What is Measurement-Based Care and why it it important?

The term “measurement-based care” (MBC) has gotten an increasing amount of attention in the mental health treatment community over the past few years, but for people who do not work in mental health, what MBC is and why it matters may not yet be well-understood. At Upward, we are strong believers in the consistent use of MBC, so it is a pleasure to have the opportunity to discuss this approach to treatment in today’s blog post.

Measurement-based care is intended as an approach that ensures repeated, accurate assessment of progress (or lack thereof) in treatment. The use of MBC is one of the core values in Upward’s approach to treatment.

Several years ago, I read an article that bothered me and its message has stayed with me ever since. The article, linked here, explains how psychotherapists often overestimate the effectiveness of the psychotherapy they provide. In other words, psychotherapists often think that the care they are giving is resulting in considerably more benefit than it actually is. There are a couple of reasons this happens, and one of them is that oftentimes, psychotherapists do not use quantitative measurements of symptom severity or treatment progress.

There are two core ways to track progress in treatment: quantitative measures and qualitative measures. Qualitative measures are what traditionally tend to be used more often by psychotherapists. These are assessments based on a provider’s observation and a client’s self-report. Quantitative measures, on the other hand, are assessments based on numbers. It is this quantitative measurement that defines measurement-based care.

We believe that the best assessment of progress must combine both the traditional qualitative approach along with the more objective quantitative approach.

The easiest way to think about this approach is to use a medical-model analogy: if your lipid profile blood test shows that your cholesterol level number is too high, then that level reading will be considered as your doctor makes a diagnosis. Your doctor may place you on a medication and repeat the lipid profile blood test a few months later. The cholesterol level number from the new test will be compared to the cholesterol level number from the initial test, and that will allow your doctor an important data point to consider as they decide whether the medication is working for you. This would be an excellent example of numbers-based, quantitative measurement. Conversely, an example of qualitative measurement in this instance would be your doctor asking you how you’re feeling on the new medication and you reporting that you are feeling better or worse.

Quantitative measures are objective, meaning they have been studied in the scientific research to ensure that they consistently and meaningfully measure what they say they measure, and that they provide meaningful, accurate information about symptom severity for clients regardless of that client’s age, race, or sex. Quantitative measures are intended to be consistently meaningful and useful for all clients, whether you use them in small-town Alabama or in Birmingham, Montgomery, Tuscaloosa, or Mobile. On the other hand, qualitative measures are subjective, meaning they are based on individual opinion, description, and experience.

So which is better: quantitative measurement or qualitative measurement? It is a trick question because the answer, at least in the collective opinion of Upward providers, is that they are both crucially important in all aspects of quality psychotherapy. Traditionally, many psychotherapists rely solely on qualitative assessment to evaluate the effectiveness of their treatment. Usually this takes the form of asking the client how they are doing and inquiring about whether the client is seeing progress. This report is combined with the psychotherapist’s own opinion regarding the client’s progress, and these data points together comprise the psychotherapist’s assessment of whether or not the treatment is working.

Upward providers think that the qualitative assessment described in that last paragraph is extremely important. However, we believe that comprehensive evaluation of progress must also include the consistent, repeated use of objective, quantitative measurement in order to assess whether a client’s treatment plan is working for them. At Upward, you will find elements of both types of measurement during intake, diagnosis, treatment planning, and psychotherapy sessions.

In addition to qualitative assessment of progress, all Upward clients are assigned at least one “index measurement” that is a quantitative measure. That index measurement corresponds to the client’s primary symptom; for example, clients struggling with insomnia will have an index measurement that has been repeatedly demonstrated to meaningfully measure the severity of insomnia. The index measurement will be used repeatedly over the course of treatment with that client as one way of ensuring that treatment is effective. If the score is improving over time, then we have a pretty good idea that the treatment plan is working and that is great! But if the score is not improving, then that is important information to have, as well. After all, the providers at Upward do not want to fall into the same trend found in the article I described at the beginning of this blog post. We don’t want to just assume that our treatment approach is working for a client: we want the numbers to prove that it is working and that the client is getting measurable results in a reasonable time frame.

So how does the process of MBC actually look for an Upward client? Will completing these index measurements be time-consuming or cumbersome? Not at all! Although there will be a lot of assessment in a client’s intake session, once a plan of care has been established, the process of providing this quantitative data is a quick one. For the majority of Upward clients, a brief assessment will arrive in their inboxes the day before their scheduled appointment and invite them to complete an assessment that generally takes less than 2 minutes to complete. The assessment score generated by this 2 minutes of effort provides valuable, quantitative, objective data that, coupled with qualitative assessments of progress, will allow a client’s provider to make a much more accurate assessment of how well treatment is working for that client.

Happily, most clients’ assessment scores indicate progress from week to week during their treatment at Upward. We love seeing this progress, and our clients love experiencing it! Some of the most satisfying quantitative data points we’ve seen just this week include:

· a client who has increased the hours of sleep they are getting each night by 65%

· a client who has decreased their anxiety symptoms by 80%

· a client who has decreased their sleep medication dosage by 100%.

Numbers like these are powerful, meaningful indicators that the treatment a client is receiving is truly working for them. 

If you are having trouble sleeping, or if you are having symptoms of anxiety, panic, depression, or PTSD, then we’d love to work with you to measurably decrease your experience of these symptoms.