Producing “Progress” Through the Implementation of Outcome Monitoring in Alcohol and Other Drug Treatment

Abstract

Outcome monitoring—a process in which clinicians use standardized tools to routinely measure client “progress” on predefined outcomes of interest over time—is increasingly being implemented in alcohol and other drug (AOD) treatment services as a way of demonstrating quality of care. However, relatively little is known about the implications and unintended consequences of implementing outcome monitoring in clinical and social practices. In this paper we draw on qualitative data emerging from focus groups with clinicians who piloted an outcome monitoring tool in Melbourne, Australia, using conceptual tools drawn from science and technology studies. Rather than acting as a stable empirical object, we argue that realities of progress are enacted multiply in relation to preexisting treatment discourses and policy, organizational practices of data collection and management, reporting tools, and clinician attitudes and practices. In particular, we trace how the tool orders the “problem” of drugs differently to the qualitative mode of ordering; how different modes of ordering progress hang together and the tensions and coordination strategies that are involved. And finally, we highlight an unintended consequence of the outcome monitoring process—the enactment of vulnerability and its distribution across the clinical relationship. We suggest that researchers, policy makers, and clinicians need to think reflectively and critically about the ways in which we and our tools and interventions are influential in producing AOD problems, what constitutes progress, and ultimately what the focus of treatment should be.