EPPP: Part 2, Skills Quiz: Intervention Evaluation
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Intervention EvaluationQuestion 1 of 20

A psychologist is using Cognitive Behavioral Therapy (CBT) for a client with Generalized Anxiety Disorder (GAD). After six sessions, the client's GAD-7 score dropped from 18 (severe) to 11 (moderate). For the next four sessions, the score has remained at 11. The client reports feeling better than at intake but is frustrated by the lack of recent progress, stating, "I feel stuck."

What is the psychologist's most appropriate next step to evaluate the intervention's effectiveness?

Refer the client for a medication evaluation, as the CBT has likely reached its maximum effect.
Reassure the client that treatment plateaus are a normal part of therapy and encourage adherence to the current plan.
Collaboratively review treatment components and the client's application of skills to identify specific barriers to further progress.
Introduce a different evidence-based treatment, such as Acceptance and Commitment Therapy, since CBT appears to be stalled.
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EPPP: Part 2, Skills Quiz

EPPP: Part 2, Skills Quiz: Intervention Evaluation

Practice Intervention Evaluation in EPPP: Part 2, Skills with focused quiz questions that help you check what you know, review explanations, and build confidence with test-style prompts.

What this quiz covers

This quiz focuses on Intervention Evaluation, giving you a quick way to practice the rules, question types, and explanations that matter most for EPPP: Part 2, Skills.

How to use this quiz

Try each quiz question before looking at the correct answer. Use the explanations to review missed ideas, then come back to similar questions until the pattern feels familiar.

All questions

Question 1

A psychologist is using Cognitive Behavioral Therapy (CBT) for a client with Generalized Anxiety Disorder (GAD). After six sessions, the client's GAD-7 score dropped from 18 (severe) to 11 (moderate). For the next four sessions, the score has remained at 11. The client reports feeling better than at intake but is frustrated by the lack of recent progress, stating, "I feel stuck."

What is the psychologist's most appropriate next step to evaluate the intervention's effectiveness?

  1. Refer the client for a medication evaluation, as the CBT has likely reached its maximum effect.
  2. Reassure the client that treatment plateaus are a normal part of therapy and encourage adherence to the current plan.
  3. Collaboratively review treatment components and the client's application of skills to identify specific barriers to further progress. (correct answer)
  4. Introduce a different evidence-based treatment, such as Acceptance and Commitment Therapy, since CBT appears to be stalled.
Explanation: The most appropriate step is to actively and collaboratively evaluate why the treatment has plateaued. This involves reviewing the client's understanding and use of CBT skills, identifying potential obstacles (e.g., subtle avoidance, core belief conflicts), and problem-solving together. This is a direct form of continuous evaluation. A) is premature without a thorough evaluation of the current intervention. B) is passive and invalidates the client's expressed frustration. D) is too drastic; modifying or troubleshooting the current evidence-based intervention should precede switching to an entirely new modality.

Question 2

A psychologist is treating a client for major depressive disorder. The client reports subjectively feeling "much more hopeful" and is re-engaging in social activities. However, the client's weekly Beck Depression Inventory-II (BDI-II) scores have slightly increased over the past three weeks, from 22 to 25. The psychologist notes the client endorses items related to sleep disturbance and indecisiveness.

What is the most appropriate initial action for the psychologist to take in response to this discrepancy between subjective report and formal measure?

  1. Trust the client's subjective report over the objective measure, as therapeutic gains are primarily self-perceived.
  2. Explore the specific content of the endorsed BDI-II items with the client to understand the meaning of the score increase. (correct answer)
  3. Prioritize the BDI-II scores as the more reliable indicator and increase the intensity of the behavioral activation component.
  4. Administer an alternative depression scale to determine which measure more accurately reflects the client's clinical status.
Explanation: When data from different sources conflict, the first step is to investigate the discrepancy. Discussing the specific items the client endorsed on the BDI-II can reveal the reason for the score increase (e.g., increased self-awareness of symptoms, side effects of a new medication, or actual worsening of specific symptoms despite overall improvement in mood). A) and C) involve ignoring one source of data, which is poor practice. D) may be a later step, but the initial action should be to understand the data already collected.

