Chapter 39.Standardized Assessment and Measurement-Based Care

The assessment process requires the clinician to make decisions by formulating, testing, and refining hypotheses based on clinical information that is often incomplete or inconsistent, often in the context of very brief clinical encounters. Evidence has been mounting for decades that in such contexts, subjective clinical judgment does not yield diagnoses that are as accurate or comprehensive as standardized diagnostic measures. Consequently, evidence-based assessment is now recognized as a key component of evidence-based care. The American Psychiatric Association guidelines recommend that “the initial psychiatric evaluation of a patient include quantitative measures of symptoms, level of functioning, and quality of life” (American Psychiatric Association Work Group on Psychiatric Evaluation 2016, p. 35). More recent research findings suggest that quantitative measures should be used not just at initial evaluation but also over the course of treatment to measure patient health and symptoms. Integrating the routine use of measurement within clinical care has been shown to result in faster improvement in client outcomes, including symptoms, interpersonal functioning, and quality of life, than routine care without ongoing assessment, particularly among patients at risk for deterioration (Bickman et al. 2011; Lambert et al. 2003). The Joint Commission (2017) has recognized the value of ongoing assessment, specifying that behavioral health care organizations should use standardized tools or instruments to monitor patient progress.