Measurement based care behavioral health is the systematic use of symptom rating scales, as well as other assessment tools, to assess behavioral health patients before and during treatment, to improve clinical decision making and quality of care, and to enrich communication between patients and clinicians. It is a critical component of quality mental health services and has been recommended by experts for decades. However, it remains unfamiliar to many mental health professionals and is still underutilized in a significant number of behavioral health practices.
Despite widespread acceptance and support from patients, practitioners, and payers alike, only 18% of psychiatrists and 11% of therapists are using measurement-based care (MBC). The reasons for this include: barriers to implementation, patient concerns, practitioner beliefs, organizational issues, and competing requirements.
Implementation Science – the study of methods to integrate evidence-based practices into routine care — offers strategies for overcoming these barriers. These include measurement feedback systems, local champions, leveraging expert consultation, training leadership, and creating incentives.
Theoretical and Empirical Support for Measurement-Based Care
There is a wide range of literature on the theoretical and empirical support for MBC. Studies have found that MBC is at a tipping point in the behavioral health field and has a large impact on improving outcomes, as well as increasing value. The research also suggests that the use of standardized assessments is important to evaluating behavioral health services at the provider and practice level, demonstrating value to payors, and reducing the risk of inappropriate care.
A review of this literature found that the majority of authors believed MBC was effective at improving clinical outcomes and demonstrating value to payors, and that it could help reduce the risk of inappropriate care and lower cost. Additionally, these studies showed that MBC is a key strategy to address the problem of treatment inertia, or the tendency for patients to not show substantial improvement with treatment or to fail to respond to medication.
The underlying cause of these difficulties may be due to the fact that clinicians are not trained in how to properly evaluate a patient’s symptoms, and they often have limited access to standardized, validated measures. This lack of training is exacerbated by the fact that most mental health treatments are delivered in small group settings, and the therapist and patient do not have enough time to meet with each other frequently or in depth.
Getting Started With MBC
The first step to implementing MBC in any behavioral health practice is to select and implement validated symptom rating scales that are appropriate for the treatment population. Then, you need to develop a standard practice for using these measures during the course of your work with patients.
Symptom rating scales are a vital tool for measuring a patient’s symptom severity and evaluating their response to treatment over time. This is an essential component of evidence-based behavioral health care, and a symptom rating scale is the simplest way to achieve this goal.
Timely Feedback – Symptoms and severity can change over time, which means therapists need up-to-date symptom data to assess patients’ progress and to determine whether they are responding to treatment. While it is a good idea to have clients fill out symptom scales at each appointment, it is more effective to push general rating scales to patients prior to their first visit or at the beginning of each treatment session.