Question 3

A psychologist is using a feedback-informed treatment (FIT) approach. At the beginning of each session, a 16-year-old client completes the Outcome Rating Scale (ORS). For the past three consecutive sessions (sessions 5, 6, and 7), the client's ORS score has dropped below the expected treatment response curve, indicating a lack of progress. The therapeutic alliance, measured by the Session Rating Scale (SRS), remains strong.

Given this data, what is the psychologist's most critical next step?

  1. Discuss the lack of progress openly with the client and collaboratively explore potential reasons and needed adjustments. (correct answer)
  2. Continue with the current treatment plan for several more sessions, as the strong alliance is likely to facilitate future progress.
  3. Seek immediate consultation with a colleague to discuss alternative treatment approaches for this client.
  4. Refer the client to a different therapist, as the data indicates a poor fit despite the positive alliance.
Explanation: A core principle of FIT is to use the data to have explicit conversations with the client about the course of therapy. Three consecutive sessions of declining scores is a clear signal that the current approach is not working for the client. The first step is to engage the client in a discussion about this observation to re-evaluate goals, methods, or unaddressed issues. B) ignores the outcome data. C) is a good step, but should happen after or in conjunction with discussing the issue with the client first. D) is premature and a last resort.

Question 4

A child is receiving treatment for Oppositional Defiant Disorder (ODD). The psychologist is using a parent management training (PMT) model. After eight weeks, the parents report a significant decrease in oppositional behaviors at home and complete a parent-rating scale that shows clinically significant improvement. However, a teacher-completed rating scale shows a slight worsening of the same behaviors in the classroom.

To effectively evaluate the overall intervention effectiveness, the psychologist should prioritize which of the following actions?

  1. Conclude the intervention is successful based on the parents' report, as they are the primary agents of change in PMT.
  2. Average the scores from the parent and teacher reports to get a more objective measure of the child's functioning.
  3. Meet with the parents and teacher together to understand the contextual differences and develop strategies to promote generalization. (correct answer)
  4. Trust the teacher's report as more objective and revise the treatment plan to focus on school-based behaviors.
Explanation: The discrepancy in reports indicates a problem with generalization of skills from the home to the school setting. The most effective evaluation involves synthesizing this information by bringing the stakeholders together to understand why the behavior differs across settings and to collaborate on a plan to address it. A) and D) both make the mistake of prioritizing one data source over another. B) is statistically simplistic and ignores the valuable clinical information contained within the discrepancy itself.

Question 5

A psychologist is providing exposure therapy for a client with social anxiety disorder. During an in-session exposure, the client's Subjective Units of Distress (SUDS) rating begins at 80/100. After 20 minutes, it has only decreased to 75/100, and the client reports an urge to escape. This pattern of minimal habituation has occurred in the past two sessions as well.

To evaluate the effectiveness of the exposure exercise and guide modification, what is the psychologist's most immediate priority?

  1. Encourage the client to remain in the situation for a longer duration until habituation occurs.
  2. Assess for the presence of subtle avoidance behaviors or cognitive processes that may be inhibiting habituation. (correct answer)
  3. Switch to a less intense exposure task on the hierarchy to ensure the client experiences success.
  4. Explain that this may be an extinction burst and that the client should push through the discomfort.
Explanation: When habituation fails to occur during exposure, a primary reason is that the client is engaging in covert safety behaviors (e.g., mental distraction, rehearsing sentences) or overt, subtle avoidance (e.g., avoiding eye contact, holding onto something tightly). The psychologist must first evaluate for these interfering behaviors before modifying the intervention. A) could increase distress without being effective if safety behaviors are present. C) may be necessary, but only after assessing why the current task is failing. D) is a plausible explanation, but an extinction burst typically involves a temporary increase in the response, not a persistent failure to habituate.

Question 6

A client with chronic pain has been in therapy for 12 sessions, focusing on acceptance and values-based action. The client reports no change in pain intensity levels but states, "The pain doesn't run my life as much. I went to my grandson's baseball game last week, which I wouldn't have done before." Weekly measures of pain intensity are unchanged, but a measure of values-consistent living shows improvement.

How should the psychologist most accurately evaluate the effectiveness of this intervention?

