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Yale MBC Collaborative Knowledge Hub

Whether you’re looking to improve upon your knowledge of MBC, gain insights on implementation strategies or learn how to introduce assessments and discuss results with clients— we have you covered. Explore videos, articles, research, and find answers to MBC's most frequently asked questions.

What is the Yale Measurement-Based Care Collaborative?

The Yale Measurement-Based Care Collaborative (YMBCC) is a group of renowned psychologists dedicated to the advancement of Measurement-Based Care (MBC). In 2022, Greenspace Health and the YMBCC formed an educational partnership and over the course of 3 sessions, attended by over 1200 providers, the YMBCC team shared incredibly valuable MBC knowledge, tips, implementation strategies, and practical activities. This Knowledge Hub is our way of ensuring this insightful content continues to provide value for service organizations or providers across North America.

Yale MBCC Logo

Meet the members of the Yale MBC Collaborative.

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Amber Childs, PhD

Dr. Amber W. Childs is a licensed clinical psychologist, specializing in child & adolescent services. She is Assistant Professor of Psychiatry, Director of Training for the Yale Doctoral Internship in Clinical and Community Psychology, and Co-Director of the Division of Quality and Innovation within the Yale New Haven Psychiatric Hospital. Contact Dr. Amber Childs at amber.childs@yale.edu.

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Sandy Resnick, PhD

Dr. Sandy Resnick is a licensed clinical psychologist and Professor of Psychiatry with experience supporting individuals with psychiatric disabilities. She is passionate about data literacy, patient-centered care, and the impact of evidence-based practices on the quality of services across the healthcare system. Contact Dr. Sandy Resnick at sandra.resnick@yale.edu.

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Jessica Barber, PhD

Dr. Jessica Barber is a licensed clinical psychologist specializing in Clinical Health Psychology and an Assistant Clinical Professor at Yale University's Department of Psychiatry and School of Medicine. Her work is focused on developing educational resources and tools to promote and support the implementation of MBC. Contact Dr. Jessica Barber at Jessica.barber@va.gov.

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Elizabeth Connors, PhD

Dr. Elizabeth Connors is a Clinical Child and Community Psychology Professor at the Yale School of Medicine and an Adjunct Assistant Professor at the University of Maryland School of Medicine. Her work focuses on improving the quality of services for underserved and minority children, adolescents, and their families. Contact Dr. Elizabeth Connors at elizabeth.connors@yale.edu.

Learn from the Yale MBC Collaborative

Select a toggle below to learn more about each MBC topic:

Categories
What is MBC
MBC
MBC
Measurement-Based Care
Equity
Learning culture
WHAT IS MBC?

Measurement-Based Care

MBC is a clinical process that uses patient-reported outcome measures (PROMs) over time to track progress and serve as the foundation for important collaborative conversations between clients and providers, and to inform treatment goals and clinical decisions. The Yale Measurement-Based Care Collaborative uses the Collect, Share, Act model to describe each important step in the process.

WHY MBC MATTERS

MBC is Flexible

Every clinic’s and clinician’s workflow is unique. MBC implementation can flex to enhance any treatment plan or service modality to better understand and respond to the unique needs and experience of clients, improve engagement in care, and overall service quality.

WHY MBC MATTERS

MBC is for Everyone

Measurement-Based Care can help all providers ensure their clients will thrive. If a person is not improving in care, their provider can catch it and make adjustments in a timely way. If a person is improving in care, both the provider and client can see it and feel confident in the work that they’re doing. MBC is effective no matter what theoretical orientation or disciple a clinician is trained on – everyone can do, and benefit from, MBC.

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WHY MBC MATTERS

MBC Supports Individualized Treatment

When the MBC is implemented well, it takes the goal of individualizing treatment to a whole new level. It allows providers to tailor treatment and goals according to the person receiving services, which drives improved engagement and outcomes.

