The Professional Counselor | Volume 13, Issue 3 194 and colleagues (2020) noted the need for individual-level data as well as interventions specifically targeted to adults living in poverty. Although outcome assessments exist to measure psychological distress or severity of mental illness symptoms (e.g., Beck Depression Inventory [BDI], Beck et al., 1961; Generalized Anxiety Disorder Screener [GAD-7], Löwe et al., 2008; Patient Health Questionnaire-9 [PHQ-9], Kroenke et al., 2001), there is a lack of measures with evidence of validity and reliability with economically vulnerable adult populations. Therefore, our investigation examined the factor structure of the Outcome Questionnaire-45.2 (OQ-45.2; Lambert et al., 2004) with an economically vulnerable adult population, increasing the applicability of the measure in mental health settings. Outcome Questionnaire-45.2 The OQ-45.2 (Lambert et al., 2004) is one of the most widely used outcome measures of psychological distress in applied mental health settings (Hatfield & Ogles, 2004). The OQ-45.2 assists professional counselors with monitoring client progress and can be administered multiple times throughout treatment, as it is sensitive to changes over time (Lambert et al., 1996). The OQ-45.2 has been implemented in outcome-based research with diverse populations such as university counseling center clients (Tabet et al., 2019), low-income couples (Carlson et al., 2017), and ethnic minority groups (Lambert et al., 2006). Lambert et al. (1996) reported strong test-retest reliability (r = .84) and internal consistency (α = .93) for the OQ-45.2, based on a sample of undergraduate students (n = 157) and a sample of individuals receiving Employee Assistance Program services (n = 289). However, researchers have yet to investigate the psychometric properties of the OQ-45.2 with an economically disadvantaged, diverse population. Given the utility of the OQ-45.2 as a client-reported feedback measure, clinicians can use the OQ-45.2 in a variety of ways to evaluate client progress, including measuring changes in individual distress across the course of counseling and before and after specific treatment interventions, as well as to glean a baseline level of distress at the start of counseling (Lambert, 2017). For example, one study used the OQ-45.2 as a primary outcome measure for anxiety symptoms in clients engaging in cognitive behavioral therapy (Levy et al., 2020). The OQ-45.2 was administered at the beginning of each weekly counseling session and change scores were calculated between each session, which helped clinicians understand that about half of their sample reported clinically significant reductions in symptoms in just nine sessions (Levy et al., 2020). This example demonstrates how the OQ-45.2 can be implemented to monitor treatment outcomes and improve the duration and efficiency of counseling. A clinician can also use salient items as part of the intake clinical interview to encourage clients to elaborate on the specific symptoms they are experiencing, and how they may be impacting their functioning, across a variety of clinical settings (Espiridion et al., 2021; Lambert, 2017; Levy et al., 2020). Factor Structure of OQ-45.2 Researchers contested the factor structure proposed by Lambert et al. (2004), suggesting the need for further validation of the three-factor oblique measurement model and exploration of other possible factor structures (e.g., Kim et al., 2010; Mueller et al., 1998; Rice et al., 2014; Tabet et al., 2019). Mueller and colleagues (1998) examined three models: (a) a one-factor model, (b) a two-factor oblique model, and (c) a three-factor oblique model, none of which fit the data well. In addition, the factors in the threefactor model were highly correlated, ranging from .83 to .91, asserting that the subscales may not be statistically indistinguishable and the OQ-45.2 might be a unidimensional measure of global distress. Kim and colleagues (2010) also explored three models to assess adequate fit of the data: (a) a one-factor model, (b) a three-factor model, and (c) a revised 22-item four-factor model. Indicating weak support for the OQ-45.2’s factorial validity across all models, researchers cautioned against widespread utilization in mental health and research settings, encouraging further psychometric exploration and validation of the OQ-45.2 (Kim et al., 2010).
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