Measurement-based care, the practice of collecting patients’ feedback as clinical data to guide treatment, is the key element in evidence-based and collaborative care. The Substance Abuse and Mental Health Services Administration has acknowledged the utility of measurement-based care in treating mental disorders as an evidence-based practice, and the Joint Commission has made it the standard of care for accreditation. The key element in MBC is the systematic and frequent administration of symptom rating scales to collect feedback from patients that guides current and future treatment.
The tools used in MBC for data collection are validated, generally brief, questionnaires and rating scales such as the Generalized Anxiety Disorder-7 (GAD-7) for anxiety, the Patient Health Questionnaire-9 (PHQ-9) for depression, and the Columbia-Suicide Severity Rating Scale (C-SSR), among others, that elicit feedback from patients (for a comprehensive list from SAMSHA- recommended, free screening tools, visit https://bit.ly/2uANP5x). In the psychotherapeutic setting, the use of MBC has these advantages:
- Encourages patients to discuss their feeling with counselors
- Provides patient feedback to inform the care team about what is working and what is not working under the current treatment plan
- Allows the care team to have a complete picture of how treatment is going (by including patient feedback as well as the team’s notes and observations)
- Allows for adjusting the treatment plan before discharge and customize care to each patient’s unique needs and preferences, which improves outcomes
- Allows providers to track symptoms such as withdrawal and anxiety so that worsening symptoms can be addressed
- Allows practices and networks of treatment centers to assess the effectiveness of programs and approaches, allowing for the discontinuation of ineffective approaches and adoption of ones that work
Studies have borne out that eliciting regular feedback from patients significantly improves outcomes, reduces the chances of deterioration in patients’ health (http://bit. ly/2ptkrZ1), and allows individual providers, small practices and large care networks to assess the utility of various programs and therapeutic approaches.
Measurement-based care in behavioral health care is an established, evidence-based model of care that can be integrated with any treatment (http://bit.ly/2ptkrZ1), from diabetes to addiction. The basic principle is to monitor the progress of treatment by administering symptom rating scales, thus combining hard data with clinical evaluation. Unlike other treatment models, consistently using measurement-based care has a positive impact on patients, payers, providers and treatment networks.
Medical practitioners and health care providers customize treatment programs based on the real-time data. Furthermore, payers can track patient progress during treatment.
Despite the effectiveness of measurement- based care, it has not been widely accepted by clinicians. Unfortunately, only 18 percent of psychiatrists and 11 percent of psychologists in the United States administer symptom rating scales to patients (http://bit.ly/2HQbIrq).
Utility of Measurement- Based Care Across Stakeholders
Studies have found that MBC is immensely beneficial to all stakeholders. Through constant monitoring and progressive changes in the treatment, measurement-based care in mental disorders can help patients, clinicians and others. Some of the advantages witnessed by these stakeholders include the following:
- Patients. Research shows that the addition of MBC to any treatment can result in a significant level of improvement in a patient’s outcomes with respect to interpersonal problems, psychological disturbance and quality of life. This is particularly true in the case of patients experiencing treatment failure. It also leads to the active engagement of the patient in his or her treatment.
- Clinicians. MBC provides information and targets that clinicians use to alter the intervention. It also helps them in assessing the treatment process and making differential diagnoses. It assists clinicians in making an objective assessment of the patient’s condition and accurate decisions pertaining to treatment.
- Mental health organizations. MBC provides data to mental health organizations and acts as an indicator of performance that can be reported to accreditation organizations. This leads to improvements in patient care and the quality of medical services provided.
Challenges in Implementation
As mentioned earlier, measurement- based care in behavioral health improves clinical outcomes, increases client engagement and enhances the treatment-related decision- making process. However, resistance to widespread adoption has impeded the growth of MBC nationwide as a viable treatment model. Barriers include:
- Time restrictions. Despite the many benefits of MBC, clinicians with heavy patient loads feel that too much time will be taken up by changing their approach to an MBC model. However, www.reshealth.net RESILIENT HEALTH | April 2018 7 given that most of the assessment tools are free of charge and are quick and easy to administer, this perceived barrier has little merit.
- Organizational resources. Limited organizational resources, such as access to technology, finances and supervisory support, can impair the implementation of MBC. However, the approach can be integrated into any program and requires minimal resource allocation.
- Patient complexity. Besides depression and anxiety, patients often have complex diagnoses. As a result, therapists who focus mainly on depression or anxiety have expressed that some measures may not be a good fit for their clients. However, MBC is an excellent tool for identifying dual- diagnosis, and research shows that treating all patient disorders concurrently offers the best chance of successful treatment.
- Implementation procedures. Another important challenge is the need to integrate the required logistics and procedures for the administration and review of the validated scales related to MBC. For the effective implementation of MBC, adequate organizational support and training are required, and procedures for guiding treatment and making clinical judgements need to be established. But the fact is, patients who complete symptom rating scales are comparatively more aware of their progress and engaged during the treatment process and have better outcomes.
There is no denying that MBC significantly improves outcomes and can be added to virtually any treatment program, for any substance use or mental health condition (or any combo of the two). With addiction spiraling out of control and mental health issues continuing to have a negative impact on millions of lives, there is no excuse for not implementing MBC on a national level. Both providers and patients stand to benefit, and the drawbacks are nil.