WHY MBC MATTERS

Equitable Care

MBC allows providers to centre the client’s voice in care and gives them a shared language to collaborate with their provider throughout treatment. No matter a person’s background, education, or comfort discussing their mental health, MBC is designed to empower them in treatment, by helping their provider better understand their unique and evolving needs.

WHY MBC MATTERS

Culture of Learning

MBC drives a culture of learning and improvement in all clinical settings. Whether you’re an individual clinician, a small clinic, or a large, multi-site organization, MBC gives you the patient-reported insights needed to reflect on what works for your client population and how to improve. This opens up space for continued learning at the core of your clinical process.

MBC Research

Dr. Elizabeth Connors describes the Measurement-Based Care research landscape and shares some of the key findings.

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HIGHER OVERALL IMPROVEMENT IN CLINICAL SYMPTOMS

(Lambert, 2013)

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HIGHER LIKELIHOOD THAT A CLIENT EXPERIENCES RELIABLE CHANGE

(Slade et al., 2008)

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LOWER DROPOUT OR CANCELLATION RATES

(Bohanske & Franczak, 2010)

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We often see the clinician's role as being the only expert in the room. MBC breaks down this dynamic because there is full transparency about treatment goals, how progress will be measured, the active role of the client to provide feedback, and how treatment decisions will be made.

Elizabeth Connors, PhD

Yale Measurement-Based Care Collaborative

If someone came up to me and said, 'I have this thing and it's going to make your job easier, it will help your clients progress faster, it's going to empower you and empower them,' I would say, 'I want that, give me that!'

Jessica Barber, PhD

Yale Measurement-Based Care Collaborative
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Measurement-Based Care Q&A With the YMBCC

Learn the MBC basics and get to know the Yale Measurement-Based Care Collaborative in this Q&A article.

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MBC implementation
MBC Implementation - training
MBC implementation - engagement
MBC implementation - measures
MBC implementation - clinical value
Implementation
Implementation

Key steps to implementation

A successful implementation of MBC can be simple to achieve. It relies on a simple and effective workflow, strong communication around the intent of MBC, clinician and client engagement, consistent clinician training, and a transparent (and often phased) roll out plan. Here are some tips to help guide your implementation planning process.

IMPLEMENTATION

Identify and engage participating staff

Determine which staff will participate, as well as which programs, clinics, or services will engage in MBC implementation. ‍One of the most important aspects of MBC is to engage providers while building your MBC implementation plan. The implementation plan should be developed collaboratively as a team and then revisited as a team throughout the process. This will help build engagement, while also ensuring your implementation addresses the unique roles and challenges across your team (Dollar et al., 2020).

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IMPLEMENTATION

Decide how to engage stakeholders

Thoughtfully engage as many key stakeholders as possible, creating conditions for increased buy-in and a greater likelihood of long term success. Individualize stakeholder involvement to ensure that everyone has a voice in the process that feels comfortable and suitable to them. Thoughtful and meaningful engagement of all stakeholders will help drive a successful implementation.

IMPLEMENTATION

Determine measures, frequency, and workflow

If appropriate, your implementation team should identify specific patient-reported outcome measures (PROMs) to be use based on your client population or specific program goals. If measures are selected, determine the frequency of use and how the MBC process will fit into your current clinic and clinician workflows. Individual clinicians can always entirely tailor their selection of assessments, or add additional measures specific to a client, if there are other domains they would like to track and discuss in session with clients (i.e. quality of life, functioning, working alliance, etc).

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IMPLEMENTATION

Share the clinical value of MBC and how outcome data will be used

It’s important to move beyond the simple collection of data and use MBC to drive clinical value for both clinicians and clients. Share with your team how your MBC implementation will enhance their overall quality of care by improving communication and alliance with clients, informing adjustments to treatment plans, and promoting shared decision-making. It is also helpful to share how you plan to leverage data as a clinic and if any measures will be aggregated for quality improvement. Ideally this includes group collaboration around trends and working together to brainstorm potential improvements as part of your workflow.