  1. Conclude the intervention is ineffective because the primary symptom, pain intensity, has not been reduced.
  2. Focus on the improvement in valued living as the primary indicator of success, consistent with the treatment model. (correct answer)
  3. Determine that the results are mixed and ambiguous, requiring a switch to a more symptom-focused treatment.
  4. Attribute the improvement in functioning to a placebo effect, as the core symptom remains unchanged.
Explanation: The effectiveness of an intervention must be evaluated in the context of its specific goals. For Acceptance and Commitment Therapy (ACT) for chronic pain, the primary goal is not to reduce pain intensity but to reduce the interference of pain with valued living (i.e., increase psychological flexibility). The client's report and the data from the values measure directly indicate that this primary goal is being met. Therefore, the intervention is effective according to its own framework. A) and C) misinterpret the goals of an acceptance-based model. D) makes an unsubstantiated causal attribution.

Question 7

In a skills-based group for individuals with borderline personality disorder, the psychologist notices that most members are showing improvement on self-report measures of emotion dysregulation. However, one member consistently reports no improvement and frequently expresses skepticism about the skills in group. This member's individual therapy log cards show very low rates of skill practice between sessions.

What is the psychologist's most appropriate first step in evaluating the intervention's effectiveness for this specific group member?

  1. Focus on the overall group progress, as it is not always possible for every member to benefit at the same rate.
  2. Privately discuss the member's lack of skill practice as a primary hypothesis for their lack of progress. (correct answer)
  3. Recommend that the member seek a different type of therapy, as the group model is clearly not a good fit.
  4. Ask the other group members to provide feedback to the skeptical member on how the skills have helped them.
Explanation: Effective evaluation is specific. The data (log cards) points to a clear mechanism for the lack of progress: the client is not practicing the skills. The most direct and appropriate evaluative step is to address this discrepancy with the client, exploring the reasons for non-adherence. This is a crucial part of assessing if the intervention is failing or if it's simply not being implemented. A) ignores the individual's needs. C) is premature without first addressing the implementation problem. D) could be perceived as shaming and is less effective than a direct, private conversation.

Question 8

A client is making excellent progress in therapy for panic disorder, with panic attack frequency dropping from five per week to zero for the last month. The client reports feeling cured and wants to terminate therapy. The psychologist, however, notes that the client has not yet completed the final modules of treatment focusing on relapse prevention.

To fulfill the duty of continuously evaluating the intervention's effectiveness through to completion, what is the psychologist's best response?

  1. Agree to terminate immediately to reinforce the client's sense of self-efficacy and autonomy.
  2. Insist the client complete the remaining sessions to prevent premature termination and ensure adherence to the protocol.
  3. Validate the client's progress and collaboratively discuss the rationale for relapse prevention as a way to maintain gains. (correct answer)
  4. Schedule a series of monthly booster sessions instead of the final weekly sessions to monitor for relapse.
Explanation: Evaluating effectiveness includes ensuring that gains are stable. While the client has achieved symptom remission, the intervention is not complete until skills for maintaining those gains are taught and practiced. The best approach is collaborative: acknowledge the success, explain the evidence-based rationale for the relapse prevention component, and make a shared decision. A) ignores a critical part of the EBT. B) is overly rigid and could damage the alliance. D) is a potential outcome of the discussion, but the discussion itself must happen first.

Question 9

A psychologist has been working with a client for six months. The client's presenting problem was complex trauma. The intervention has been integrative and phase-based. The client reports a strong therapeutic alliance and feeling understood, but objective measures of PTSD symptoms show no reliable change, and the client continues to report significant functional impairment.

Given the lack of progress on objective measures despite a long course of therapy, what is the psychologist's most pressing ethical and clinical responsibility?

  1. Continue with the current approach, as complex trauma requires long-term therapy and change may not be linear.
  2. Refer the client to a specialist in a different modality, such as EMDR or Somatic Experiencing.
  3. Systematically review the case conceptualization and treatment plan, and seek consultation from a peer or supervisor. (correct answer)
  4. Focus the therapy on enhancing the therapeutic alliance, as this is the most robust predictor of positive outcomes.
Explanation: When an evidence-informed intervention is not producing change in a reasonable timeframe, the psychologist has an ethical responsibility to re-evaluate their approach. This involves a critical review of the case formulation and treatment plan, and seeking outside perspective through consultation to identify blind spots or alternative strategies. A) risks providing ineffective treatment indefinitely. B) may be the eventual outcome, but only after a thorough re-evaluation and consultation. D) is insufficient; a strong alliance is necessary but not always sufficient for change, and the lack of progress must be directly addressed.

