The report of the Standing Medical Advisory Committee to the Department of Health, The Quality of Medical Care (1990), states that outcome is the most relevant indicator of quality of medical care. In addition to providing information about the appropriateness of treatments, there are important ethical and resource implications if activities are found to be unjustified. However, measuring outcome is difficult if there is no quantifiable change in symptoms or function following treatment. In child psychiatry this is a relatively common dilemma and outcome studies, while agreed to be essential, are frequently abandoned at an early stage or fail to get off the ground because of the complexity of the problems they generate. In a review of the ways in which child mental health services attempt to measure outcome (Pound & Cottrell, 1989) the authors acknowledge these difficulties and conclude that a start should be made by “Asking the customer's opinion” about the treatment they have received. In other words, “Are they satisfied?”.
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