A Practical Guide to Measurement-Based Care in Substance Use Disorder Treatment

Based on Greenspace Health’s educational webinar featuring Dr. Kelli Scott (Northwestern University Feinberg School of Medicine), Dr. Sandra Resnick (Yale University School of Medicine), and Dr. Jessica Barber (Yale University School of Medicine).

Substance use disorder (SUD) treatment presents a distinct challenge for clinicians. Progress is rarely linear, recovery looks different for every person, and some of the most important clinical signals, including early disengagement, shifts in motivation, and declining functioning, are easy to miss without a consistent framework for tracking them.

Measurement-Based Care (MBC) is emerging as one of the most practical tools available to address that gap. Yet its adoption in SUD settings remains inconsistent, often held back by misperceptions, administrative concerns, and a lack of clear guidance on how to get started.

In a recent educational session, Greenspace Health brought together three leading experts: Dr. Kelli Scott of Northwestern University, and Dr. Sandra Resnick and Dr. Jessica Barber of the Yale Measurement-Based Care Collaborative. We gathered the most important insights from the session into this guide on how your organization can implement MBC in practice.

What Is Measurement-Based Care?

Before getting into implementation, it’s worth making sure we’re on the same page about what MBC actually is. Dr. Resnick offered a clear definition during the webinar:

“MBC is a collaborative clinical practice that can be integrated into any mental health treatment over time. We use patient-reported outcome measures (PROMs) to track progress over time, to increase engagement, and to collaboratively discuss goals and changes to the treatment plan.”

Dr. Resnick and Dr. Barber have developed the Collect, Share, Act clinical process to guide clinicians in using data collaboratively. It’s exactly what it sounds like: you collect measures, share the results back with clients and have a conversation about them, and then do something with what you learn.

Critically, MBC is not a checklist, a compliance requirement, or an algorithm. As Dr. Resnick put it, “It’s a powerful clinical tool that empowers clients and can make treatment more effective.”

This distinction matters enormously for buy-in. In Dr. Resnick’s experience, resistance often dissipates once clinicians understand what MBC actually involves:

Why MBC Is Especially Valuable in SUD Care

MBC has a strong evidence base in general mental health. It reduces dropout rates, supports informed decision-making, and improves outcomes. But the panelists argued it has unique and underappreciated value specifically in SUD settings.

1. Recovery isn’t linear, and MBC helps you see the whole picture

Traditional pre/post measurement models miss a lot of what matters in SUD recovery. Dr. Scott emphasized that focusing only on substance use outcomes can mean overlooking meaningful early signs of progress:

This is where incorporating broader measures, such as quality of life, functioning, or values-based outcomes, becomes especially powerful.

2. Quality-of-life measures unlock different conversations

Dr. Barber made a compelling case for going beyond SUD-specific PROMs:

She shared a recent example from her own practice: a client who, because they answered a question about happiness every week, began actively noticing small moments of joy throughout their daily life. “This client spontaneously turned our Measurement-Based Care question into this simple, beautiful practice that was having an impact on them every day.”

3. MBC helps providers manage large, complex caseloads

Dr. Scott highlighted a practical reality in many SUD settings, particularly opioid treatment programs, where providers have multiple clients and might meet with each one for only 30 minutes per month:

4. MBC can reduce provider burnout

This point tends to surprise people. Dr. Resnick argued that MBC isn’t just good for clients; it’s good for clinicians:

Dr. Scott added: “Measurement-Based Care is something that can help us be more efficient and effective and actually save us time in the end, because it helps us check in quickly and see what our clients need most.”

What Makes SUD Implementation Different

MBC is not a one-size-fits-all practice, and SUD settings have distinct realities that shape how implementation should be approached. Dr. Scott, who co-leads the HEALing Measurement Center (a NIDA-funded research center working to scale MBC across SUD programs in Pennsylvania), offered a detailed picture of what those contextual factors look like in practice.

Key challenges she and her team have identified include:

• The structure and length of measures, and how they balance against existing documentation requirements
• Cost of implementation
• Organizational buy-in and whether MBC is recognized and rewarded
• Stigma, including both internalized stigma in clients and stigmatizing beliefs among providers
• Fear of surveillance, where clients may worry that disclosing struggles could result in losing take-home medication doses, housing, or other supports tied to compliance

That last point deserves particular attention. As Dr. Scott explained:

“Clients might be hesitant to disclose their substance use for fear of potential consequences, which have been really true in the past — things like losing access to take-home doses of medication and having to come in every day, potentially even being discontinued from treatment. So, we’re really in a different context here. We have to think about how we can frame Measurement-Based Care as truly a clinical support tool and not something that can reify some of that stigma.”

At the same time, SUD organizations have real strengths that facilitate MBC adoption: strong relationships and communication structures, deep commitment to supporting recovery, and positive beliefs about MBC’s potential once it’s properly understood.

A Practical Implementation Guide

Based on the panelists’ collective experience, here is a framework for getting MBC off the ground in your SUD setting.

Step 1: Setting the Context for Why

Before selecting a measure or configuring any technology, get clear on the clinical rationale for MBC at your organization. This sounds obvious, but it’s the step most organizations skip—and it’s often why implementations stall.

