Measurement-Based Care: What It Is, Why It Matters, and How It’s Used in Mental Healthcare

Measurement-based care (MBC) is a healthcare approach that bases clinical care on client information collected during treatment. It can be used in various healthcare settings, including behavioral health contexts (which is what this article will focus on). Because of its tailored approach to treatment, studies show that MBC significantly improves client outcomes. In addition to benefiting clients, MBC has been shown to benefit mental healthcare providers and mental health organizations since it is a straightforward way for providers to track progress and ensure that treatment is successful. Keep reading to learn more about how MBC works, what it looks like in practice, and how you can receive this kind of care from your behavioral healthcare providers.

What is measurement-based care?

MBC is a clinical practice centering patient-reported information. It has three major components: 

1. Collection

The first component of MBC is the collection of client or patient-reported information, sometimes referred to as patient-reported outcome measures. Clients usually report information by completing a questionnaire documenting symptoms, thought processes, or actions. The questionnaire can be filled out before a visit with a therapist, psychiatrist, or other mental healthcare provider. 

Depending on how the provider has set up client visits, the client may fill out a similar questionnaire at every visit to track progress. Clients may feel more engaged when they complete questionnaires that help them communicate their experiences. Additionally, this is a chance for clients to reflect on their progress. 

2. Sharing

The next component of MBC is sharing client-reported information with providers. This should be done promptly so the provider has new, up-to-date information at every visit. Providers collect patient information differently: one provider may keep a binder with all of a client’s questionnaires while others may input information into a graph or chart to view progress. 

3. Action

The final component of MBC involves taking action on the data collected. There are several ways that client data can be used to take action in the mental healthcare treatment process. Providers might incorporate the information provided in the questionnaires into the client visit. They may also use the client-reported data to create goals for each session, and—because the questionnaires are collected at every visit—the provider and client can see if goals are being met over time. 

The importance of measurement-based care  

MBC has been scientifically proven to help all parties involved in behavioral healthcare. Here’s a breakdown of how MBC benefits clients, healthcare providers, and healthcare organizations:

For clients, MBC: 

• Improves outcomes such as psychological disturbances, interpersonal problems, social role functioning, and quality of life—even in clients who were identified as having more difficulty responding to treatment 
• Improves clinical outcomes in young people
• Helps clients feel more involved in their treatment process 
• Allows clients to gain better insight into their experiences with mental health conditions 

For clinicians, MBC:  

• Allows clinicians to intervene appropriately and faster when a client is not making progress 
• Helps clinicians create useful goals for clients 
• Gives clinicians quicker insight into how a client is doing each session 
• Facilitates easy conversations between providers at different institutions who use the same questionnaires in their MBC practice 

For health organizations, MBC:  

• Helps provide easily-comparable data that can give mental health organizations more information to study 
• Assists in the formation of new mental health programs that target unmet needs

What does MBC look like in practice? Two case studies

To understand how MBC can work in the real world, let’s go through a couple of examples. Both of these cases show how MBC is used in a mental healthcare context, and illustrate the three major components of MBC (collection, sharing, and action):

Case 1 

A 17-year-old  was recently discharged from the hospital for depression and is now in an intensive outpatient program (IOP) following discharge. Each week, she meets with an individual therapist. 

Collection: Each week, the client fills out a piece of paper with 13 questions on it called the Patient Health Questionnaire Modified for Teens (also known for short as the PHQ-Modified) questionnaire. This form usually only takes about 5 minutes to complete and is a diagnostic tool used by clinicians to help identify depression in their patients. 

Some PHQ-Modified questions are multiple-choice, and ask patients how often they experience certain symptoms. Answer choices for these questions are ranked on a scale from “nearly every day” or “more than half the days” to “several days” or “not at all.” Sample questions in this format include:

• How often have you felt bothered by the following for the past two weeks: Little interest or pleasure in doing things? 
• How often have you felt bothered by the following for the past two weeks: trouble concentrating on things like school work, reading, or watching TV? 
• How often have you felt bothered by the following for the past two weeks: feeling tired or having little energy? 

Other PHQ-Modified questions ask patients yes or no questions, including the following:

• In the past year, have you felt depressed or sad most days, even if you felt okay sometimes?
• Has there been a time in the past month when you have had serious thoughts about ending your life?

By filling out the form each week, the client can reflect on her experiences throughout the last week, note progress or lack of progress, and share a lot of information in a short amount of time. 

Sharing: This information is shared with the client’s therapist. The therapist uploads this information into a confidential chart online to see how the client’s answer choices have changed over the last several weeks. The therapist immediately shares this information with the client. 

Action: The therapist then uses this information for a number of functions. One of these functions might be to identify treatment targets. 

For example, the therapist may say, “I noticed that you no longer are feeling tired or without energy because you marked “not at all” on this question. Now that you have more energy let’s focus on ways that you can get out of the house and participate in social activities.” 

Another way the therapist might use this information is to clarify information. For example, the therapist may say, “You’re speaking about how you feel less depressed, but your answer to the question about having little pleasure or interest in activities actually went up. Tell me more about this.” By clarifying discrepancies between what is said in the sessions and what is written down in the client questionnaire, the therapist and client can better communicate and help the client make insights. 

Case 2 

A 9-year-old with ADHD is being seen weekly by his school’s therapist. His father attends the sessions as well. 

Collection: Although many different questionnaires can be used by school therapists, this provider has decided to use the Pediatric Symptom Checklist. The pediatric symptom checklist is a questionnaire that has 35 short questions. It is used by clinicians as a screening tool to identify cognitive, behavioral, and emotional problems in children that can then be treated. It can be filled out by the child with a parent. Example questions include: 

• Complaints of aches/pains: never, sometimes, often. 
• Absent from school: never, sometimes, often. 
• Fights with others: never, sometimes, often.  
• Does not listen to rules: never, sometimes, often. 
• Tires easily, has little energy: never, sometimes, often.  
• Distracted easily: never, sometimes, often.  
• Refuses to share: never, sometimes, often.  
• Gets hurt frequently: never, sometimes, often. 

The client and father spend time filling out the form together. This gives the parent the opportunity to discuss how the week went with his son. Before they even begin the therapy appointment, they have reflected on the week and are starting to discuss successes and areas for improvement. 

Sharing: The father hands the form to the school therapist, who keeps all of the client’s forms in a confidential binder. She has written charts and marks the child’s progress for about 5-10 minutes before his session begins. When the session begins, the therapist shows the graph to the boy and his father. They can immediately see differences between this week and the last. 

Action: As mentioned earlier, the therapist then incorporates this information into the therapy session. For example, the therapist can use the information to discuss successes. She may say something like, “I notice you’re getting tired less easily, and you’ve been able to get along better with friends from school. I’d love to hear more about this progress.” Additionally, the therapist can use the form to bring up areas for improvement that the client may forget to share or may not want to talk about. For example, the therapist may say, “Your score for not listening to rules went up the last two weeks. Tell me more about this.” By getting real-time information, the therapist, parent, and client can all work together collaboratively toward shared goals. 

Measurement-based care at Charlie Health 

If you want to set and achieve mental health goals with measurement-based care strategies, Charlie Health may be able to help. 

Charlie Health is a virtual Intensive Outpatient Program (IOP) that uses measurement-based care to help clients meet their goals. If you are interested in this type of treatment, fill out this short form to get started today.