Using Measurement-Based Care to Enhance Any Treatment.

Measurement-based care (MBC) can be defined as the practice of basing clinical care on client data collected throughout treatment. MBC is considered a core component of numerous evidence-based practices (e.g., Beck & Beck, 2011; Klerman, Weissman, Rounsaville, & Chevron, 1984) and has emerging empirical support as an evidence-based framework that can be added to any treatment (Lambert et al., 2003, Trivedi et al., 2007). The observed benefits of MBC are numerous. MBC provides insight into treatment progress, highlights ongoing treatment targets, reduces symptom deterioration, and improves client outcomes (Lambert et al., 2005). Moreover, as a framework to guide treatment, MBC has transtheoretical and transdiagnostic relevance with broad reach across clinical settings. Although MBC has primarily focused on assessing symptoms (e.g., depression, anxiety), MBC can also be used to assess valuable information about (a) symptoms, (b) functioning and satisfaction with life, (c) putative mechanisms of change (e.g., readiness to change), and (d) the treatment process (e.g., session feedback, working alliance). This paper provides an overview of the benefits and challenges of MBC implementation when conceptualized as a transtheoretical and transdiagnostic framework for evaluating client therapy progress and outcomes across these four domains. The empirical support for MBC use is briefly reviewed, an adult case example is presented to serve as a guide for successful implementation of MBC in clinical practice, and future directions to maximize MBC utility are discussed.

[1]  M. Trivedi,et al.  Measurement-based care for refractory depression: a clinical decision support model for clinical research and practice. , 2007, Drug and alcohol dependence.

[2]  Russell E Glasgow,et al.  A proposal to speed translation of healthcare research into practice: dramatic change is needed. , 2011, American journal of preventive medicine.

[3]  E. Hawkins,et al.  Providing feedback to psychotherapists on their patients' progress: clinical results and practice suggestions. , 2005, Journal of clinical psychology.

[4]  E. Scott Huebner,et al.  Research on Assessment of Life Satisfaction of Children and Adolescents , 2004 .

[5]  Aaron R Lyon,et al.  From distal to proximal: routine educational data monitoring in school-based mental health , 2013, Advances in school mental health promotion.

[6]  N. Jacobson,et al.  Depression in Context: Strategies for Guided Action , 2001 .

[7]  E. Meadows,et al.  Practitioner’s Guide to Empirically Based Measures of Depression , 2001, Journal of Cognitive Psychotherapy.

[8]  Pursuing an Evidence-Based Culture Through Contextualized Feedback: Aligning Youth Outcomes and Practices , 2011 .

[9]  L. Goebel A peer review feedback method of promoting compliance with preventive care guidelines in a resident ambulatory care clinic. , 1997, The Joint Commission journal on quality improvement.

[10]  Susan G Silva,et al.  The role of readiness to change in response to treatment of adolescent depression. , 2009, Journal of consulting and clinical psychology.

[11]  P. Hovmand,et al.  Implementation of Evidence-Based Practice in Community Behavioral Health: Agency Director Perspectives , 2007, Administration and Policy in Mental Health and Mental Health Services Research.

[12]  S. Murphy,et al.  Designing a pilot sequential multiple assignment randomized trial for developing an adaptive treatment strategy , 2012, Statistics in medicine.

[13]  C. Martell,et al.  Behavioral activation for depression. , 2008 .

[14]  J. Prochaska,et al.  Stages and processes of self-change of smoking: toward an integrative model of change. , 1983, Journal of consulting and clinical psychology.

[15]  D. Jobes Managing suicidal risk : a collaborative approach , 2006 .

[16]  Michael B. First,et al.  Handbook of Psychiatric Measures , 2000 .

[17]  C. Eiser,et al.  A review of measures of quality of life for children with chronic illness , 2001, Archives of disease in childhood.

[18]  Michael J. Constantino,et al.  The working alliance: Where are we and where should we go? , 2006, Psychotherapy.

[19]  G. Klerman,et al.  Interpersonal psychotherapy of depression , 1984 .

[20]  A. Belanger,et al.  Reliability and Validity , 2004 .

[21]  C. Dowrick,et al.  Patients’ and doctors’ views on depression severity questionnaires incentivised in UK quality and outcomes framework: qualitative study , 2009, BMJ : British Medical Journal.

[22]  L. Palinkas,et al.  Implementation of Evidence-based Practice in Child Welfare: Service Provider Perspectives , 2007, Administration and Policy in Mental Health and Mental Health Services Research.

[23]  Michael J. Lambert,et al.  Is It Time for Clinicians to Routinely Track Patient Outcome? A Meta‐Analysis , 2006 .

[24]  B. Löwe,et al.  A brief measure for assessing generalized anxiety disorder: the GAD-7. , 2006, Archives of internal medicine.

[25]  L. Bickman,et al.  Development and Psychometric Evaluation of the Youth and Caregiver Service Satisfaction Scale , 2012, Administration and Policy in Mental Health and Mental Health Services Research.

