Front Matter

Foreword v

Preface vii

01 What Is Measurement-Based Care? 3

02 Using Measures to Guide Clinical Practice and Improve Treatment Response 7

03 Getting Started 23

04 Operations Infrastructure 35

05 Overview of Psychometrically Sound Measures 61

06 Psychometric Test Access and User Qualifications 69

07 Psychometrically Sound Scales 73

08 Aggregating Patient Data for Program Fidelity 97

09 From Personalized Patient-Centered Care to Practice-Based Evidence 125

Appendix A: Why-What-How Operationalization Worksheet 131

Appendix B: Stakeholders Graphic 133

References. 135

Index 147

Color Gallery

THIS book is a must read for all behavioral health care and human services clinicians and leaders who aspire to lead their practice and organization into a successful and prosperous future. It provides the “how to” information for using measurement-based care (MBC), the critical component to delivering high-quality, high-value care, treatment, and services.

The use of MBC in behavioral health care and human services will likely have the greatest impact on moving this industry forward now and in the future. In seeking parity in access to health care resources, behavioral health care and human services clinicians and organizations must demonstrate measurable outcomes for the care, treatment, and services they provide to the individuals they serve. The medical health care sector has long provided clinical data to demonstrate the degree to which individuals stabilize or improve from the care delivered, thus showing measurable value for the resources used to deliver care. Behavioral health care and human services organizations have not done the same and therefore have struggled to achieve parity with payers, regulators, patients, and other important stakeholders. In 2018, seeking to help move the field forward, the Joint Commission (TJC) Behavioral Health Care and Human Services accreditation program introduced a standard requiring all of its accredited organizations to use MBC in the delivery of care, treatment, and services to the individuals they serve, making TJC the only accreditor to require its use.

As the executive director of the Behavioral Health Care and Human Services program at TJC, I knew this change represented an immense step forward for the clinicians and organizations currently accredited and those seeking accreditation. As a result, we needed to collaborate with innovative leaders who have effectively implemented MBC in order to help these organizations move forward. Dr. Giedzinska was recommended to me as a leader who had embraced MBC and was using it effectively within her organization, Sierra Tucson. To that end, Dr. Giedzinska has been a valued collaborator in our endeavor to move the use of MBC forward. She has shared her organization’s journey in implementing MBC with our accredited organizations and those seeking accreditation. She has demonstrated an in-depth knowledge of MBC, the benefits of its use, how to implement it in an organization effectively, and how to use data from MBC throughout the course of care and to improve the services offered by her organization to the entire population it serves. By way of this book, she is now sharing this valuable information with the industry at large.

Many behavioral health care and human services clinicians and organizations struggle to get started with utilizing MBC. It is important for them to understand the return on investment for using MBC in terms of the improvements in the clinical outcomes of the individuals they serve; overall improvements in the quality and safety of the care, treatment, and services provided; and recognition from external parties such as regulators, payers, and associations. Through this book, the authors demonstrate that these goals can be achieved through the use of MBC.

In this book, Dr. Giedzinska utilizes her advanced training and extensive experience in clinical psychology and program leadership to guide readers through the journey of embracing MBC in a practical manner. She helps them overcome the fear of embarking on this new journey by breaking it into steps that are easy to understand and implement. She presents a compelling reason to use MBC, in partnership with the individual served, to improve the therapeutic alliance, reinforce patient progress, and improve clinical outcomes. Furthermore, she demonstrates that aggregating the data from the population served aids in improving program fidelity, demonstrates value to third parties, and improves the overall quality and safety of the services provided to all the individuals served by the clinician or organization.

Her views in this book on the importance of MBC and her practical tips on implementation and use of the data will guide the behavioral health care and human services industry and all the individuals it serves.

MEASUREMENT-BASED care (MBC). Chances are, if you are reading this right now, you are considering how to implement this process into your clinical practice. The good news: you have opened the right book. The not-so-good news: there is a bit of work ahead of you (or your team) to put this process into practice, but those efforts are worthwhile. There is a lot of goodness in implementing MBC, and not only for your patients but also for you and your clinical practice. In fact, implementing MBC practices into mental health treatment may be very good for our industry overall.

If you are like us, you are very busy and probably have already advanced through to some of the chapters in this book to check out the specific sections relevant to you. That’s great, but we ask that you first read Section I before diving in to start implementing the hands-on approaches offered in the rest of this book. Section I sets the stage and foundation for the “WHAT”, the “WHY,” and the “HOW” of MBC. As a busy clinician, familiarizing yourself with this content is important because if you cannot justify why on Earth you are spending all this extra time and resources to measure your patient’s mental health progress, chances are you will not stick with these methods. And you will want to stick with them, because there are more benefits to integrating MBC into your practice than there are for NOT integrating it into your practice.

Before you begin, it is important to understand some of the potential barriers—largely based on misconceptions—that require consideration, which Section I outlines. One of these is the age-old debate between clinical and actuarial judgment. In mental health patient-centered care, these two aspects serve patients better when they are integrated rather than viewed as contentious adversaries. Another potential barrier to implementation is the understandable fear surrounding the “punitive” nature that patient-reported progress data may have on one’s clinical competence. This is largely a myth worth demystifying. Practice fidelity is a reality to which all of us must hold ourselves accountable, and MBC processes can actually serve as the foundation on which therapeutic practice fidelity rests. Have you ever met a mental health practitioner who did therapeutic clinical work for any reason other than the desire to help reduce patients’ suffering? Not likely. Therefore, we want our approaches to work, and additional information that informs us about our patients’ mental health progress is something clinicians should embrace rather than fear. MBC is one of those methods that will help you help others, and better than you ever thought possible.

The benefits of MBC far outweigh any barriers, in our opinion. For the past 20 years, numerous empirical studies have demonstrated the positive impact that MBC has had on therapeutic success. There is collective agreement that when mental health clinicians review the self-reported data with their patients, whether as the initial assessment of the patient’s psychological profile or as the mid-treatment review of the patient’s therapeutic progress, the therapeutic alliance and rapport are strengthened as a result. Patients’ clinical presentation is supported by the data, which appears to have a validating effect—and we know the therapeutic power that validating patients can have. When patients are able to discuss these data with their clinician, that important need to be heard and understood is expanded dimensionally. For instance, discussing self-reported data epitomizes patient-centered care by strengthening collaborative treatment decision-making and ultimately enhancing personalized treatment plans. Consider thus how this process would promote treatment compliance; one of the most important findings from implementing MBC throughout treatment is its ability to prevent treatment failure by catching patients who would otherwise imperceptibly “fall through the cracks.”

Using psychometric data in this manner becomes one of your most powerful clinical tools. Trust us on this: Once you overcome bias, fears, or even challenges to your ego (yes, we all know at least one clinician among us with “clinical pride”) and integrate the methods outlined in this book, your clinical practice will be more effective, your patients will show better treatment responses, and you, yourself, will likely have greater job satisfaction.