Question 10

During the course of therapy, a client experiences a significant external life event (e.g., a promotion at work) and subsequently reports a dramatic reduction in anxiety symptoms. The client attributes all of the improvement to this external event, stating, "I guess I just needed a win at work, not therapy."

To properly evaluate the contribution of the therapeutic intervention, what is the psychologist's most appropriate response?

  1. Agree with the client's attribution to support their sense of agency and empowerment.
  2. Gently challenge the client's attribution by pointing out the therapeutic work that preceded the improvement.
  3. Administer a battery of assessment measures to objectively parse out the effects of therapy versus the life event.
  4. Explore how the skills learned in therapy may have helped the client to secure or manage the promotion effectively. (correct answer)
Explanation: This response is collaborative and helps the client integrate their life experiences with the therapy. It reframes the situation not as an either/or attribution (therapy vs. life event) but as a synergistic one, where therapy may have provided the foundation for the client to succeed. This allows for a more nuanced evaluation of the intervention's effectiveness. A) negates the value of the therapy entirely. B) can lead to a power struggle over who gets 'credit' for the change. D) is impractical and unlikely to yield a clear answer.

Question 11

A psychologist calculates a Reliable Change Index (RCI) for a client's score on an anxiety inventory. The client's score has moved from 25 to 19. The RCI calculation indicates that the change is statistically reliable (p < .05). However, the client's score of 19 is still well above the clinical cutoff of 10 for the measure.

How should the psychologist interpret this information to evaluate the intervention?

  1. The client has made both reliable and clinically significant progress, and the intervention is a success.
  2. The client has made reliable change, but has not yet achieved a clinically significant outcome. (correct answer)
  3. The client has not made clinically significant change, therefore the reliable change is likely a statistical artifact.
  4. The client has not made reliable change, because their score remains in the clinical range.
Explanation: This question tests the distinction between reliable change and clinical significance. Reliable change (indicated by the RCI) means the observed change is greater than what would be expected from measurement error alone; it is a real change. Clinical significance means the client's score has moved from the 'dysfunctional' range to the 'functional' range. Here, the client has made real progress, but they are not yet 'well.' This is a crucial distinction in evaluating treatment effectiveness. A), C), and D) all confuse or incorrectly define these two separate concepts.

Question 12

A client in long-term psychodynamic therapy for personality issues does not have a primary, easily quantifiable symptom like panic attacks or depressive episodes. The therapy goals are broad, such as "improving interpersonal relationships" and "developing a more coherent sense of self."

What is the most appropriate method for the psychologist to continuously evaluate the effectiveness of the intervention in this case?

  1. Use standard symptom-based measures like the BDI-II or GAD-7 as proxies for overall functioning.
  2. Periodically review process notes and recordings with a consultant to assess the evolution of thematic material.
  3. Co-create specific, observable behavioral markers with the client that would indicate progress toward their goals. (correct answer)
  4. Assume the intervention is effective as long as the client continues to attend sessions and reports the alliance is strong.
Explanation: Even when goals are broad and internal, effective evaluation requires operationalizing them. The best way to do this is to collaborate with the client to define what "improving relationships" would look like in their actual life (e.g., "initiating one conversation with a coworker per week," "stating a need to my partner without apologizing"). This creates concrete, measurable data points to track progress. A) uses measures that may not be relevant to the therapy goals. B) is a useful tool for therapist development but is not a direct measure of client outcome. D) conflates attendance with effectiveness and is not a valid form of evaluation.

Question 13

A client undergoing treatment for substance use disorder has maintained abstinence for 60 days, verified by urine toxicology screens. However, during sessions, the client consistently reports high levels of cravings, social isolation, and anhedonia. The client states, "I'm not using, but I wouldn't call this 'recovering'."

In evaluating the overall effectiveness of the intervention, the psychologist should conclude that:

  1. the intervention is highly effective, as abstinence is the primary goal of substance use treatment.
  2. progress is limited, as the client's internal state and quality of life have not improved alongside abstinence. (correct answer)
  3. the client's subjective reports are likely indicative of a potential relapse and should be interpreted with skepticism.
  4. the intervention has been successful in one domain (abstinence) but a new treatment plan is needed for mood symptoms.
Explanation: Effective substance use treatment aims not just for abstinence but for broader recovery, which includes improved quality of life, coping skills, and psychosocial functioning. While abstinence is a major achievement, the client's reports of high cravings and poor quality of life are crucial evaluation data indicating that the intervention is not yet fully effective. The psychologist must address these aspects to support lasting recovery. A) uses too narrow a definition of success. C) is invalidating. D) is a possible next step, but the initial conclusion (B) is that progress is limited and the current approach needs re-evaluation.