IMPLEMENTATION

Create a flexible training plan

Clinicians don’t need to be experts on assessments or MBC to gain value from the implementation process. That said, it’s important to provide your team with training prior to launch, and create ongoing learning opportunities that are responsive to the current state of your unique implementation. Here is an example training activity that the YMBCC recommends early on to get providers comfortable leveraging outcome data to inform their care process.

See the exercise
IMPLEMENTATION

Define success and identify areas for support

Ensure there is a shared understanding of your team’s MBC goals with well-defined and clearly communicated benchmarks for success. Share the planned MBC workflow, communicate how success will be measured, identify ways leadership can continue to support and encourage staff, and celebrate progress along the way!

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IMPLEMENTATION

Don’t be afraid to start small with a phased rollout

Every clinic will approach their implementation in a unique way. Some may start with one program or a specific group of clinicians and expand their implementation from there, while others start by rolling out MBC across every program and clinician. There is no one-size-fits-all approach; choose the direction best suited for your clinical team.

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13 Steps for Implementing Measurement-Based Care

If you’re interested in a more detailed implementation plan, Dr. Sandy Resnick and a team of Measurement-Based Care researchers developed a 13-step MBC Implementation Planning Guide to support leaders with the uptake of MBC across a variety of mental health settings.

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MBC makes your treatment better! It's important to communicate to clinicians that we're not doing this because it's a checkbox or because the agency said so, but that we really care about our clients and we really know that this makes treatment better.

Sandy Resnick, PhD

Yale Measurement-Based Care Collaborative

As clinicians, we use interventions when we believe in them. So when we have the willingness of clinicians and providers to engage in MBC because they understand it and they believe in what it offers, then we're off to a really good start.

Amber Childs, PhD

Yale Measurement-Based Care Collaborative

MBC Implementation: The Maryland CBH example

Elizabeth Connors explains how the MBC pilot project came about in Maryland and what the group did to ensure a successful large-scale implementation.

MBC - Share
MBC - Collect
Share
MBC implementation - define success
MBC IN PRACTICE

Collect, Share, Act

Collect, Share, Act is a straightforward and impactful clinical model that helps guide clinicians to effectively use MBC. With MBC implemented as part of their care process, clinicians are more likely to identify treatment inertia or regression, understand the cause of symptom changes, enhance client engagement, and see stronger treatment outcomes.

MBC IN PRACTICE

Collect

Collect is not just about gathering data, it’s also about engaging the client by explaining MBC and providing the rationale for why it’s being used throughout their treatment. Providers will also want to determine which measures are most appropriate for their clients needs and ensure the client understands how they relate to their treatment goals. Lastly, it’s important to administer these measures regularly and repeatedly throughout care, so you can generate a complete picture of the clients progress.

MBC IN PRACTICE

Share

The process of Share is all about making sure the client and clinician understand the assessment results, and that the results reflect the clients experience. Since every response carries rich insights into the clients experience, it’s the perfect opportunity to get curious about their results with them, get on the same page about the goals of treatment, and ultimately develop a shared language to be used throughout your sessions. This fosters collaborative discussions between clinicians and clients to inform care decisions, treatment changes and ultimately improve outcomes.

MBC IN PRACTICE

Act

Act is the final stage, where the clinician and client can reflect on the data and collaboratively brainstorm on appropriate next steps in the treatment approach or process. Together, identify what’s working, areas for potential improvement, and determine whether the focus of treatment should shift in any way. This stage is vital to supplementing clinical judgment about changes to treatment plans, goal setting, and additional therapeutic interventions– by inserting and prioritizing the clients voice.

What is the Collect, Share, Act model of Measurement-Based Care?

Dr. Sandy Resnick explains each step of the Collect, Share, Act model and uses examples to demonstrate how Measurement-Based Care outcome data can be used in practice to engage clients and inform clinical decision-making.

