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Just released!

Two Simple Free Tools to Dramatically Increase Retention in Child Therapy

As the school year is about to begin I want to share two tools that has changed how I practice psychotherapy with children and families. I have used these tools for several years - with individual children, groups, parents - and it has helped me improve all aspects of engagement, retention, and achieving treatment goals with children and families.

Some of you may already be familiar, but for those who haven't heard or tried it, the tools are The Outcome Rating Scale (ORS) and the Session Rating Scale (SRS). Both tools are developed by psychologist and researcher Scott D. Miller, Ph.D. He is currently the founder of the International Center for Clinical Excellence. The best part is, the tools are evidence-based and free to use by psychotherapists and counselors. Instructions to download the tools are featured below.

For full disclaimer, I am not affiliated with Scott D. Miller, Ph.D. My recommendation is based entirely on my own professional experience and feedback I received from colleagues who implemented the tool in their practice.

The tools are only recommended for professionals to use, It is not designed for parents to use at home. However, if parents find them relevant, I encourage you to bring it up to your psychotherapist or counselor!

What do the tools measure?

The tools essentially measure clients' feedback on their therapy sessions and their sense of progress towards well-being. The tools are completed together during sessions to facilitate real time feedback.

The Outcome Rating Scale is used at the beginning of each session and the Session Rating Scale is used near the end. They can be completed within minutes and are designed for all ages. There are 3 variations for age groups - children under 5, ages 6-12, and ages 13-adults.

(The child variation for ages 6-12 are shown below.)

Child Outcome Rating Scale:

Child Session Rating Scale:

How can this improve treatment outcomes?

Understanding clients' experience on their sessions is important because it informs psychotherapists on overall progress, what is going well and areas to focus on. This information can shape the quality of care and ensure goals are relevant to the treatment.


  • Having children and parents provide feedback is empowering and collaborative. This encourages them to have more ownership in their treatment and in making adequate changes in their lives.

  • Increases children and parents engagement and satisfaction with their sessions. When they are satisfied with the sessions, they are more likely to engage, follow through and complete the course of treatment.

  • Feedback will maintain focus on treatment goals and coming up with new goals (if necessary).

  • Consistently track and monitor progress over time with valid data.

  • Improve overall quality of care.

The tools are great at asking the right questions that will immediately inform therapists how the sessions are going. The questions also easily lead to follow up questions and content to further explore.

How I use the tools:

  • I inform my children and parents the purpose and importance of getting feedback in our sessions.

  • I provide a hard copy of the Outcome Rating Scale near the beginning of our sessions and the Session Rating Scale before the end of each sessions.

  • I make sure to use them in every session. But sometimes we're not able to get to them so it's okay if we miss it occasionally.

  • The feedback the child or parent provides can lead to the focus of the session. Or I keep a mental note to explore further at a later time.

  • After the sessions, I review the tools, score the data and plan next steps for future sessions.

  • I have to be consistent with using these tools in every session to see the full benefits.

How to get the Outcome Rating Scale and Session Rating Scale:

1. Go to

2. Click on "Fit Measures Licensing".

3. The license to use the ORS and SRS are free for individual professionals.

4. Click on "Add to cart."

5. Submit required information.

6. Receive download link for the tools.

7. Unzip the file and you will see the tools in many different languages. Select the language you prefer find the tools in a word document!

I hope you will consider using these tools to better facilitate feedback from children and their parents. I guarantee you'll see immediate value in your practice! Do you plan to use these tools with your clients? Do you already use them? Or do you have questions on how they work? Feel free to leave comments below!


Research articles on the Outcome Rating Scale and Session Rating Scale:

Duncan, B., Miller, S., Sparks, J., Claud, D., Reynolds, L., Brown, J., & Johnson, L. (2003). The Session Rating Scale: preliminary psychometric properties of a “working” alliance measurement. Journal of Brief Therapy, 3(1), 3-12.

Bringhurst, D.L., Watson, C.W., Miller, S.D. & Duncan, B.L. (2006). The reliability and validity of the Outcome Rating Scale: A replication study of a brief clinical measure. Journal of Brief Therapy, 5, 1, 23-30.

Campbell, A & Hemsley, S. (2009). Outcome Rating Scale and Session Rating Scale in psychological practice: Clinical utility of ultra-brief measures. Clinical Psychologist, 13, 1, 1-9.

Miller, S.D., Duncan, B.L., Brown, J., Sparks, J.A. & Claud, D.A. (2003). The Outcome Rating Scale: A preliminary study of the reliability, validity, and feasibility of a brief visual analog measure. Journal of Brief Therapy, 2, 2, 91-100.


Play Attune is about providing parents and professionals practical play activities and resources focused on enhancing children's social and emotional wellness. Behind every content we share is the belief that children learn valuable life skills through meaningful relationships and experiences.

Play Attune is created by William, a child and family psychotherapist with extensive experience working with families in various settings. We recently launched in the summer of 2018 and we invite you to join us on learning more and contributing to shape our content!


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