How to Practice Measurement-Based Care

A step-by-step guide.

“Routine outcome measurement is great—but how do I actually use this information to practice measurement-based care?!”

This is a common question for many clinicians new to using outcome measurement in their practice—and for good reason.

For many of us, integrating routine outcome measurement into practice simply wasn’t a part of our clinical training. We never learned the ins-and-outs of how to use symptom rating scales as part of our treatment offering, nor did we learn how to make clinical decisions based on measured patient progress (or lack thereof).

Well, the good news is…it’s actually pretty simple!

The clinical team at Blueprint put our heads together and developed a simple step-by-step model for all of those clinicians out there who are asking (…or afraid to ask…) the big question of how to actually practice measurement-based care.

Using the acronym SOCCER, the information below will take you through an easy-to-follow guide for how to start practicing measurement-based care today.

Here’s how it works…

Step 1: Select outcome measures that are connected to your treatment goals

For this first step, take a moment to ask yourself what you want to achieve when working with a given patient. For some, this might be a reduction in symptoms or eliminating a certain type of maladaptive behavior. For others, it might be improving overall wellbeing, quality of life, or relationship satisfaction. The great thing about measurement-based care is it can be applied to ANY form of treatment so long as the appropriate outcome measures are utilized. In this way, it is critically important to make sure that you are selecting outcome measures that are consistent and tightly aligned with your unique approach to treatment, NOT simply what is standard practiced or used by your colleague down the hall.

Step 2: Operationalize change expectancy

This step might sound intimidating, but trust me—it’s not! All we are advocating here is that you take some time to consider how each patient you work with is expected to change over time. Why? Because each patient has their own path toward personal growth. It’s important for you as a clinician to have an understanding of how each patient you work with is expected to grow or change across time such that you can use the information collected through outcome measures to ensure that this expected progress is being made, and flag those patients who may not be keeping up as planned. To accomplish this, you might ask yourself the question “how do I expect this patient to have changed 6-8 weeks from now?” and use this as a benchmark for knowing when and how to respond to patients who may need additional support (more on this below).

Step 3: Collect outcome measurements at regular intervals

Luckily, this step is now pretty darn easy. Several online platforms exist that can help you assign patients appropriate outcome measure(s) based on the outcome of Step 1. Whenever possible, it's best to aim for weekly assessments as this will provide you with the most up-to-date information that you can integrate into each and every session you have with your patients. Even better, your patients will quickly learn to get in the habit of completing these measures routinely as part of their standard care experience with you—so it’s really a win-win for everyone involved.

Step 4. Collaborate with your clients

Let’s be real…there is nothing inherently special about the nine questions on the PHQ-9. Same goes with pretty much any other outcome measure out there. The real special sauce is not the measures themselves, but how you use them to cultivate meaningful conversations with the patients you serve. Making sense of the assessment results collaboratively with your clients is a keystone component of measurement-based care. This is because patients benefit greatly from working together with you to understand their own health and wellness - what it looks like right now and how it has changed over time. My go-to phrase when collaborating with my patients is the simple but evocative “what do you make of that?” when reviewing results of an outcome measure or assessment. With that said, I encourage you to find your own style or approach and am confident that you will be surprised by the depth and richness of the conversations that come when you are able to instill a sense of curiosity within your caseload about their lived experiences.

Step 5. Examine the trend in progress over time

Remember when we talked about that fancy term called “change expectancy” in Step 2? Well this is where it comes in handy! After a few weeks of working with a patient, you want to start looking at how their progress maps on to what you had expected upon starting treatment with them. You might ask yourself questions like “are they making the change that I expected them to make?” or “are they on track to hit the benchmark?” If the answer is yes…props to you and your patient and keep up the good work! If the answer is no, you can proceed to the last and final step.

Step 6. Respond by changing or adding to your treatment

There’s an old saying that goes like this - “If you always do what you’ve always done, you’ll always get what you’ve always got.” Yeah…it may sound a little silly at first, but there is some deep wisdom in this reality. How many times have you taken the same approach with a client for months, if not years, despite the fact that no change was being made? I know I have, and it’s only natural. The problem is that research has identified this very phenomenon of “clinical inertia” (i.e., doing the same thing regardless of the outcome) as a significant problem across our entire mental healthcare ecosystem. At the end of the day, the purpose of putting in all this effort to practice measurement-based care is all about undermining unhelpful clinical inertia by identifying non-responsive patients early in treatment and getting them the additional support they need when they need it. At the very least, a general guideline for a first-line response to patients who have fallen off their change trajectory is to refer out for a medication evaluation if you are a therapist, and to refer out for psychotherapy if you are a prescriber. With that said, measurement-based care is agnostic to how you respond…what’s important is that you do respond.

Want to learn more?

Check out this page on upcoming Blueprint Workshop Series events that dive deeper into the nuts and bolts of measurement-based care.

Be well!