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I pitch MBC as the opportunity for the client to be in the driver's seat of their treatment: "It's about what you say is happening, and the data is going to be the thing that we hold out in front of us to ensure we’re on the same page and that we’re working towards your goals in care.

Amber Childs, PhD

Yale Measurement-Based Care Collaborative
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Collect, Share, Act: A Transtheoretical Model for Actioning Measurement-Based Care in Mental Health Treatment

The Yale Measurement-Based Care Collaborative is working to bridge the gap between MBC knowledge and its practical application through the Collect, Share, Act model of MBC. This is a helpful guideline for mental health providers to introduce MBC into their clinical work.

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MBC - Self check-in
MBC - Identify progress
MBC - Partners in care
CLIENT IMPACT

Self Check-In

MBC invites clients to reflect on their progress on a regular basis. Through repeat assessment, clients can better understand themselves and identify the goals they want to accomplish in treatment. The measures also offer a straightforward way to self-assess and to organize their thoughts before and during sessions.‍

CLIENT IMPACT

Identify Progress

MBC can help clients and their providers identify and better understand progress that may have otherwise flown under the radar. This leads to important discussions around what’s working or going well for a client, which can help build engagement and confidence in the care process and provides hope during more difficult times.

CLIENT IMPACT

Partners in Care

MBC gives clients a simple entry point for collaboration with their mental health provider. When clients understand MBC and how it will support their treatment process, they become more engaged and empowered as a partner in their care. It offers them a way to assess their progress in reaching their goals and a routine space for them to share their perspective on how treatment is going.

Will my clients engage in MBC?

The simple answer is yes! Dr. Sandy Resnick uses a metaphor about Starbucks Rewards to draw parallels to the value provided to clients through the MBC process.

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I really believe in the value of centring and elevating the voices of the people who we serve, and letting their experiences be what guides our work together. At the core, MBC is about what the patient says is important to them. What could be more powerful than empowering others to be active partners in their own wellness?

Amber Childs, PhD

Yale Measurement-Based Care Collaborative
Measurement-Based Care - Therapy
Clinical insights
Clinical impact - early signal
Clinical impact - support
CLINICAL IMPACT

Flexible to Your Workflow and Needs

MBC is immensely versatile. Providers can monitor symptoms, functioning, quality of life, treatment satisfaction, alliance, and more. Your MBC implementation can, and should, flex and be customized to meet your clinical goals. This versatility means MBC can be incorporated into virtually and type of treatment or service.

CLINICAL IMPACT

Gather Rich Insights

MBC gives clinicians the opportunity to learn more about their clients than they would be able to otherwise. The process helps providers dig deeper with clients to understand their needs, experiences, and symptom changes to inform care decisions. This leads to improved engagement, therapeutic alliance, and outcomes.

CLINICAL IMPACT

Early Signal

Research shows that it is very difficult for providers to predict how someone will progress in treatment or recognize when they’re not improving in care. MBC helps offer an early signal to providers when treatment is not going as expected. This flag helps to inform potential adjustments or collaborative discussions between a client and clinician, empowering clinicians to use their clinical expertise to make informed decisions based on the needs and goals of each client.

CLINICAL IMPACT

Quality Check and Support

Many providers deliver eclectic therapy where they use their training, knowledge of research and evidence, and clinical experience to individualize treatment plans for each client. MBC offers a continuous quality check to evaluate the effectiveness of those individualized plans and provides guidance to areas where an adjustment may improve the clients experience and outcomes.

How does Measurement-Based Care inform and enhance clinical judgment?

Dr. Elizabeth Connors shares the value of MBC in clinical decision-making and offers tips to optimize its use for the greatest impact on clinical outcomes (Fortney et al., 2017; Lambert et al., 2018; Lewis et al., 2019; Shimokawa et al., 2010).

