What is measurement informed care? 

Measurement informed care works when client’s symptoms are measured before, during, and after treatment. It helps clients get better faster and stay better longer. It helps clinicians increase the income in their practice. It helps insurance companies and healthcare systems improve outcomes while reducing costs.

We offer measurement informed care through our Mental Health Dashboard service.

Why should you use measurement based-care? 

Measurement based-care focuses on 3 main actions: 

  • The client completes regular assessments 
  • The provider reviews client progress
  • Real-time insights for adjustments

What are patient outcomes of measurement based-care? 

Patient outcomes in measurement based-care illustrate significant improvements in clinical outcomes for behavioral health organizations. 

  • 120% increase in remission from depression 
  • 20% reduction in the no-show rate 
  • 45% improvement in blood glucose values 

(SAMSHA website)

  • Patient empowerment: Tapping into the client’s strengths in their development and progress through treatment. 
  • Choice: Discuss with patients their options for treatment.
  • Collaboration: Helping create and facilitate a multidisciplinary team of individuals who are supporting the client and their goals. 
  • Safety: Creating a space where the client feels physically and emotionally safe. 
  • Trustworthiness: Making clear expectations regarding what the client is coming to treatment for, how those goals will be attained, and who will provide the services.

What are trauma-informed care and/or trauma-focused services?  

Trauma-informed care accepts the need to understand a client’s life experiences in order to deliver effective care. Trauma informed care has the potential to improve client engagement, treatment adherence, health outcomes, and provider and staff wellness. 

Measurement informed care is sometimes criticized as not being trauma-informed. This is not the case. Measurement informed care enhances and enables trauma informed care by flagging low engagement or treatment adherence that would otherwise be missed. This creates an opportunity for the provider better understand the client’s story, experiences, and hesitations. Measurement informed care can also be used to advocate illustrate medical necessity, which is critical when advocating for insurance coverage.

What is trauma or traumatic experiences in clinical care?

The Substance Abuse and Mental Health Services (SAMSHA) defines trauma as, “Individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life-threatening and that has lasting adverse effects on the individuals functioning and mental, physical, social, emotional or spiritual well-being”. 

What are important organizational practices within the clinical practice to implement when treating those with traumatic experiences? 

  • Training both clinical and non-clinical staff 
  • Creating, building, and maintaining a safe environment 
  • Leading and communicating about the transformation process 
  • Engaging clients in organizational planning 
  • Helping prevent secondary traumatic stress in staff members 

What are important clinical practices to implement when treating those with traumatic experiences? 

  • Involve clients in the treatment process 
  • Screen for trauma (screening is the first step in measurement informed care)
  • Train staff in trauma-specific approaches 
  • Engaging referral sources and partnering organizations 

How do you screen for trauma?

Depending on the clinician, the way and type of screening used may differ. However, it is important to screen each patient for trauma history as early as possible. One very common test is the ACES test, which looks at Adverse Childhood Experiences the individual may have encountered while growing up. 

What psychological assessments are used in measurement-based care? 

Adult-focused models: 

  • Narrative Exposure Therapy (NET)
  • Eye Movement Desensitization and Reprocessing (EMDR)
  • Seeking Safety 

Child-focused models: 

  • Child-Parent Psychotherapy 
  • Attachment, Self-Regulation, and Competency (ARC) 
  • Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) 

What is a trauma-informed system? 

A Trauma-Informed System: 

  • Realizes the widespread impact of trauma and understands potential paths for recovery 
  • Recognizes the signs and symptoms of trauma in clients/students, families, and staff
  • Responds by fully integrating knowledge about trauma into policies, procedures, and practices to resist re-traumatization

What are different standards of care in the mental health field?

  • Statutes within each state
  • Licensing board regulations 
  • Case Law 
  • Ethical Codes of Professional Associations 
  • The Respected Minority Principle 

How does measurement-based care (MBC) work?

MBC works by incorporating symptom rating scales, baseline conditions, and then the improvement of behaviors that patients exhibit after the interventions are implemented. This helps clinicians understand where the patient is at in the beginning, and then they help the patient recognize problem behaviors by providing them with tools and resources to help them reach their end goals. 

Why should we use MBC methods in mental health care settings?

MBC can help administer better and greater positive outcomes for the patients. There are three reasons why measurement-based care is crucial in any health care setting: 

What are the criteria for assessment tools to be used as standardized instruments? 

3. It is becoming the standard of care 

What are the criteria for assessment tools to be used as standardized instruments? 

  1. Clients get better faster (need fewer sessions within each course of therapy).
  2. Clients stay better longer (need fewer courses of therapy over their lifetimes).
  3. Clinicians can negotiate better rates with insurance companies (get paid more per service).
  4. Insurance companies reduce expenditures on mental health while improving mental health outcomes for their members.

What measures are looked at through MBC?

Users of our Mental Health Dashboard service have access to over 200 diagnostic and problem-specific measures. The service includes monitoring by a clinician who will review each users file weekly to make adjustments or recommendations.

What are psychiatric measures? 

Most generally speaking, psychiatric measures can be used to identify the presence and severity of a psychiatric problem. Each psychiatric measure is named for the problem it is measuring and usually indicates whether it is brief (under 15 minutes) or extensive.

What are outcome measures? 

These are questionnaires, checklists, and worksheets that help monitor and check in on where the patient is currently at in relation to the goals they have set for therapy. The outcome measures used are typically brief and improve the quality of the mental health care provided to the client. 

How do you measure suicidal ideation? 

There are many different kinds of scales to measure self-harm, suicidal ideation, and suicidality. A few of the different ones are listed below: 

  • Acquired Capability for Suicide Scale – Fearlessness About Death (ACSS-FAD)
  • Columbia Suicide Severity Rating Scale (C-SSRS) 
  • Interpersonal Needs Questionnaire (INQ-15)
  • Non-Suicidal Self-Injury Assessment Tool (NSSI-AT) 
  • Suicidal Behaviors Questionnaire-Revised (SBQ-R)

What is a behavioral assessment? 

A behavioral assessment is when a study is done to evaluate a person’s behavior using several different techniques. This includes observation, interviews, and monitoring from the client themselves. 

What is the satisfaction with life scale? 

This scale is to help understand and measure the cognitive judgments related to one’s satisfaction with life. The responses are viewed on a Likert scale ranging from 1-7, and typically take only a couple of minutes to finish. 

Main source: https://www.samhsa.gov/sites/default/files/programs_campaigns/childrens_mental_health/atc-whitepaper-040616.pdf

How do you measure depression? 

Depression severity depends on each individual and their circumstances. Some different kinds of scales to measure depression include: 

  • Behavioral Activation for Depression Scale (BADS-SF) 
  • Clinically Useful Depression Outcome Scale 
  • Montgomery & Asberg Depression Rating Scale (MADRS) 
  • Severity Measure for Depression (Adapted from PHQ-9)