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      Implementing Measurement-Based Care in Behavioral Health : A Review

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          Abstract

          Measurement-based care (MBC) is the systematic evaluation of patient symptoms before or during an encounter to inform behavioral health treatment. Despite MBC's demonstrated ability to enhance usual care by expediting improvements and rapidly detecting patients whose health would otherwise deteriorate, it is underused, with typically less than 20% of behavioral health practitioners integrating it into their practice. This narrative review addresses definitional issues, offers a concrete and evaluable operationalization of MBC fidelity, and summarizes the evidence base and utility of MBC. It also synthesizes the extant literature's characterization of barriers to and strategies for supporting MBC implementation, sustainment, and scale-up.

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          Clinical versus mechanical prediction: a meta-analysis.

          William M. Grove, David H. Zald, Boyd S. Lebow … (2000)
          The process of making judgments and decisions requires a method for combining data. To compare the accuracy of clinical and mechanical (formal, statistical) data-combination techniques, we performed a meta-analysis on studies of human health and behavior. On average, mechanical-prediction techniques were about 10% more accurate than clinical predictions. Depending on the specific analysis, mechanical prediction substantially outperformed clinical prediction in 33%-47% of studies examined. Although clinical predictions were often as accurate as mechanical predictions, in only a few studies (6%-16%) were they substantially more accurate. Superiority for mechanical-prediction techniques was consistent, regardless of the judgment task, type of judges, judges' amounts of experience, or the types of data being combined. Clinical predictions performed relatively less well when predictors included clinical interview data. These data indicate that mechanical predictions of human behaviors are equal or superior to clinical prediction methods for a wide range of circumstances.
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            Leadership and organizational change for implementation (LOCI): a randomized mixed method pilot study of a leadership and organization development intervention for evidence-based practice implementation

            Gregory Aarons, Mark Ehrhart, Lauren Farahnak … (2015)
            Background Leadership is important in the implementation of innovation in business, health, and allied health care settings. Yet there is a need for empirically validated organizational interventions for coordinated leadership and organizational development strategies to facilitate effective evidence-based practice (EBP) implementation. This paper describes the initial feasibility, acceptability, and perceived utility of the Leadership and Organizational Change for Implementation (LOCI) intervention. A transdisciplinary team of investigators and community stakeholders worked together to develop and test a leadership and organizational strategy to promote effective leadership for implementing EBPs. Methods Participants were 12 mental health service team leaders and their staff (n = 100) from three different agencies that provide mental health services to children and families in California, USA. Supervisors were randomly assigned to the 6-month LOCI intervention or to a two-session leadership webinar control condition provided by a well-known leadership training organization. We utilized mixed methods with quantitative surveys and qualitative data collected via surveys and a focus group with LOCI trainees. Results Quantitative and qualitative analyses support the LOCI training and organizational strategy intervention in regard to feasibility, acceptability, and perceived utility, as well as impact on leader and supervisee-rated outcomes. Conclusions The LOCI leadership and organizational change for implementation intervention is a feasible and acceptable strategy that has utility to improve staff-rated leadership for EBP implementation. Further studies are needed to conduct rigorous tests of the proximal and distal impacts of LOCI on leader behaviors, implementation leadership, organizational context, and implementation outcomes. The results of this study suggest that LOCI may be a viable strategy to support organizations in preparing for the implementation and sustainment of EBP. Electronic supplementary material The online version of this article (doi:10.1186/s13012-014-0192-y) contains supplementary material, which is available to authorized users.
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              Using Measurement-Based Care to Enhance Any Treatment.

              Kelli Scott, Cara Lewis (2015)
              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.
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                Author and article information

                Journal
                Title: JAMA Psychiatry
                Abbreviated Title: JAMA Psychiatry
                Publisher: American Medical Association (AMA)
                ISSN (Print): 2168-622X
                Publication date (Electronic): December 19 2018
                Affiliations
                [1 ]Kaiser Permanente Washington Health Research Institute, Seattle
                [2 ]Department of Psychology, UCLA (University of California, Los Angeles)
                [3 ]Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
                [4 ]Department of Psychological and Brain Sciences, Indiana University, Bloomington
                [5 ]Department of Psychology, Ohio University, Athens
                [6 ]Department of Psychology, West Virginia University, Morgantown
                [7 ]School of Public Health, Brown University, Providence, Rhode Island
                [8 ]Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
                [9 ]Department of Leadership, Policy and Organizations, Peabody College, Vanderbilt University, Nashville, Tennessee
                [10 ]Regenstrief Institute, Indianapolis, Indiana
                Article
                DOI: 10.1001/jamapsychiatry.2018.3329
                PMC ID: 6584602
                PubMed ID: 30566197
                SO-VID: 5d089422-d8ad-40df-b010-7f1515605f0c
                Copyright © © 2018
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