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If someone's not improving, we can catch that and make those adjustments in a timely way. If someone is improving, we can see it and we can all feel way more confident in the work that we're doing. And as a clinician, that feels amazing.

Jessica Barber

Yale Measurement-Based Care

How does Measurement-Based Care help inform clinical discussions and decisions?

Dr. Amber Childs compares the role of a clinician using MBC to that of a dancer following choreography, illustrating that a clinician's training, experience, and expertise is really what brings MBC to life.

Your FAQs, Answered by the Yale MBC Collaborative

Categories
How is MBC different from traditional measurement?

Dr. Jessica Barber shares how the process of MBC is really what distinguishes it from traditional measurement. She explains Collect, Share, Act and how the model helps the provider and client collaborate on treatment goals and outcomes.

Can MBC be used with all programs and populations?

Dr. Elizabeth Connors shares the important factors that allow MBC to be added to any treatment modality, program, or population to improve care quality and outcomes.

(Fortney et al., 2017; Scott & Lewis, 2015; Lambert et al., 2018; Gondek et al., 2016)

What excites the Yale MBC Collaborative most about the growing momentum & implementation across the industry?

The members of the Yale MBC Collaborative share their excitement about the impacts of MBC.

Why is MBC vital to gathering clinically useful data?

Dr. Sandy Resnick shares how using patient-reported outcome measures (PROMs) empowers clients to be more honest about how they’re doing and offers providers a clearer picture of the progress being made in treatment.

Is Measurement-Based Care just for psychologists or does it work for all providers?

Dr. Sandy Resnick shares that Measurement-Based Care can work for any type of behavioral health provider.

Is Measurement-Based Care effective within short-term treatment modalities?

Dr. Elizabeth Connors provides some examples of Measurement-Based Care being used in short-term clinical practice.

How do you introduce Measurement-Based Care to clients?

Dr. Amber Childs shares how she introduces MBC to teenagers to illustrate the importance of the rationale for clients. When you intentionally frame the value of MBC to clients at the start of treatment, break down the measures, and outline the ways that they will be used to improve collaboration, it helps clients understand how MBC will benefit them and better engage them in the care process.

How do you get your clinicians excited about using MBC?

Dr. Amber Childs and Dr. Sandy Resnick explain the importance of clinician buy-in when implementing MBC.

What would you say to clinicians concerned about MBC being utilized for performance evaluation?

While traditional measurement has typically been an exercise in reporting, MBC flips that model on its head by ensuring that the process is, first and foremost, focused on providing clinical value.

Dr. Sandy Resnick shares how MBC should offer a safe space for clinicians, where outcome data is used as a jumping off point for collaborative discussion about treatment plans and how to improve overall services— not to inform performance evaluation.

What insights can you share on the approach to MBC across systems or within collaborative implementations?

Dr. Elizabeth Connors uses the Maryland CBH Coordinated Implementation to illustrate how MBC can be leveraged across larger system settings to improve population health outcomes.

How do I approach introducing MBC to my clients?

Dr. Connors discusses the importance of sharing the rationale for MBC when introducing it to clients. She offers tips for clinicians and gives an example of how you might approach the conversation with a client.

How does Measurement-Based Care inform clinical judgment, discussions, and decision-making?

Dr. Elizabeth Connors shares various ways that MBC helps enhance clinical judgment and the importance of reviewing results regularly to inform treatment discussions and decisions.

(Fortney et al., 2017; Lambert et al., 2018; Lewis et al., 2019; Shimokawa et al., 2010)

Dr. Amber Childs compares the role of the clinician using MBC to that of a dancer following choreography— a clinician’s training, experience, and expertise is really what brings an impactful MBC process to life.

How do you share Measurement-Based Care data with clients, and build a learning culture amongst a care team?

Dr. Amber Childs walks through how she approaches Share in session, from interpreting results to getting curious about what they mean with clients. She also explains how you can work as a care team to understand and respond to assessment results.

How can I approach discussing (or ‘getting curious’ about) assessment results with clients?

