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Treating Depression with Measurement-Based Care

Advances in health care and recent data from research provide a steady stream of clinically-validated and evidence-based treatment methods for behavioral health professionals that were previously not available. As time progresses, newer treatment procedures and practices keep evolving, yielding scientifically-proven, patient-facing treatments. Measurement-based care (MBC) is one such treatment approach that is gaining ground globally in the health care field.

MBC is the practice of implementing clinical care based on patient feedback and data collected throughout the treatment process. It is already a core component of various earlier evidence-based practices. In fact, MBC could be the missing link in the huge gap between what should be accomplished and what actually has been achieved in clinical practice.

The efficacy of MBC has been verified repeatedly in clinical trials as a practice that improves care and can be used in any medical discipline, including mental health and addiction treatment. Clinical trials have yielded data that support implementing MBC in addressing comorbidities— by weeding out underlying psychiatric conditions that severely impact substance use problems.

Research has shown that MBC added to any intervention yields widespread benefits. Using an MBC approach lets providers closely monitor the progress of any treatment, highlights ongoing treatment targets, prevents deterioration of symptoms and improves outcomes for clients. The use of MBC in treating depression (a major cause of disability worldwide) is similarly proven to be extremely effective.

Unfortunately, routine implementation of MBC has a long way to go; very few clinicians routinely use it for treating health conditions, be it addiction or mental health issues. In patients with depression, the use of MBC has largely been relegated to only assessing symptoms of disorders such as depression and anxiety, but it has much broader applications. The use of MBC can help providers to tease out crucial information about a range of factors key in assessing treatment for depression, including symptoms, satisfaction with life and functioning, mechanisms of change, and willingness to change and progress (or lack thereof) over the course of treatment.

Barriers to Treating Depression

Although depression is one of the most common mental disorders, the treatment and level of care for it is, overall, inconsistent and inadequate. Although the use of antidepressants has soared in the United States, not many U.S. adults receive the appropriate intervention or any treatment at all, according to a 2016 article in JAMA. The study showed that of patients who screened positive for depression, less than 30 percent received any treatment, and of those who did, only 33 percent of patients with serious psychological distress and 17 percent with less psychological distress received care from a psychiatrist. Providers and treatment networks often perceive that implementing MBC is time-consuming, expensive, difficult and disruptive, and that training staff is difficult—none of which is true.

Treating Depression: Why Measurement-Based Care Works

Data show that, when treating depression, the majority of physicians do not routinely use validated treatment guidelines when prescribing antidepressants. The mental health field, unlike other medical specialties, has been slow to embrace newer, evidence-based treatment methods. However, MBC’s ability to observe symptoms over time, assess severity, treatment adherence and medication side-effects offers a simple yet effective way to enhance current and clinically-verified depression treatment methods, and in the process provide optimal, evidence-based and individualized care for patients. However, only 20 percent of mental health professionals routinely use MBC to treat depression.

Incorporating MBC into any treatment plan is not complicated; most of the assessment tools are available free of charge online (see the link to the Substance Abuse and Mental Health Services Administration Screening Tools at the end of this article), are easy to use, and take very little time to administer. Using assessment tools to obtain patient feedback during treatment lets the care team identify gaps, assess the provider-patient relationship, track progress, identify potential relapse red flags, and understand if medication (if used) is working.

There are other valuable applications of using MBC. The assessments provide valuable data that can be used to evaluate the overall performance of a practice or facility and can be gathered as data that can be supplied for accreditation. Continuous performance assessment can be used for funding decisions, to create new programs and dispose of ones that are ineffective, and to overall improve the quality of care provided and patient outcomes. MBC also encourages clinicians to follow standard treatment practices within an organization, ensuring that every patient seeking depression treatment receives adequate, evidence-based care.

MBC streamlines the patient assessment process and facilitates the identification of differential diagnoses and co-occurring conditions, such as substance use. Furthermore, MBC can also aid in enhancing the clinician’s judgement as it offers an objective assessment of the progress made by a patient.

Recent Success of MBC

A recent initiative by the U.S. Department of Veteran Affairs has made the use of MBC the standard in treating mental health disorders resulted in positive outcomes for both veterans and providers. The veterans who participate in providing clinically- validated measures at regular intervals better understand the interventions used to treat them. The outcomes are shared promptly with other providers who are part of the care team. The relationship forged between the providers and the veterans improves treatment plans, assessment of progress and adjustment of the treatment process over time. The mutual decision-making and regular assessment of treatment plans has led to a higher engagement from the veterans resulting in better treatment outcomes.

The success of MBC can be replicated for every patient with mental health conditions, including those with depression, whether moderate or severe. Implement MBC – your facility will thank you for it, your patients will benefit from it.

Sources

  1. Beck JS, Beck AT. Cognitive behavior therapy: Basics and beyond. New York: Guilford Press; 2011.
  2. Klerman GL, Weissman MM, Rounsaville BJ, Chevron ES. Interpersonal psychotherapy of depression. New York: Basic Books; 1984.
  3. Lambert MJ, Whipple JL, Hawkins EJ, Vermeersch DA, Nielsen SL, Smart DW. Is It time for clinicians to routinely track patient outcome? A meta-analysis. Clinical Psychology: Science and Practice. 2003;10(3):288–301. http://dx.doi. org/10.1093/clipsy.bpg025.
  4. Trivedi MH, Daly EJ. Measurementbased care for refractory depression: A clinical decision support model for clinical research and practice. Drug and Alcohol Dependence. 2007;88:S61–S71. http://dx.doi.org/10.1016/j. drugalcdep.2007.01.007.
  5. Lambert MJ, Harmon C, Slade K, Whipple JL, Hawkins EJ. Providing feedback to psychotherapists on their patients’ progress: Clinical results and practice suggestions. Journal of Clinical Psychology. 2005;61(2):165– 174. http://dx.doi.org/10.1002/ jclp.20113. [PubMed]
  6. Treatment of Adult Depression in the United States. JAMA Intern Med. 2016;176:1482-1491. https://www.ncbi.nlm.nih.gov/ pubmed/27571438
  7. Morris DW, Trivedi MH. Measurementbased care for unipolar depression. Current Psychiatry Reports. 2011;13(6):446–458. http://dx.doi.org/10.1007/s11920- 011-0237-8. [PubMed]
  8. Bickman L. A measurement feedback system (MFS) is necessary to improve mental health outcomes. Journal of the American Academy of Child and Adolescent Psychiatry. 2008;47(10):1114.
  9. Garland AF, Kruse M, Aarons GA. Clinicians and outcome measurement: What’s the use? The Journal of Behavioral Health Services & Research. 2003;30(4):393–405. http://dx.doi.org/10.1007/ BF02287427. [PubMed]
  10. Sapyta J, Riemer M, Bickman L. Feedback to clinicians: Theory, research, and practice. Journal of Clinical Psychology. 2005;61(2):145– 153. http://dx.doi.org/10.1002/ jclp.20107. [PubMed]

Resources

  • American Psychiatric Association. Treating Major Depressive Disorder A Quick Reference Guide. https://psychiatryonline. org/pb/assets/raw/sitewide/ practice_guidelines/guidelines/ mdd-guide.pdf
  • Substance Abuse and Mental Health Services Administration. Screening Tools. https://www. integration.samhsa.gov/clinicalpractice/ screening-tools)

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