Table 4. Key Themes Regarding Barriers to using ROM (illustrative quotes in parentheses).

	Proportion of clinicians mentioning each theme
Poor IT support “We need IT support - tablets and a better data input and sharing system”	35%
Difficulties capturing complexity “ROM has limited capacity to capture the therapeutic process. It is problem focused rather than holistic, and doesn't capture systemic changes or capacity to reflect/mentalise/regulate”	35%
Lack of time “ROM takes up time and adds to the pressure of time in sessions”	30%
Doesn’t always feel appropriate “ROM is not always appropriate for crisis or extended assessment”	20%
Commissioners may misuse the data “A concern is how the data is extrapolated to reflect a service’s performance, particularly when the goal-based outcomes are person-specific”	20%
Feels like a top-down directive “Lets do things that are meaningful, that clinicians feel are useful [instead]”	15%