Aug 25, 2021  |   < 1

Pathstone: Using MBC to improve client engagement and reduce dropout

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Number of Clinicians and Staff: 140

Population Served: Child and Youth

Programs: Individual Counselling and Therapy, Brief Services, Live In Treatment Services, Day Treatment (school-based programming) Intensive In-Home services

Org Type: Lead Agency for Niagara service area

Greenspace Platform: Measurement-Based Care

Key Assessment(s): GAD-7, PHQ-9


To address an organizational priority of increasing client engagement and improving data quality, Pathstone partnered with Greenspace Mental Health. The shift from a pre-and-post model of measurement to consistent measurement-based care using Greenspace not only increased therapeutic engagement and reduced dropout, but meaningfully improved treatment outcomes.

Pathstone previously used a variety of measures completed on a Pre and Post schedule. This model of measurement was causing several key challenges:

  • Significant indirect time required from front-line staff;
  • Clients voiced feeling overwhelmed by the length of measures;
  • Clients voiced not seeing the relevance to treatment;
  • The quality of data being collected was not high enough to inform programming decisions.

As an Agency we wanted to improve engagement, make the best use of time, and see results in a change over time model.

Greenspace was implemented by Pathstone agency wide. The program is being used on a daily basis by front-line staff across a wide range of programs.

Completion methods:

Remote automated delivery
In-session completion
Waiting room completion via ‘Kiosk’


Individual Counselling and Therapy
Brief Services
Live In Treatment Services
Day Treatment (school-based programming) Intensive In-Home services


Greenspace assessments (PHQ 9 & GAD 7) have allowed me to see the progress I am making through therapy. I am proud that I have been able to make positive changes to my mental health. Using Greenspace to see how far I have come helps me get through difficult times and gives me hope for the future!

Testimonial from a youth client


20% Reduction in client dropout rates.

82% Therapeutic Alliance (BR-WAI) Score.

25% Estimated savings in staff time.

For Pathstone, the implementation of Greenspace and measurement-based care has had a meaningful impact on client engagement and treatment quality. The comments below were provided by Pathstone’s clinical leadership who spearheaded this initiative:

  • Making the move from a pre-and-post model has unequivocally allowed Pathstone to improve treatment. We have seen satisfaction scores go up. We are seeing reduced times in service. Higher levels of engagement. And better outcomes. We are also able to improve programs based on the data that we are pulling from Greenspace.
  • We would estimate at minimum we have gained 25% from each staff in time savings. Meaning that staff can spend 25% more time on direct service – where previously this would have been directed to indirect service scoring measures. We see this expressed in multiple programs resolving waitlists as a result of increased therapist availability.
  • Client feedback has been exceptional and youth feel engaged, expressing an understanding of their symptoms. The graphs and visual representations have made a marked difference for users. Users report the simplicity and speed as high motivators. We have had clients express a desire to remain on the platform post service.
  • Staff report ease of use and variability in measures as a key motivator for their participation.



Greenspace assessments provided us with new insights into what our child was experiencing in regards to his anxiety and stress. We did not realize he was struggling as much as he was. These assessments allowed us to have better conversations with our son and be more supportive of what he is experiencing.

I like that I can look at the charts and see that I have been beating my anxiety, that the lines on the carts match how I am feeling and I can see on the screen how much better I am getting. I look forward to doing them in sessions and when I have been feeling sad, and it helps me talk about what might have been going on in the past week. I also like “marking” my therapist, I think that is fun.

When we have tough spots, I can see that we have improved so much from where we started, it keeps me from feeling hopeless and going backwards. For myself it helps me with checks and balances, I can see where I am having a tough time and can help me recharge or seek help before the wheels fall off.


One of the strengths of Pathstone’s implementation plan was their team’s understanding of the importance of change management throughout. This shift to measurement-based care is ultimately a change in clinical practice.

To ensure success, there was thoughtful planning related to selecting measures, rationale, digital capabilities and comfort level with staff. This was a culture shift that required a planned and phased process. And Pathstone continues to do this on an ongoing basis – with a mindset that this is not static, but continuously looking to improve.

Thank you to the leadership team at Pathstone Mental Health for participating in this case study, and for being an outstanding partner.


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Data used to monitor symptoms over time