Measurement based care behavioral health (MBC) is the practice of routinely using validated symptom rating scales to assess patients’ progress in treatment. It improves patient outcomes, enhances clinical decision making and quality of care, enriches communication between patients and providers, and demonstrates the value of treatment.
The practice of measuring patient symptoms and progress in treatment is quickly becoming the standard for behavioral health care. It enables practices to provide objective evidence that a care plan is working, which can improve patient outcomes and increase retention.
MBC requires two simple components: validated, brief, standardized self-report questionnaires and systematic administration of those questionnaires. These questionnaires must have established scoring thresholds and be sensitive in measuring changes in symptoms over time.
Symptom rating scales can be administered by clinicians at the beginning of treatment to establish baselines and to track progress over time, as well as during sessions. They are used to help determine how well a client is responding to therapy, medication management, and other treatments.
Research shows that symptom monitoring and response or remission rates improve treatment outcomes for mental health conditions, such as depression and anxiety. For the most part, these measures are used to assess the effectiveness of medication management and psychotherapy.
To implement measurement based care, therapists need to be trained in the use of symptom rating scales and understand their strengths and limitations. They must also be aware of the importance of re-assessing symptom severity and symptom change from session to session so that the information can be provided to patients at a time when it is most meaningful to them. Several randomized controlled trials have shown that frequent and timely feedback of patient-reported symptoms in the context of the clinical encounter improves treatment outcomes for most patients receiving medication management or psychotherapy.
In addition, therapists must be familiar with the range of available validated symptom rating scales and which ones are appropriate for their particular practice. Some symptom rating scales are specific to certain populations and diagnosis categories, while others have more global focus such as overall distress or functional status.
The most effective symptom rating scales are reliable, sensitive to change, and able to be assessed in the context of the clinical encounter. The most effective symptom rating scales are designed to assess the full spectrum of symptoms that can arise during a patient’s course of treatment, including residual symptoms that might not be recognized until they are addressed.
While the benefits of measurement based care are clear, many providers and health systems struggle to implement it in their organization. This is largely due to barriers at multiple levels, including the patient, practitioner, and practitioner’s organization.
These barriers can be addressed by developing a program that focuses on implementation science–the study of methods to integrate evidence-based practices into routine care. This can include the use of measurement feedback systems, leveraging local champions, forming learning collaboratives, training leadership, improving expert consultation with clinical staff, and generating incentives.