Measurement is a tool often overlooked in mental and behavioral health. When diagnosing and tracking a patient’s progress, it is inherently more difficult to capture practical quantitative data on a patient versus in the context of physical health. However, research has now clearly outlined a model for measuring care that generates meaningful objective data; and is effective. It involves the consistent use of standardized assessments – often referred to as patient reported outcome measures (“PROMS”).
By simply measuring effectively (without changing any programming or treatment protocol), data shows that it has a major impact on treatment outcomes and success. This includes a 42% higher level of symptom change and a 40% reduction in drop out rates.
However, not all measurement is created equal. There are infinite ways in which an organization can implement a process for collecting PROMS. And not all of these models will positively impact patient care. Therefore, it is important to highlight what the research identifies as “effective measurement” – which can generate the positive results highlighted above.
For example, having a client dealing with anxiety complete the GAD-7 assessment every 2 weeks will paint a much clearer picture of their progress in comparison to measuring their symptoms at only the start of treatment or discharge.
To highlight the importance of this exercise, when surveying clinics across North America the most common model for measurement that our team encounters is a Pre/Post model. This involves each patient completing a PROM at the beginning and end of treatment. This in theory is the simplest way of collecting aggregate data on program outcomes. However, it does not actually make measurement a part the clinical conversation or decision-making in treatment. As a result, it is not going to have any impact on client outcomes or engagement.
Defining “Effective Measurement” – The 3 Pillars
When looking at the research, there are 3 core components that need to be in place:
- Consistent completion;
- Customized assessments; and
- Visibility for patients.
1. Consistent Completion
This refers to clients receiving and completing clinically validated assessments to track their progress on a consistent basis. This means that assessments are completed throughout treatment; as opposed to only on intake and discharge. This leads to measurement becoming part of the clinical discussion – making it more relevant and engaging for clients. It also generates important information for clinicians (and clinics), in being able to quickly identify changes in symptoms or a lack of progress.
2. Customized Assessments
The assessments used need to be customized or tailored to each client’s presenting issues and symptoms (ie. Completing the PHQ-9 for depression). The information generated from these assessments will be more useful and relevant to both parties, in comparison to a general assessment that does not directly address a client’s concerns. This not only leads to more focused care for the client, but also more buy-in to the process from both the clinician and the client. Further, the data-set generated for an organization will be far more granular.
For example, if a client is presenting with depression and social anxiety, it will make the most sense for them to regularly complete assessments targeting those areas. This could include the PHQ-9, the SPIN (Social Phobia Inventory) and the WAI (Working Alliance Inventory – tracking therapeutic alliance). At the organization level, it would now be easy to identify the programming or providers that have the most impact for clients presenting with social anxiety.
3. Visibility for Patients
It is important that clients are able to have access to their own results, and a clear visualization of their progress throughout treatment. Research has demonstrated that visibility to clients actually has a greater impact on outcomes than providing visibility to clinicians (the most impact obviously comes from providing visibility for both sides). This paints a picture of how a core benefit from measurement-based care might be its ability to engage a client in treatment and provide a better understanding of one’s presenting issues. This represents a big shift from the traditional view of measurement as a data collection exercise.
When speaking with mental health professionals and organizations, it can clearly be a challenge to implement a measurement model that incorporates these 3 factors. This is due to the significant manual effort involved and the risks of taking away from session-time (among other reasons). However, our team would argue that the benefits outweigh the challenges. Further, there are opportunities to leverage technology (like Greenspace). This can greatly lessen the burden associated with implementing an effective model of measurement, while having a meaningful impact on client engagement (dropouts, cancellations and no-shows).
If you are interested in learning more about the research in this space, or would like to explore how other organizations have approached measurement-based care, please connect with us at firstname.lastname@example.org.