This commentary on the articles published in the special section on the developmentand implementation of measurement feedback systems (MFSs) discusses three challenging themes in the process of MFS implementation: design and planning,organizational context, and sustain-ability and unintended consequences. It is arguedthat the implementation of MFSs is complex, but is an important step in improving outcomes in routine care for children and young persons. In the past decade, the implementation of measurement feedback systems (MFSs), also referred to as progress feedback or (routine) outcome monitoring, has taken a leap worldwide. Several countries have mandated the use of MFSs as part of routine care (e.g. United Kingdom, Aus-tralia, Norway, the Netherlands), and in other countries large public or private initiatives exist (e.g. United States, Germany, Chile). By using an MFS, the client's progress in treatment is tracked by frequent administration of stan-dardized measures. The MFS supports the clinician in deciding to adapt treatment when insufficient progress has been made. There are several feedback systems available (e.g. OQ Measures, PCOMS, TOP), and by now MFSs have been introduced in a variety of settings (inpatient, outpatient, group and individual therapy), populations (e.g. youth, adults, elderly) and disorders (e.g. addiction, com-mon mental disorders, eating disorders) (Bickman et al. 2011; Crits-Christoph et al. 2010; Kraus et al. 2005; Lambert et al. 2004; Miller et al. 2005; Probst et al. 2013; Simon et al. 2013). Some studies have found large effects of using MFSs (Shimokawa et al. 2010), but a recent review suggests that the effects can vary substantially over studies (Krägeloh et al. 2015). A potential explanation for this variation in effectiveness might be the way in which MFSs have been implemented (de Jong 2014). For exam-ple, two recent studies found that half of the clinicians did not use the feedback they were provided with (e.g. De Jong et al. 2012; Simon et al. 2012). As such, it is worth taking a closer look at the processes associated with the imple-mentation of MFSs, as the articles in this special section aim to do. Dixon-Woods et al. (2012) analyzed evaluation reports from a large number of quality improvement pro-grams in the UK, and identified three themes for imple-mentation: (1) Design and planning of the improvement intervention; (2) Organizational and institutional contexts, professions and leadership; and (3) Beyond the interven-tion: sustainability, spread and unintended consequences. The articles in this special section will be discussed within the context of these themes.
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