[26]  Eric L. Daleiden,et al.  Driving with Roadmaps and Dashboards: Using Information Resources to Structure the Decision Models in Service Organizations , 2008, Administration and Policy in Mental Health and Mental Health Services Research.

[27]  R. Tredgold Patients and Doctors , 1887, The Hospital.

[28]  A. Beck,et al.  Cognitive behavior therapy : basics and beyond , 2011 .

[29]  Christopher Dowrick,et al.  Management of depression in UK general practice in relation to scores on depression severity questionnaires: analysis of medical record data , 2009, BMJ : British Medical Journal.

[30]  Donald Thompson,et al.  Outcome Assessment via Handheld Computer in Community Mental Health: Consumer Satisfaction and Reliability , 2011, The Journal of Behavioral Health Services & Research.

[31]  R. DeRubeis,et al.  The temporal relation of adherence and alliance to symptom change in cognitive therapy for depression. , 1999, Journal of consulting and clinical psychology.

[32]  Mark T Hegel,et al.  Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. , 2002, JAMA.

[33]  Michael VonKorff,et al.  Randomised trial of monitoring, feedback, and management of care by telephone to improve treatment of depression in primary care , 2000, BMJ : British Medical Journal.

[34]  Psychometric considerations in self-monitoring assessment. , 1999 .

[35]  S. L. Nielsen,et al.  Enhancing psychotherapy outcomes via providing feedback on client progress: a replication , 2002 .

[36]  L. Bickman,et al.  Beyond outcomes monitoring: measurement feedback systems in child and adolescent clinical practice , 2009, Current opinion in psychiatry.

[37]  E. Hawkins,et al.  The therapeutic effects of providing patient progress information to therapists and patients , 2004 .

[38]  Gregory A. Aarons,et al.  Clinicians and outcome measurement: What's the use? , 2003, The Journal of Behavioral Health Services & Research.

[39]  Manuel Riemer,et al.  Effects of routine feedback to clinicians on mental health outcomes of youths: results of a randomized trial. , 2011, Psychiatric services.

[40]  J. Weisz,et al.  Provider attitudes toward evidence-based practices: are the concerns with the evidence or with the manuals? , 2009, Psychiatric services.

[41]  K. Hawley,et al.  Understanding Barriers to Evidence-Based Assessment: Clinician Attitudes Toward Standardized Assessment Tools , 2010, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[42]  R. Spitzer,et al.  The PHQ-9: validity of a brief depression severity measure. , 2001, Journal of general internal medicine.

[43]  Bruce F Chorpita,et al.  Identifying and Selecting the Common Elements of Evidence Based Interventions: A Distillation and Matching Model , 2005, Mental health services research.

[44]  J. Kimberly,et al.  The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research , 2012, Implementation Science.

[45]  K. Comtois,et al.  Recovery from disability for individuals with borderline personality disorder: a feasibility trial of DBT-ACES. , 2010, Psychiatric services.

[46]  E. Balas,et al.  Managing Clinical Knowledge for Health Care Improvement , 2000, Yearbook of Medical Informatics.

[47]  E. Diener,et al.  Review of the Satisfaction with Life Scale , 1993 .

[48]  S. Erickson,et al.  The Concordance of Self-Report With Other Measures of Medication Adherence: A Summary of the Literature , 2004, Medical care.

[49]  M. Fava,et al.  Primary Versus Specialty Care Outcomes for Depressed Outpatients Managed with Measurement-Based Care: Results from STAR*D , 2008, Journal of General Internal Medicine.

[50]  A. Simons,et al.  Wanted: Reliable and Valid Measures for the Science of Cognitive Behavioral Therapy Dissemination and Implementation , 2013 .

[51]  C. Dowrick,et al.  record data severity questionnaires: analysis of medical practice in relation to scores on depression Management of depression in UK general , 2009 .

[52]  Peter Mendel,et al.  Implementation of the CALM intervention for anxiety disorders: a qualitative study , 2012, Implementation Science.

[53]  M. Nock,et al.  Delineating mechanisms of change in child and adolescent therapy: methodological issues and research recommendations. , 2003, Journal of child psychology and psychiatry, and allied disciplines.

[54]  R. Gallop,et al.  A preliminary study of the effects of individual patient-level feedback in outpatient substance abuse treatment programs. , 2012, Journal of substance abuse treatment.

[55]  G. Thornicroft,et al.  The feasibility of routine outcome measures in mental health , 1999, Social Psychiatry and Psychiatric Epidemiology.

[56]  Kimberly Hoagwood,et al.  The organizational social context of mental health services and clinician attitudes toward evidence-based practice: a United States national study , 2012, Implementation Science.

[57]  S. Kolakowsky-Hayner,et al.  The Satisfaction With Life Scale , 2013, The Journal of head trauma rehabilitation.

[58]  Implementing standardized assessments in clinical care: now's the time. , 2009, Psychiatric services.

