FIT: A Brief History

Using Feedback Informed Treatment Programs To Measure Progress and Outcomes

Created more than 20 years ago, FIT reached limited adoption in the early years mainly because it did not have the support of cloud computing and fast, easy technology to implement the program on a broad scale…After 20 years, The time for FIT has come.

Does FIT improve outcomes? To answer that question, let’s examine the research on the factors that promote positive treatment outcomes.

Therapeutic Factors Contributing To Positive Treatment Outcome

Fit History Chart

Next to Client Factors, the most important variable affecting progress and outcomes in treatment is the patient/therapist alliance and therapist effects. FIT is the single most valuable tool for measuring and improving the therapeutic alliance, as well as quality of therapy.

A Brief History of The FIT Process

  • First introduced in 1996 in a discussion of the need for attention and measurement of patient progress in Behavioral Health Treatment by Howard, Maros, et al.4

    • Addresses the importance of assessing whether a given treatment is working for a specific individual, not just whether it tends to work for a large group of people.

    • Suggests that comparing an individual’s progress as measured throughout treatment with expectation.

  • Shortly thereafter, Lambert, et. al.5 introduce the Outcome Questionaire-45 (the OQ45), a 45-question survey for progress monitoring.

  • 2009 The Brief Addiction Monitor (BAM) introduced by the U.S. Dept. of Veterans Affairs specifically for use in SUD treatment.

    • 17-item survey that assesses substance use as well as risk and protective factors.

  • 2012 The entire May issue of Canadian Psychology is dedicated to FIT, as well as most of the June, 2012 issue of their magazine

  • 2013 FIT accepted by SAMHSA as evidence-based programs and practices.

  • 2016 The Kennedy Forum announces that progress measurement, or lack thereof, is the single most important factor in contributing to outcomes in MH/SUD treatment.

  • 2017 The Joint Commission announces a requirement that accredited SUD treatment facilities use a standardized tool for progress and outcomes measurement with internal procedures for reacting to the data (Standard CTS.03.01.09).

How Measuring Results Helps Us Improve

Companies have quarterly reports, sports teams have stats, even individuals are measured by win/loss records, batting averages or times in Olympic events. Those measurements help drive better results over time.

In the field of medicine however, measurement and reporting of results and outcomes is not as common, and for good reason; doctors simply do not want to be at the bottom of a curve. For example; In ordinary hernia operations, the chance of recurrance for surgeons at the bottom of the scale is one in 10, while those in the middle see one recurrence in 30 operations, and for those surgeons at the top of the scale, only one in 500 patients suffer a recurrence.

For treatable colon cancer, the 10-year survival rate ranges, by surgeon, between 20% and 63%. For heart bypass operations, even at hospitals with a good volume of experience, mortality rates in New York range between 1% and 5% with most hospitals above the 1% range.

When it comes to death from colon cancer or on an operating table, there’s a big difference between 20% and 63% or 1% and 5%. Armed with such data, smart shoppers would force a few surgeons into a new career in lawn care and force the rest to improve.


Atul Gawande, The New Yorker: “The Bell Curve” December 2004

2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.

ADULT CARDIAC SURGERY in New York State, New York State Department of Health, 2010-2012

4 Howard, K.I., Moras, K., Brill, P.L., Martinovich, Z., & Lutz, W. (1996). Evaluation of Psychotherapty

5 OQ-45; Lambert et al., (1996); Lambert et al., (2004), The Reliability and validity of the Outcome Questionnaire

13 ICCE Manual on Feedback Informed Treatment, Miller, pages. 6-8. See Suggested Reading at the end of this deck.