Dr. Amber Childs discusses her experience of Share in an adolescent intensive outpatient program and how to use assessment results to foster client-clinician collaboration in session.

How can I talk to my clients about significant shifts in their assessment results?

Dr. Elizabeth Connors shares how to discuss significant symptom changes with your clients and how to collaborate on potential adjustments to the treatment approach or plan.

How does MBC impact therapeutic alliance?

Dr. Elizabeth Connors summarizes some of the research findings on the relationship between MBC and therapeutic alliance.

(Brattland et al., 2019; Dowrick et al., 2009; Carlier et al., 2010; Castonguay et al., 2006; Eisen et al., 2000)

Will my clients engage with Measurement-Based Care?

Dr. Sandy Resnick uses a metaphor about Starbucks Rewards to draw parallels to the value provided to clients through the process of MBC. She outlines that if we have a feedback loop where client assessments meaningfully inform care and provide value to the client, they will engage.

Why is it vital to discuss assessment results in session with clients?

Dr. Elizabeth Connors explains that MBC is a person-centred model of care, designed to empower clients throughout their treatment process. Sharing results directly with clients is a foundational component of MBC. Doing so ensures they are empowered to play an active role in setting treatment goals, highlighting progress and setbacks, and in making treatment decisions or changes.

(Bickman et al., 2011; Hatfield et al., 2010; Lambert et al., 2003; Lewis et al., 2019; Resnick & Hoff, 2020; Walfishet al., 2012)

How does MBC impact therapeutic alliance and client engagement?

Dr. Elizabeth Connors shares the evidence behind the positive impact of MBC on therapeutic alliance and client engagement.

(Dowrick et al., 2009; Carlier et al., 2010; Castonguay et al., 2006; Zimmerman &  McGlinchey, 2011; de Jong et al., 2021; Eisen et al., 2000)

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How can Measurement-Based Care can help clients transition out of care?

Dr. Sandy Resnick offers an example from her own early clinical experience, where the measures used during treatment were essential to driving the progress she made with her client, and also helped signal when it was the right time to transition out of care.

How should clinicians choose which assessment(s) to use?

Dr. Amber Childs shares some tips to consider when determining the appropriate measure(s) to use with specific clients, programs, population types, and more.

Can I practice MBC if I’m not familiar with many assessments?

Dr. Amber Childs explains that an extensive knowledge of assessments is not important. What matters most, is the work you do to get curious about results and collaborate with your client to inform care discussions and decisions.

How do I practice interpreting results as an individual clinician, or collaboratively with my care team?

During our 2nd educational panel with the Yale Measurement-Based Care Collaborative, we all participated in an important exercise to illustrate how simple, yet valuable, using MBC in care can be. The ‘PHQ-9 Three-Ways’ exercise is used by the YMBCC to help any service provider feel comfortable with the simple process of exploring MBC data and getting curious, alongside their clients, to understand what the results may be saying.

The Yale MBC Collaborative shared sample PHQ-9 scores from three different clients—all with slightly different responses. The audience then looked at the responses and highlighted what stood out to them, what hypotheses they were forming, and what they might ask the client in session to dig deeper into their experience.

Watch this clip and try it for for yourself:

Is there an ideal frequency to administer assessments?

Dr. Elizabeth Connors shares some of the research around this question, which suggests that higher frequency (every 1-2 weeks) is ideal. However, there may be variation required when using specific assessments or with certain client populations and program types (Bickman et al., 2011).

Do you have any tips for using the ORS and SRS rating scales?

Speaking from her own clinical experience, Dr. Elizabeth Connors shares insights on leveraging the ORS and SRS in practice. She recommends accessing the Better Outcomes Now website for more information.

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This page is written and maintained by Greenspace, who is ultimately responsible for the content. YMBCC has provided consultation and reviewed the content for accuracy.

Last updated on October 2nd, 2023 | Disclaimer