SWAN-OM: Session Wants and Needs Outcome Measure

What SWAN-OM is and what it measures

It measures two things in the same session at two different moments: beforehand, what the person wants from the conversation they are about to have; at the end, whether what they chose actually happened. It does not measure symptoms or compare them against a norm, so it does not replace other measures focused on assessing symptoms, which track change over the medium and long term; this instrument is meant to cover the gap those leave when the encounter is a single one and the modality is single-session or brief therapy.

Its structure is hybrid, both idiographic and nomothetic, since it combines predefined items with a free-text item for setting goals, and putting a number on those goals allows both the aggregate analysis of a service and one person's particular goal. The name is the English acronym for Session Wants and Needs Outcome Measure, and what it captures is the ask: what someone brings to that encounter and expects from it. In any therapeutic encounter we may meet a wide range of problems and difficulties, and the SWAN-OM works from the theoretical framework of those problems and of the support needs they generate.

Who it is for, and who it is not for

It was developed with young people aged 12 to 25 in a digital service and has published evidence authored by me, in a British context and with an English-speaking population (De Ossorno García et al., 2021).

It was conceived and designed from the outset to be administered on paper in a waiting room, so it needs no technology and works as well in person as online. For adults it may need only light adaptation, but it still requires future validation, since no research has yet been carried out with an adult population and we do not know how it behaves in a population other than young people.

Note: the Spanish version has been translated and back-translated, but its pilot validation is still pending, so today it serves to structure a session and not to publish psychometric results in Spanish as a validated instrument.

How SWAN-OM works

Two steps and under three minutes to administer. Before the session the person picks one or more of the six themes and then up to three items to focus on, which saves them reading the whole list, and at the end they score those same items on a five-point scale running from −2 to 2.

The opening instruction says the appointment will be offered anyway if they would rather skip the questions, and that is not a courtesy: a measure that conditions access stops being a measure and becomes a triage filter. The goals chosen are shown to the practitioner minutes before the encounter begins, and at the end it is the client who scores those same goals.

The scale

How a score is read

This is the part practitioners ask about most and the part the literature explains worst, so I set it out here: what a score means for one person, what it says about whether the session helped, what to do next, and what appears once a whole service's scores are pooled.

For one person: where the number comes from

Before the session every selected goal starts at zero, since nothing has happened yet; afterwards the person says how far the session helped them with each one, on the five-point scale. A 2 means they strongly agree the session helped them with that goal, a 0 means the session changed nothing about it, and a −2 means they strongly disagree.

The total score for the session is the mean of the goals that person chose, so their scores are added up and divided by the number of goals, which is up to three, since clients can select between one and three goals for a session. The free text item is scored like the rest.

Total score = sum of the scores ÷ number of goals selected

Valence: whether the session helped or not

The mean is not read as a percentage and is not compared against any norm; it falls into one of three bands, and that is what answers whether the person came out of the session satisfied.

That this reading has to do with satisfaction is not an assumption: in the concurrent validity study the scores were compared against the ESQ, which measures satisfaction with the service, the YCIS, which measures session impact, and the PANAS, which measures positive and negative affect; and across the sessions evaluated in the research, positive affect rose and negative affect fell, with p < 0.001 in both cases (De Ossorno García et al., 2023), so it is also an indicator of satisfaction with the encounter.

Two worked examples

A note on the source: the user manual carries these two examples and the mean in the second one is miscalculated, giving 0.6 where the sum comes to 1.5. The arithmetic is corrected here and the items are kept exactly as the manual has them.

What happens next: continue, offer more sessions, or refer on

Single session does not mean one session and no more, and this is what gets misread most often: in single-session work there is always the chance of further support if it is needed or if the need surfaces during the session. The framework the instrument sits in, and the practitioner's stance in single-session work generally, has three conditions at once: the intention is to help in a single session, since the person may not come back; further help is available if it is needed, inside the service or elsewhere; and both practitioner and client know both of those things.

