What is CORE?

The CORE System consists of three interdependent fee-free paper-based tools, supported by specialist software services, training and backup provided by CORE IMS.

The original CORE Outcome Measure CORE-OM is a client self-report questionnaire designed to be administered before and after therapy. The client is asked to respond to 34 questions about how they have been feeling over the last week, using a 5-point scale ranging from 'not at all' to 'most or all of the time'. The 34 items of the measure cover four dimensions: subjective well-being; problems/symptoms; life functioning; and risk/harm. The responses are designed to be averaged by the practitioner to produce a mean score to indicate the level of current psychological global distress (from 'healthy' to 'severe').  The questionnaire is repeated after the last session of treatment; comparison of the pre- and post-therapy scores offers a measure of 'outcome' (i.e. whether or not the client's level of distress has changed, and by how much).

CORE-OM was designed as a non-proprietary measure of psychological distress. Crucially, it was informed by feedback from practitioners as to what they considered to be important to include.  Since its development CORE-OM has been validated with samples from the general population, NHS primary and secondary care, and in older adults.  Two practitioner-completed forms complement the CORE-OM by providing contextual information.

• The Therapy Assessment Form (CORE-TA)helps to profile the client, their presenting problems/concerns and their pathway into therapy. • The End of Therapy Form (CORE-ET) helps to profile the client's pathway through and out of therapy, alongside a range of subjective outcome assessments. The use of CORE-TA and CORE-ET alongside CORE-OM distinguishes CORE from standalone outcome measures by routinely adding critical contextual detail on the client and the therapy process.

These 3 paper-based tools can be downloaded as forms and used free of charge under the terms of the CORE copyright.

When the CORE-OM was developed, the aim was for practitioners to calculate a mean item score by summing the individual item scores and dividing by 34 to yield a mean score ranging from 0 to 4. Over the years, however, the system has changed to take into account feedback from practitioners who have found it easier to assign meaning to whole numbers rather than fractions. It is now standard practice to multiply the mean item score by 10, to give the clinical score.

The therapist can examine the extent to which a client's CORE-OM score represents a 'clinical population' by comparing the score at referral with a national 'clinical cut-off' score of 10. This clinical cut-off was established by asking a large sample of the UK population to complete  the questionnaire and comparing their scores statistically with those for large samples of clients in therapy.  Four bands of scores above the clinical cut-off have been established as representative of mild (green), moderate and severe (red) levels of distress.

For practitioners to assess meaningful improvement over the course of therapy, two numeric changes are essential: reliable change and clinically significant change.

The family of CORE measures

For assessment and outcome, the full CORE-OM is recommended, or the full version can be used without the risk items (i.e. CORE-NR). Several shorter forms of CORE-OM have also been derived for screening and research purposes. For repeated administration (session-by-session), two parallel short versions were designed for research studies whose objectives required administration of alternate forms in order to reduce memory effects. There is also a version for use in the general population, named CORE-14, comprising 14 items derived from CORE-OM.  In addition, further versions are being developed for particular groups. For example, a version for young people (CORE-YP) is well advanced, and a programme of work is focusing on developing translations of CORE-OM for ethnic and European languages.

In 2006, at the request of the CORE user network, the CORE System was enhanced by the addition of a 10-item version for screening and review (CORE-10), and a 5-item version for tracking recovery and improvement (CORE-5). These new additional outcome monitoring and management tools form essential resources for the new online generation of IT support software CORE Net.

All CORE measures can be downloaded as forms and used free of charge under the terms of the CORE copyright.


CORE software systems

CORE software provides comprehensive data capture, storage, filtering, analysis and report functions, all designed to support service management, compliance with clinical governance and ongoing quality improvement.

CORE PC (i.e. CORE for personal computers) has been in use across the NHS since 2001.  Developed in response to requests from services for a clearer understanding of their CORE System data, the software was designed to help resource service quality assessment and development. CORE PC can be used to quantify the numbers of clients who fall into specific categories (e.g. age bands, ethnicity, gender, employment, medication, problem presentation, and type of therapy ending), and offers tools to identify and explore sub-sets of those who fall into categories outside service quality targets (e.g. long waiting times, early termination of therapy, clinical deterioration, and/or poor attendance or psychological mindedness). CORE PC has a current active user base of over 250 UK services that are currently collating data for over 100,000 patients annually.

CORE Net is the new web-based system that offers dynamic, real-time data collection, harnessed to 'outcomes management' methodology informed by US insurance-based managed health care. The methodology is much less reflective than traditional approaches to evaluation and outcome measurement. It complements CORE-OM with the new shorter CORE-10 and CORE-5 measures that provide information to inform tracking and flag reports to help maximise the potential for client gains. Forms can be completed online by a practitioner and client working together, or privately by clients, or can be used as traditional 'pen and paper' measures for subsequent online entry by administrative staff.