Using Measurement-Based Care to Enhance Any Treatment

Abstract

Measurement-based care (MBC) can be defined as the practice of basing clinical care on client data collected throughout treatment. MBC is considered a core component of numerous evidence-based practices (e.g., Beck & Beck, 2011; Klerman, Weissman, Rounsaville, & Chevron, 1984) and has emerging empirical support as an evidence-based framework that can be added to any treatment (Lambert et al., 2003, Trivedi et al., 2007). The observed benefits of MBC are numerous. MBC provides insight into treatment progress, highlights ongoing treatment targets, reduces symptom deterioration, and improves client outcomes (Lambert et al., 2005). Moreover, as a framework to guide treatment, MBC has transtheoretical and transdiagnostic relevance with broad reach across clinical settings. Although MBC has primarily focused on assessing symptoms (e.g., depression, anxiety), MBC can also be used to assess valuable information about (a) symptoms, (b) functioning and satisfaction with life, (c) putative mechanisms of change (e.g., readiness to change), and (d) the treatment process (e.g., session feedback, working alliance). This paper provides an overview of the benefits and challenges of MBC implementation when conceptualized as a transtheoretical and transdiagnostic framework for evaluating client therapy progress and outcomes across these four domains. The empirical support for MBC use is briefly reviewed, an adult case example is presented to serve as a guide for successful implementation of MBC in clinical practice, and future directions to maximize MBC utility are discussed.

Keywords: feedback systems; measurement-based care; outcome monitoring; progress monitoring.

Figure 1

Measurement Based Care Scale Total Score Trajectories for Sample Client: Stephanie. Lower scores on the GAD-7 (Generalized Anxiety Disorder 7-items), PHQ-9 (Patient Health Questionnaire 9-items; Depressive severity measure), and Social Phobia scale indicate clinical improvement. Conversely, higher scores on the Satisfaction with Life Scale and Readiness to Change (specifically Action) Scale indicate improvement. The vertical line at Session 10 depicts a change in the treatment plan to focus on social phobia, whereas the previous sessions focused on depression. Session 11 involved Motivational Interviewing techniques targeting the low Action scores on the Stages of Change Scale.