Measurement-Based Care: implementation challenges for community-based mental health teams.

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Implementing measurement based care ("MBC") holds significant upside. The research points to a more engaged client base, a reduction in drop-out rates and an improvement in long-term symptom change.

Yet most clinics are not doing MBC. According to a recent study by the Canadian Psychological Association, only 20% of mental health clinicians have implemented any form of measurement. This is not due to a lack of interest or disagreement with the research; but taking inventory on current practices there are multiple reasons why implementing routine measurement can be a challenge for teams.

  1. Administrative Burden.
  2. Gaps in Technology.
  3. General vs. Specific Assessment Tools.

1. Administrative Burden

The most cited challenge is quite simply the administrative time spent having to fill out measures. Yet, the predominant method for filling out measurement tools is by pen and paper in the waiting room or in session. Typically, this gives way to not continuing with a measurement strategy. There are a variety of reasons why this would be the case; they’re not referenced during session, it is forgotten to be done routinely or there is a backlog of administrative work needed to score, interpret and input into any medical record or database. These considerations all amount to an omission frequently agreed upon by clinicians that implementing MBC feels like more of an exercise in data collection than it a tool for therapy.

2. Gaps in Technology

Technology can play an important role in saving administrative time. However, there are similar limitations with using typical electronic health records (“EHR”) or practice management systems for measurement. An EHR system requires a clinician or admin to manually enter information; while assessments used within MBC are primarily completed by clients. Therefore, the assessments still must be completed by clients on paper; and then entered by the clinician into the EHR. Another option is to complete the assessments interview-style during sessions – but this tends to take significantly longer.

3. General vs. Specific Assessment Tools

A third challenge relates to a very common mistake that we see made. Many clinics will attempt to implement MBC by introducing just one general assessment tool for the entire client population to complete. This seems like the simplest approach. It also would create consistent population-level data. However, it underestimates the importance of measurement being tailored for each client.

In order to effectively measure care, not only do measures need to be routine, but they also need to be customized to the needs and symptoms that individual is presenting with. This practice adds incredible value for the client to see a reduction in their primary symptoms.

By tailoring measures to presenting issues, clinicians will also be more eager to buy-in because (a) the information is more useful, (b) it lends credibility to the work they are doing and (c) it inherently feels less like data collection. Organizations then benefit from a more accurate understanding of clinical symptom change at the population level. However it all starts with adding value for both the client and clinician.

4. Bonus Issues

There are a few other issues that stand out for organizations:

  1. Clinicians  and clients not seeing value.
  2. No visibility for clients into results (visualization  of change).
  3. Limited real-time reporting for managers.

Wrapping Up

In conclusion, our experience has shown that clinicians understand that MBC can drive better results for clients, however it is some of the above challenges that lead to limited adoption. The administrative effort associated with managing this manually (or utilizing an EMR system) is the first hurdle.This is compounded when we introduce the need to use different assessments foreach client (or by program), and when we wish to engage clients with a visualization of their progress. This doesn’t even account for the complexities of aggregating and analyzing the collected data.

Ultimately, technology is needed. This includes automating the delivery of assessments to clients, providing clients with visibility into results, and scoring and aggregating the collected data in a way that makes sense for your clinic.

Greenspace Mental Health is a technology platform that supports healthcare systems and individual mental health organizations with measurement-based care. Greenspace reduces the effort required to successfully implement this evidence-based practice; and helps to drive improved client outcomes.

The team at Greenspace is passionate about improving the quality of mental healthcare, and has worked with systems to successfully implement measurement-based care across the United States and Canada .