Question 14

A psychologist is treating a client who shows a pattern of initial rapid improvement in the first few sessions, followed by a sudden worsening of symptoms or the emergence of a new 'crisis' just as progress seems to be consolidating. This pattern has repeated itself three times over 20 sessions.

When evaluating the intervention, this cyclical pattern most strongly suggests the psychologist should assess for what?

  1. An inappropriate treatment modality that is causing iatrogenic effects.
  2. Client ambivalence about change or a pattern of attachment-related anxiety. (correct answer)
  3. The presence of an undiagnosed neurological or medical condition.
  4. The need to decrease the frequency of sessions to give the client more time to integrate gains.
Explanation: While other options are possible, this specific pattern of 'flight into health' followed by relapse or crisis is a classic clinical presentation suggesting deep-seated ambivalence about change, fear of termination, or attachment dynamics where getting better threatens a key relational pattern (including the one with the therapist). Evaluating the intervention's effectiveness requires shifting focus to this underlying process, which is impeding sustained progress. A) is possible, but the initial improvement makes it less likely. C) should be ruled out but the pattern is more psychological. D) is a strategy, not an evaluation of the underlying cause.

Question 15

After 10 sessions of an evidence-based intervention for PTSD, a client's PCL-5 score has increased, indicating a worsening of symptoms. The client also reports feeling more overwhelmed and dysregulated since starting treatment. The client has been adherent to the intervention.

What is the psychologist's most critical and immediate responsibility?

  1. Continue the intervention as planned, as an initial increase in distress can be part of the healing process.
  2. Reassure the client that this is a temporary setback and redouble efforts on the current treatment components.
  3. Refer the client to a higher level of care, such as an intensive outpatient or inpatient program.
  4. Immediately pause the current intervention, re-evaluate the client's stability, and consult with a colleague. (correct answer)
Explanation: The primary ethical principle is 'do no harm'. When an intervention is leading to a clear and measurable worsening of the client's condition (iatrogenic effects), the psychologist must immediately pause and re-evaluate. This involves assessing the client's safety and stability, reconsidering the case conceptualization and treatment choice, and seeking consultation. Continuing the intervention (A, D) risks further harm. Referring out (C) may be the ultimate outcome, but it is not the immediate first step; the psychologist must first assess the situation and stabilize the client.

Question 16

A psychologist is using a manualized intervention for OCD. The protocol calls for weekly administration of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). The client finds the weekly repetition of the lengthy measure to be burdensome and has stopped completing it carefully, often circling the same numbers each week regardless of their actual symptom level.

What is the best course of action for the psychologist to continue evaluating the intervention's effectiveness?

  1. Explain the importance of the measure for evidence-based practice and insist on its proper completion.
  2. Discontinue all formal measurement and rely solely on the client's qualitative report in session.
  3. Interpret the client's non-compliance as resistance to treatment and address this as a therapeutic issue.
  4. Collaborate with the client to select a briefer, less burdensome measure or method to track symptoms and progress. (correct answer)
Explanation: Effective continuous evaluation requires valid data. If the measurement process itself becomes a barrier, it compromises data quality. The best approach is to problem-solve with the client to find a method of tracking progress that works for them, such as a briefer scale, a simple SUDS rating, or a behavioral log. This maintains the principle of data-driven treatment while adapting to the individual's needs. A) may damage the alliance and is unlikely to solve the problem. B) abandons objective measurement entirely. D) is an unhelpful interpretation that may not be accurate; the issue is more likely response burden than resistance.

Question 17

A psychologist is providing services via telehealth to a client in a rural area. The psychologist relies on client self-report and a weekly PHQ-9 administered via a secure portal to monitor depressive symptoms. For two weeks, the client has not completed the PHQ-9, and in session, their affect appears more blunted. When asked, the client says, "I'm fine, just tired."

How should the psychologist best evaluate the client's status and the intervention's effectiveness in this telehealth context?

