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Assessing the use of the transtheoretical model to manage referrals in mental health services

Jackson Lord (Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK.)
Rachel Sabin-Farrell (Derbyshire Healthcare NHS Foundation Trust, Derby, UK.)

Mental Health Review Journal

ISSN: 1361-9322

Article publication date: 9 February 2024




The transtheoretical model (TTM) has been applied to varying areas of physical health, e.g. diabetes. However, research into its applicability to psychotherapy is mixed. The TTM is applied through the University of Rhode Island Change Assessment (URICA). Investigating the utility of the URICA is needed to improve patient care and outcomes. This study aims to assess whether the URICA scores relate to patient outcomes; patient attendance; practitioner ratings of patient readiness, appropriateness, insight, motivation and potential for improvement; and to explore practitioner’s perspectives on the URICA.


Correlational methods were used to assess the relationship between the URICA and therapeutic outcome, attendance and practitioner-rated areas. Content analysis was used to analyse practitioner qualitative data.


The URICA did not correlate with either therapeutic outcome or attendance. A significant negative correlation was found between the URICA and practitioner-rated appropriateness of the referral. This means practitioners perceived individuals with lower URICA scores to be a more appropriate referral, despite the score indicating a reduced readiness to change. Qualitative categories included positive views, negative views, ambivalence and changes to measure and process. To conclude, the URICA does not explain a patient’s outcome or attendance. The URICA may not be appropriate to use in its current format in mental health services; therefore, assessing the TTM verbally may be more helpful.


This study provides research into suitability of using the URICA to assess the TTM and its applicability to attendance and outcome in psychological therapies.



The service evaluation was supported by Nottinghamshire Healthcare NHS Foundation Trust.

Thanks to Amanda Holt for providing expertise in editing the paper to ensure its clarity, and Dr Michael Baliousis, Dr Dave Dawson and Professor Thomas Schröder for input into the paper.

Funding statement: The paper was completed as part of a DClinPsy training program for which funding is provided by Health Education England (HEE), no extra funding was required for this paper.

Since submission of this article, the following author has updated their affiliation: Dr Jackson Lord is based at Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK.


Lord, J. and Sabin-Farrell, R. (2024), "Assessing the use of the transtheoretical model to manage referrals in mental health services", Mental Health Review Journal, Vol. ahead-of-print No. ahead-of-print.



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