Measurement-based care is still vastly underused: Less than 20% of clinicians have adopted it despite advances in technology that have made measurement easier to implement (Jensen-Doss, A., et al. Administration and Policy in Mental Health and Mental Health Services Research, Vol. 45, No. 1, 2018).
But many of those using the methodology underscore that it has strengthened their practice by clarifying treatment goals, putting more agency in the hands of patients, and providing an evidence-based way to keep improving how they work with patients. Thanks to the flexible nature of MBC, they’ve also been able to tailor it to meet the needs of diverse patients and settings.
Martinez, for example, worked at a therapeutic day program for children and teens that strongly involved parents as well. He used standard depression and anxiety screeners to assess young people’s symptoms but also worked with a care team to incorporate a brief idiographic measure called Youth Top Problems, which asks young people and their parents to list the top three issues each wants to work on.
Because parents and kids pick the issues themselves, it is easy for both parties to see tangible progress in areas that make an immediate practical difference, such as kids getting along better with siblings or parents not yelling at their kids as much. It also gives therapists and nurses clear goals to track over time.
“Treatment can meander, it can wander, and using MBC in these ways helps to define our focus,” Martinez said.
Meanwhile, Ajeng Puspitasari, PhD, a clinical professor and director of clinical training at the University of Wisconsin–Milwaukee and a member of the APA advisory committee for MBC, has used the modality not only with patients who have depression and anxiety but also with those who have serious mental illness or suicidal thoughts and behaviors. Like Martinez, she supplements symptom measures with other measures, for example, those that assess more internal factors like emotion regulation and mindfulness.
“Because these patients often struggle with ‘big feelings,’ they tend not to see how much progress they’re making,” she said. “But if we use measures that look at more than just symptoms, we can say, ‘Okay, maybe your depression is not going down, but look at how far you’ve come in your ability to manage symptoms, to be mindful, to regulate your emotions.’” Such input gives patients who are struggling hope and confidence that they are improving, she said.
On a larger scale, Robbie BabinsWagner, PhD, chief executive officer at the Calgary Counselling Centre in Alberta, Canada, first implemented MBC in 2004 and has been refining it ever since.
All 120-plus members of the clinical staff use the same measurement system, making it relatively easy to study how the system is working overall, Babins-Wagner explained. Before each session, patients fill out a form called the Outcome Questionnaire, a checklist that asks about symptoms of distress, social role functioning, and interpersonal relationships. With the best practice use of MBC, the findings are consistently used as a fulcrum for communication and intervention, resulting in a slow but steady increase in patient improvement (Psychotherapy, Vol. 53, No. 3, 2016).
The ability to analyze long-term data also means that center clinicians have discovered ways to improve treatment they might not have noticed otherwise, Babins-Wagner added. For example, one therapist grew curious about factors that influenced the center’s depression rates. She used 10-year data to compare the effects of individual therapy and group therapy. To the therapist’s surprise, patients who underwent individual counseling followed by 14 weeks of group therapy were no longer depressed at the end of treatment, while those who only undertook individual counseling were less depressed but did not meet the cutoff score for depression.
The center is now changing its program to make group therapy a regular part of depression and anxiety treatment. “We don’t care if the data are good or bad because we learn something no matter what they tell us,” Babins-Wagner said.