  1. Respect the client's self-report and privacy, and do not press the issue of the missing measures.
  2. Insist that the client complete the measures before the end of the session to ensure data continuity.
  3. Recommend a temporary switch to in-person sessions, as telehealth is proving inadequate for monitoring this client.
  4. Note the behavioral data (blunted affect, non-completion of forms) and gently inquire about what might be making it difficult to report on their mood. (correct answer)
Explanation: Effective evaluation in telehealth requires careful attention to all available data streams, including behavioral observations. The non-completion of forms and blunted affect are important data points that contradict the client's verbal report. The best approach is to use these observations to open a collaborative conversation, hypothesizing that the client may be finding it difficult to engage, which is itself a sign of worsening depression. A) is negligent. B) is overly demanding and may harm the alliance. D) may not be feasible and ignores the immediate clinical need to address the observed signs in the session.

Question 18

A psychology supervisee presents a case in which the client has shown no measurable improvement after 12 sessions. The supervisee expresses a strong belief that their chosen theoretical orientation will eventually work if they just 'stick with it.' The supervisor notes that the supervisee has not used any formal outcome measures.

What is the supervisor's primary responsibility in this situation to ensure proper evaluation of the intervention?

  1. Instruct the supervisee to immediately begin using a standardized outcome measure to track progress objectively. (correct answer)
  2. Encourage the supervisee to seek their own therapy to explore potential countertransference issues.
  3. Allow the supervisee to continue, as developing fidelity to a theoretical model is an important part of training.
  4. Take over the case from the supervisee to ensure the client receives effective care.
Explanation: The supervisor's primary responsibility is to ensure the client's welfare and to teach the supervisee competent practice. A core competency is the continuous evaluation of treatment. The most immediate, direct, and instructional action is to have the supervisee start using objective data to inform their clinical judgment, moving them away from relying solely on belief in their model. B) might be relevant but isn't the primary, most direct intervention. C) prioritizes training theory over client welfare. D) is an extreme step that should only be taken if the client is at risk and other supervisory interventions fail.

Question 19

A psychologist is treating an immigrant client from a collectivist culture for symptoms of depression. The psychologist administers a standardized depression inventory developed and normed in the United States. The client's scores indicate minimal to mild depression, yet the client presents with significant somatic complaints, social withdrawal, and reports from family describing profound changes in functioning.

In evaluating the intervention's progress, which principle should most guide the psychologist's interpretation of the assessment data?

  1. Standardized measures provide the most objective data and should be weighted more heavily than subjective family reports.
  2. The discrepancy suggests the client may be minimizing symptoms, requiring a more direct, confrontational therapeutic style.
  3. The standardized measure may lack cultural validity, and progress should be evaluated using more culturally congruent indicators. (correct answer)
  4. Somatic complaints are likely a separate medical issue and should be addressed through a referral to a physician.
Explanation: Continuously evaluating an intervention requires using appropriate measures. The primary issue here is the potential lack of cultural validity of the assessment tool. Depressive symptoms can manifest differently across cultures, with somatic and functional complaints being more prominent than affective symptoms in some. The most critical evaluation step is to recognize this and seek culturally relevant indicators of progress, such as improved family relationships or engagement in community roles, rather than relying solely on a potentially invalid measure. A) ignores the issue of cultural validity. B) is culturally insensitive. D) is possible, but the context strongly suggests a cultural manifestation of distress.

Question 20

A psychologist is conducting a program evaluation for a new community-based intervention. They are using a pre-test/post-test design with a standardized outcome measure. At the end of the program, the mean score for participants shows a statistically significant improvement.

To most accurately evaluate the intervention's effectiveness, what additional information is most crucial for the psychologist to consider?

  1. The effect size of the change and the clinical significance of the outcomes for individual participants. (correct answer)
  2. Whether the participants enjoyed the program and would recommend it to others.
  3. The credentials and experience level of the facilitators who delivered the intervention.
  4. A comparison of the results to those from a randomized controlled trial of a different intervention.
Explanation: Statistical significance only indicates that the observed change is unlikely to be due to chance; it does not indicate the magnitude or practical importance of the change. To evaluate effectiveness, the psychologist needs to know the effect size (how much change occurred) and the clinical significance (did participants improve meaningfully/move to a functional range). B) relates to satisfaction, not effectiveness. C) relates to implementation fidelity, which is important but secondary to the outcome data. D) is a useful comparison but is not essential for the initial evaluation of the program's own results.