[59]  James O Prochaska,et al.  Stages of change. , 2011, Journal of clinical psychology.

[60]  David C. Atkins,et al.  Collaborative assessment and management of suicidality (CAMS): feasibility trial for next‐day appointment services , 2011, Depression and anxiety.

[61]  Jonathan Green,et al.  The conceptualization and measurement of therapeutic alliance: an empirical review. , 2008, Clinical psychology review.

[62]  M. Lambert,et al.  Patient-focused research: using patient outcome data to enhance treatment effects. , 2001, Journal of consulting and clinical psychology.

[63]  T. Tracey,et al.  Factor structure of the Working Alliance Inventory. , 1989 .

[64]  J. Weisz,et al.  Youth Top Problems: using idiographic, consumer-guided assessment to identify treatment needs and to track change during psychotherapy. , 2011, Journal of consulting and clinical psychology.

[65]  John D. Hamilton,et al.  A Measurement Feedback System ( MFS ) Is Necessary to Improve Mental Health Outcomes , 2008 .

[66]  Brian Salter,et al.  Patients and doctors: reformulating the UK health policy community? , 2003, Social science & medicine.

[67]  Martin M. Antony,et al.  Practitioner's guide to empirically based measures of anxiety , 2002 .

[68]  M. Trivedi,et al.  Measurement-Based Care for Unipolar Depression , 2011, Current psychiatry reports.

[69]  I. McDowell,et al.  Measuring health: A guide to rating scales and questionnaires, 3rd ed. , 2006 .

[70]  R. Spitzer,et al.  The PHQ-9: A new depression diagnostic and severity measure , 2002 .

[71]  J. Weisz,et al.  Kernels vs. Ears, and Other Questions for a Science of Treatment Dissemination. , 2011, Clinical psychology : a publication of the Division of Clinical Psychology of the American Psychological Association.

[72]  S. Eisen,et al.  A self-report symptom and problem rating scale to increase inpatients' involvement in treatment. , 2000, Psychiatric services.

[73]  B. Barnaby Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual , 2015 .

[74]  S. Haynes,et al.  Idiographic assessment: conceptual and psychometric foundations of individualized behavioral assessment. , 2009, Clinical psychology review.

[75]  Karen A. Blase,et al.  Implementation Research: A Synthesis of the , 2005 .

[76]  Do Peterson,et al.  Collaborative care for patients with depression and chronic illnesses. , 2010, The New England journal of medicine.

[77]  B. Lebowitz,et al.  Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. , 2006, The American journal of psychiatry.

[78]  A. Simons,et al.  A manual-based intervention to address clinical crises and retain patients in the Treatment of Adolescents With Depression Study (TADS). , 2007, Journal of the American Academy of Child and Adolescent Psychiatry.

[79]  S. L. Nielsen,et al.  Enhancing outcome for potential treatment failures: Therapist–client feedback and clinical support tools , 2007 .

[80]  E. S. Casper The theory of planned behavior applied to continuing education for mental health professionals. , 2007, Psychiatric services.

[81]  Alliance predicts patients' outcome beyond in-treatment change in symptoms. , 2000, Journal of consulting and clinical psychology.

[82]  J. Fries,et al.  The Patient-Reported Outcomes Measurement Information System (PROMIS): Progress of an NIH Roadmap Cooperative Group During its First Two Years , 2007, Medical care.

[83]  A. Kazdin Mechanisms of Change in Psychotherapy: Advances, Breakthroughs, and Cutting-Edge Research (Do Not Yet Exist). , 2006 .

[84]  J. Sapyta,et al.  Feedback to clinicians: theory, research, and practice. , 2005, Journal of clinical psychology.

[85]  D. Barlow,et al.  Clinical Handbook Of Psychological Disorders , 2015 .

[86]  R. Beidas,et al.  Free, brief, and validated: Standardized instruments for low-resource mental health settings. , 2015, Cognitive and behavioral practice.

[87]  Wayne F. Velicer,et al.  Stages of change in psychotherapy: Measurement and sample profiles. , 1983 .

[88]  J. Garske,et al.  Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review. , 2000, Journal of consulting and clinical psychology.

[89]  A. Kazdin Mediators and mechanisms of change in psychotherapy research. , 2007, Annual review of clinical psychology.

[90]  M. Lambert,et al.  Improving psychotherapy outcome: the use of immediate electronic feedback and revised clinical support tools. , 2008, Clinical psychology & psychotherapy.

[91]  A. Rush,et al.  Maximizing the Adequacy of Medication Treatment in Controlled Trials and Clinical Practice: STAR*D Measurement-Based Care , 2007, Neuropsychopharmacology.

[92]  M. Saggese Maximizing Treatment Effectiveness in Clinical Practice: An Outcome-Informed, Collaborative Approach , 2005 .

[93]  Patrick E. McKnight,et al.  Strengthening research methodology: Psychological measurement and evaluation. , 2006 .