The state of California has implemented three standardized functional assessment tools in an effort to help providers better meet the needs of children, youth and families. Care Providers are required to complete outcome measures at the beginning and end of behavioral health and addictions treatment, as well as every three to six months following the first administration. The three measures are:
- Child and Adolescent Needs and Strengths (CANS)
- Pediatric Symptom Checklist (PSC-35)
- Adult Needs and Strengths Assessment (ANSA)
Historically, client reported data has not been consistently used or required within Behavioral Health and Addictions Services. This means that services have had very little data informing what works and what doesn’t— and, as a result, the quality of behavioral health care has been slow to improve.
California’s move towards mandatory measurement is an important step in the right direction for the quality of care in California, bringing the state closer to Measurement-Based Care (MBC) and the significant benefits that come with it. However, it’s important to note that while assessments administered every 3-6 months can assist with reporting, they don’t meaningfully impact the quality of care for an individual or help to significantly improve the system overall, like MBC can.
Why not?
Well, just knowing something has changed in the last 3-6 months doesn’t help explain why that change has happened, dig into patterns, or inform conversations between clients and providers that can reveal more information about the causes.
To better understand the differences, let’s compare the CANS measurement requirement in California to Measurement-Based Care (MBC):
CANS
CANS is a thorough measurement assessment that provides top-line information as to where a client is when they enter care, and where they are at the end. This allows for data to be collected and used to report on care outcomes and to help inform a system of care.
The problem? You don’t learn why something has changed.
It could have been the result of of therapy, sleep patterns, significant life changes, etc., which may have nothing to do with the therapeutic process. Imagine you have a client with headaches everyday, and three months later their headaches stop. Just knowing they’ve stopped is important, but you would want to understand why they’ve stopped in order to help ensure the headaches don’t return, how to manage them when they do or to help inform the next person you see that has similar symptoms. Without knowing why, treatment can’t improve.
Measurement-Based Care
With Measurement-Based Care, an assessment like the CANS would be an ongoing part of therapy, administered every two weeks or at an interval decided by the provider and client – offering data that is full of insights to inform treatment. Here are some of the key benefits:
- The assessment and visualization of results engages clients in their care process and allows them to better understand their symptoms and triggers;
- Clinically-useful information for providers help them understand what’s working and what’s not, to better inform treatment decisions;
- Increased engagement and knowledge empowers clients to explore how they’re feeling, allowing them to better explain their experiences and symptom changes to their provider;
- Improved communication and therapeutic relationship between client and clinician promotes collaborative decision making throughout the care process.
Measurement-Based Care flips the measurement model on its head—making its purpose, first and foremost, to provide clinical value to the clinician and client and ultimately improve client engagement, therapeutic alliance, and clinical outcomes. The benefits don’t end there, as MBC also provides clinics, hospitals and health systems with the data they need to innovate services and improve quality of care for everyone, regardless of people’s backgrounds, experiences and presenting issues.
Ensuring that measurement is a part of the clinical process in California, and elsewhere, is a great step in the right direction—but it’s just addressing the tip of the iceberg; MBC addresses what is underwater. We’re excited to see the continued adoption of Measurement-Based Care across North America, and the drastic improvement of care that will be seen with it.
