Measurement-Based Care: What Is It?, How to Implement, & Examples

More providers are being asked to move towards measurement-based care in behavioral health care delivery. But what exactly is measurement-based care and when did these regulations start? The American Psychological Association adopted the policy of using evidence-based practices in 2005 (APA, 2005). This involved using standardized tools and assessments to track a client's progress throughout their treatment. Funding entities, like the government, are now incorporating measurement requirements in their regulations, which are often vaguely written and, quite frankly, not very helpful. I've read them, too. You've read them. Clearly, they were not written by people who were measurement specialists or providers. So vague. Not helpful. And questionably clinically useful, I dare say. 

For many providers, tracking client progress will seem like a good idea in theory. Still, navigating the barriers to measurement-based care seems pointless because the requirements may seem divorced from patient care. If you're a provider who prefers not to track their clients that way because you like to rely on your clinical judgment, this might feel especially burdensome. I get it. I can tell you the merits of tracking and measurement. But you know them. You've heard the rationales. You’ve seen the journal articles.

You can track progress with instruments and measurements, but you may prefer your clinical judgment to assess things like if a client is going to decompensate. But then you hear about measurements that might be able to identify decompensation before they start decompensating. You've probably even heard Meehl's argument (1952), in which he explained that clinical judgment is sometimes influenced by cognitive biases that we all have, and measurement can help ameliorate that bias. Even so, you may not know if you can streamline the demands of record keeping with clinical care. 

So all of this may seem like .... AAAAAAAA.

I get it. There are a lot of things that are just too much for me to deal with. Apparently, I am incapable of dealing with my own calendar, which is why I have an office manager who helps me out. Adding measurement-based care to everything else that you have to do in order to do the actual thing you are supposed to do, take care of people, is just arduous, like me and calendars. 

So, allow me to break down a couple of examples where, due to regulations, you might need to implement measurement-based care.

Let's take the agency. How do you turn the vaguely written regulation into something measurable? I’ll make it sound simple, but the actual execution is far from it. For instance, I look at the regulation and think to myself, “How can I turn this vague-sounding nonsense into something useful?” I probably try to figure out why they are asking me to do the thing. For instance, off the top of my head, there was a regulation that said something about periodically going over goals with the client. That's really broad. The client should have goals to work towards. Great. In my very sarcastic brain, after many salty words, I may say to myself, “So, is this a yes or no question or a process question?” This sounds like a straightforward process, but the part that’s difficult is figuring out what the regulations are actually asking and/or figuring out how something vague or abstract can be turned into something concrete and measurable. This takes training and practice. It’s learnable in other words. Having the experience of creating variables and seeing how it plays out in different types of analysis helps to inform this process too. 

As a clinician, it may be more useful over time for you to keep track of the process more than whether the client has goals or not because you may want to know if the client is struggling to come up with goals, making goals that are too ambitious, or making goals and not following through. You may also want to track the process of planning with the client the barriers the client is anticipating to problem-solve ahead of time so that you can increase the probability that one, they will actually move forward on the goal and two, so that they can rehearse in their head moving towards the goal. Is it possible to add this into a data collection system that is for both regulatory purposes and clinical purposes without adding a lot of work to the clinician gathering the data? Yes. It is. You just have to think through the process. Let’s look at this further. 

Getting back to my imagining how I would do it, to me, all of that might be more important: the process and getting paid and keeping track of what regulatory bodies need for accreditation. The funding agency may not care about all of this. So do you keep any of this data, or do you just say, “Yep? Goals made.” What if there is an audit and the funding agency suddenly decides they want to process information, and you were tracking that? What then? Is there a way to cleanly track all of this that doesn't take much programming skill or time? Yes, there is. Goals created? Yes or no. Barriers identified? Yes or no. What were they? List them. Summarize plan. Boom. A spreadsheet is all you'd need for that.

What about the provider? Have you noticed all of the mood trackers the bullet journal enthusiasts do? I have. All of these new apps track your mood, your food, your whatever. Everyone is already used to tracking their life. They are swimming in their own data. Are they tracking these things that have any kind of psychometric validity? Who knows? But people are used to doing it. And, they're used to doing it on fun and fancy, well-designed graphically pleasing interfaces, either because they made them to be pretty or the designer who made the tracking sheet or the app made it to be pretty. 

I have a confession. Even though I'm a measurement specialist, I hate tracking things about my day-to-day life. I hate it. I don't want to tell you what I ate. Yes, I know the scientific evidence for how it helps people make better nutrition choices, but I don't wanna. I know I shouldn't eat that cookie either, but I will do it anyway. But I'm not the type of person who uses the cute bujo tracking sheet. For those who like those tracking sheets, behavioral health providers could benefit from that data or even use their measurements because it's what your client is doing anyway. It'd be an excellent add-on for your clients. Added care from you. Bonus for you: You'd get the measurement-based data you need, if you needed it, to report to whomever you are required to report it to. So win-win. 

So what’s your pitch lady? This is going to be different from where you think it is going to go. I'm a measurement specialist. I love data. I love sifting through them like it's a box of chocolates. Data are yummy to me. But I get why people don't want to collect it. Coming up with what to measure is daunting and confusing. Maintaining data is often a tedious and odious task, taking time from doing things you'd rather be doing, like taking care of others. And I don't tend to do it in my own life. I wasn't the mom writing down all of my kid's data while he was a baby. I documented his every move with photos and videos, but did not quantify his life. 

I'm not going to say to you behavioral health providers that measurement-based care is the best thing ever.Measurement-based care has its good points. We all know them. It also has its drawbacks. We all know them too. Need help figuring out how to get through the humbug of it all? Let me help!  At Mind Alchemy, we are a company specializing in measurement-based care, data analytics, behavioral science, and more. Whether you HAVE to implement measurement-based care, or you WANT to, we can help collect, analyze, and organize your data. 

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American Psychological Association Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. American Psychologist, 61(4), 271–285. https://doi.org/10.1037/0003-066X.61 .4.271