When MBC is introduced as a compliance requirement, clinicians treat it as a checkbox. When it’s introduced as a clinical tool that makes their work more effective and their clients’ experiences more meaningful, it becomes part of how care is actually delivered. The difference in how you frame the rollout shapes everything that follows.

This means the first conversations about MBC should not be about which platform to use or which measures to select. They should be about the clinical problem you’re trying to solve. Are counsellors struggling to identify early warning signs before a client disengages? Are clients leaving treatment without a clear sense of their own progress? Is your team losing the thread across long gaps between sessions? MBC addresses all of these, but only if clinicians understand how and why before they’re asked to use it.

Step 2: Start with co-design

The single piece of advice that came up most consistently across all three panelists was this: don’t implement from the top down. Involve clinicians, clinical leaders, and clients in designing how MBC will work in your specific context.

This also means building in autonomy. When clinicians have the opportunity to experiment (trying a measure, swapping it out, comparing notes with colleagues), they develop both competence and genuine ownership of the practice.

Step 3: Reduce existing burden before adding new requirements

One of the most impactful things the HEALing Measurement Center has done is actively remove outdated documentation requirements to make room for MBC. Dr. Scott described this as “de-implementation”:

“We did a formal evaluation with our sites to say: what do you do now? What’s actually required? Can we take away some of this [documentation] so we can make room and time for Measurement-Based Care? That has been a really impactful step in reducing that administrative burden.”

Audit your current workflows before adding MBC on top of them. Then think carefully about how MBC fits into the clinical workflows that already exist. Measures completed before a session begins lets clinicians enter the room with a grasp of what the client is experiencing. For counsellors with large caseloads and limited session time, that kind of seamless integration can inform focused discussions on what actually matters.

Step 4: Don’t overthink measure selection

The panelists emphasized that the measure matters less than most organizations think. As Dr. Resnick put it, “The magic is not the measure; the magic is in the conversation, it’s in the sharing, it’s in the listening. Engaging clients in this process is what makes things so valuable.”

Practical guidance for selecting measures:

• Look at individual items, not just total scores. Ask: what conversations could these questions unlock?
• Go beyond SUD-specific PROMs: consider quality of life, functioning, and values-based indicators
• Involve clients in the selection: ask them how they liked filling out a given measure; ask what they’d want to track

The right measure is the one that generates useful clinical conversations and can be used consistently. Start with 1–3 measures and add based on clinical need and client feedback. Measures of quality of life and recovery are particularly valuable in SUD settings for building alliance and surfacing client strengths. Here are some measures relevant to SUD settings to help you get started:

Substance use & severity: AUDIT-C, DAST-10, Brief Addiction Monitor (BAM)
Mental health (co-occurring): PHQ-9, GAD-7
Quality of life & recovery: Quality of Life in Recovery (QLIR), EQ-5D
Recovery capital: BARC-10, ARC
Therapeutic alliance: BR-WAI

Step 5: Iterate continuously

The panelists were clear that even the experts don’t have all the answers for every SUD context. There is no gold-standard MBC model for all SUD cases. What works is a mindset of continuous learning: monitoring what’s working, checking in with clients about their experience, and adjusting as you go.

“Feel free to iterate and try stuff, see how it works,” Dr. Barber said. “There’s nothing wrong with doing some measures at certain visits and swapping them throughout the course of treatment. Flexibility is important, and everyone here has the opportunity to figure out what will work for your setting, for your teams, for your clinicians.”

Making the Case: MBC, ROI, and Reporting

Funders, boards, and accreditation bodies increasingly want to see evidence that programs are tracking outcomes systematically. When implemented effectively, MBC generates exactly that kind of data.

The key is sequencing it correctly. Dr. Resnick was direct on this point:

“Before you can aggregate the data, you have to have high rates of adoption by providers and clients before the data is really meaningful. Focusing on that return on investment with the client — the effectiveness of the services, success stories, how measurement-based care helps clients feel more engaged — then as adoption increases based on that clinical success, adding in responsibly aggregated data that helps you do quality improvement.”

Programs that build adoption first, through the clinical value clinicians actually feel, generate the kind of sustained engagement that eventually produces reportable, meaningful outcomes data.

Sharing success stories internally is part of this. Dr. Barber shared a particularly moving example:

Stories like that, shared across teams, build the kind of organizational belief in MBC that sustains the practice long after the initial rollout. That belief, in turn, is what makes the reporting credible because the data reflects improvements in care that was actually happening, not a compliance exercise.

Final Thoughts

The panelists closed the session with a simple, shared conviction: when MBC is implemented well, sustainability takes care of itself, because clinicians and clients experience the difference.

Dr. Barber described a morning session that same day:

“I’m sitting with a client and we’re looking at a beautiful graph showing their improvement. There’s nothing better than knowing that this person truly feels empowered and truly has that confidence that they’ve grown. When the benefit of a practice is as apparent as this — why would you not want to keep it up?”

MBC isn’t an add-on. When embedded into the fabric of care, it becomes the way you practice. That’s the shift organizations are working toward, and the experts at Northwestern and Yale are proving, one program at a time, that it’s achievable.

Want to explore what MBC implementation could look like at your organization? Book a demo with an implementation specialist.