Kleinstäuber, University of Otago
Michael J. Lambert, Brigham Young University
Karin Tritt, University Hospital Regensburg
Christoph Pieh, Danube University Krems
Thomas H. Loew, University Hospital Regensburg
Reiner W. Dahlbender, University Hospital Ulm
Jamie Delgadillo, University of Sheffield


Within the Routine Outcome Monitoring system “OQ-Analyst,” the questionnaire “Assessment for Signal Cases” (ASC) supports therapists in detecting potential reasons for not-on-track trajectories. Factor analysis and a machine learning algorithm (LASSO with 10-fold cross-validation) were applied, and potential predictors of not-on-track classifications were tested using logistic multilevel modeling methods. The factor analysis revealed a shortened (30 items) version of the ASC with good internal consistency (α = 0.72–0.89) and excellent predictive value (area under the curve = 0.98; positive predictive value = 0.95; negative predictive value = 0.94). Item-level analyses showed that interpersonal problems captured by specific ASC items (not feeling able to speak about problems with family members; feeling rejected or betrayed) are the most important predictors of not-on-track trajectories. It should be considered that our results are based on analyses of ASC items only. Our findings need to be replicated in future studies including other potential predictors of not-on-track trajectories (e.g., changes in medication, specific therapeutic techniques, or treatment adherence), which were not measured this study.