The instrument can be administered more than once, since each session is measured on its own and the scores do not depend on how many came before. That gives a service two practical signals it can act on without waiting for anything else:

• Scores that stay below −0.5 after three to six sessions suggest this way of working is not the right one for that person, and something else should be sought.
• The SWAN-OM does not assess risk and is not a triage tool: if risk appears, safeguarding takes priority, administration stops, and those scores are discarded.

For a service: what pooling the goals shows

Services stand to gain from pooling the instrument's goals, since that gives them an overall view of the kinds of problem their clients tend to bring, which asks are the most frequent, and how well their practitioners manage to align the support they give with those asks.

What a SWAN-OM score does not tell you

• It does not measure the therapist's quality or skill. It measures what the person wanted from that session and whether they got it, and the instrument was developed expressly for that and not to appraise whoever is delivering the session.
• It does not replace symptom measures. The CORE-10 and the SDQ measure something else over a different timescale, and the SWAN-OM covers the gap they leave when the encounter is a single one.

What it does give you is an indication of whether single-session services are working well, and of whether the people using that kind of support feel satisfied with what they received; it is therefore a good instrument for evaluating the implementation of single-session or walk-in services, since we know they save time in working out what the goals are and let the practitioner know the priorities before the encounter takes place.

The 21 SWAN-OM items, by theme

Each item has two wordings, the one the person selects beforehand and the one they score once the session has ended, and they are deliberately not the same sentence: the first asks about a want and the second about a fact.

Ideally the second part should be completed without the therapist present, to reduce bias. The first part, by contrast, always reaches the therapist before the session starts, since it holds the goals that the single session or brief therapy will work on.

Note: the selection wordings are the published ones, reproduced from Table 2 of De Ossorno García et al. (2023) under its CC BY 4.0 licence. The matching end-of-session wordings are in that article's appendix and are not reproduced here, since the versions printed in the 2021 development paper belong to the candidate phase and differ from the final ones.

What the validation data says

The figures come from the two published articles and from the implementation study, whose sample was 1,401 administrations over six months in a live service (De Ossorno García et al., 2023).

• More than 40,000 young people have used it over three years.
• 78.7% selected goals before the session and 86.1% completed the measure at the end.
• More than 80% completed it in under three minutes.
• Adequate internal consistency, α = 0.79, and a unidimensional structure, which keeps interpretation simple.
• Concurrent validity with the ESQ, YCIS and PANAS, and after the session positive affect rose and negative affect fell, with p < 0.001 in both cases.
• Perceived achievement was above 75% across every category of the instrument.
• The most requested items were “feel better”, at 11.61%, and “find ways I can help myself”, at 11.07%, and the highest scored at the end was “feel listened to”.
• A later study of 1,255 free-text responses found scoring to be equivalent for free text and for predefined items, which supports the idiographic component (Banwell et al., 2026).

SWAN-OM-ES: the paper copy, in Spanish

Its validation publications, and the APA register

The instrument is catalogued by the American Psychological Association. Here you will find the publications about it, including the research process that shaped the instrument and its validation in an English-speaking population.

Who developed SWAN-OM

The instrument was developed inside Kooth, with CORC, the Anna Freud National Centre, University College London and the University of Manchester contributing to its evaluation and its psychometric validation.

The instrument's credits are Aaron Sefi, Julian Edbrooke-Childs, Santiago de Ossorno García, Florence Ruby, Louisa Salhi and Jenna Jacob.

Though it is worth saying that many more people took part: from the children and young people who helped shape the questions and gave them their structure and design, to Professor Terry Hanley lending his wisdom, some of the service's clinical psychologists, and the engineers and designers who brought ideas, changes and improvements during its development.

An instrument is not made by one person; it is made by a whole service deciding the question is worth asking. To everyone who put hours, doubts and corrections into this: thank you for the shared work, and for listening first to the people who were going to answer it. So if you are thinking of adding single sessions to your service, or of how to measure therapeutic work session by session, it matters that the instrument is fitted, adapted and above all that the context is understood before it is used.

Consultancy: putting an outcome measure into a live service

Single session therapy, which is what this was built for