A Digital Feedback System to Support Implementation of Measurement-Based Care by School-Based Mental Health Clinicians

Abstract

Objective. Evidence supports the utility of measurement-based care (MBC) to improve youth mental health outcomes, but clinicians rarely engage in MBC practices. Digital measurement feedback systems (MFS) may reflect a feasible strategy to support MBC adoption and sustainment. This pilot study was initiated to evaluate the impact of a MFS and brief consultation supports to facilitate MBC uptake and sustainment among mental health clinicians in the education sector, the most common mental health service delivery setting for youth. Method. Following an initial training in MBC, 14 clinicians were randomized to either: (1) a digital MFS and brief consultation supports, or (2) control. Baseline ratings of MBC attitudes, skill, and use were collected. In addition, daily assessment ratings tracked two core MBC practices (i.e., assessment tool administration, provision of feedback) over a six-month follow-up period. Results. Clinicians in the MFS condition demonstrated rapid increases in both MBC practices while the control group did not significantly change. For clinicians in the MFS group, consultation effects were significant for feedback and approached significance for administration. Over the follow-up period, average decreases in the current study were moderate with only one of the two outcome variables (administration) decreasing significantly. Inspection of individual clinician trajectories revealed substantial within-group trend variation. Conclusions. MFS may represent an effective MBC implementation strategy beyond initial training, although individual clinician response is variable. Identifying feasible and impactful implementation strategies is critical given the ability of MBC to support precision healthcare.

Impact of a Web-Based Electronic Health Record on Behavioral Health Service Delivery for Children and Adolescents: Randomized Controlled Trial

“…At the same time, practitioners in the EHR group reported spending significantly more time reviewing and applying client progress data in supervision, and significantly less time on administrative tasks. This finding provides support to the proposal that use of EHR systems can facilitate greater attention to client progress and subsequent problem solving and is consistent with prior research indicating that digital feedback technologies can effectively support assessment-related provider behavior change [ 63 , 64 ]. This is an encouraging result given that “treating to target” is a commonly-cited principle of effective behavioral healthcare, and has been found to account for substantial variance in positive outcomes [ 65 ].…”

Collaborative Care to Improve Access and Quality in School‐Based Behavioral Health

“…CC models use a well‐specified measurement‐based care approach, which aligns very well with the general orientation schools express toward incorporating data into decisions and is likely provide explicit opportunities to increase the use of multiple sources of assessment data in the education sector. When it occurs, outcome monitoring in schools is traditionally focused on educational data (eg, attendance, discipline, academic achievement), but numerous examples of studies promoting mental and behavioral health‐oriented tracking have begun to emerge in the SBH literature . These studies suggest that the introduction of the measurement‐based care component of the CC model may be acceptable and feasible to school‐based staff.…”

“…Furthermore, a digital registry for outcome tracking, originally designed to support CC for adults, has been adapted for use with youth receiving school‐based mental health services . Recently this registry was found to increase school clinicians' use of measurement‐base care in their practice in a small scale randomized trial . Nevertheless, such a tool may need to be improved to support the range of practices contained within an adapted CC model for the education sector.…”

“…Attention to these variables is also likely to improve the contextual fit of CC for SBH practice, resulting in a model that is more compelling and useful for education sector stakeholders, such as school administrators or embedded service providers. If CC is introduced to schools with an accompanying registry, it also affords relatively straightforward opportunities for local systems—such as schools and districts—to gather locally‐relevant “practice‐based evidence” about the effectiveness of the model in their respective contexts. In the future, controlled trials of CC in schools and data collected in the context of routine implementations should attend to both behavioral health and academic variables.…”

Evidence Base Update for Brief, Free, and Accessible Youth Mental Health Measures

“…A comprehensive evaluation of the psychometric properties for identified measures is needed to inform our understanding of the current state of the science and to set an agenda for future research. Second, since the publication of this initial review, multiple repositories designed to house freely accessible measures were created, there has been an increased emphasis on developing pragmatic measures to be used in EBA (Jensen-Doss, 2015), and implementation efforts focused on EBA for youth are underway (e.g., Jensen-Doss, Ehrenreich-May, et al, 2018;Lyon et al, 2019). Related, the initial search was conducted prior to the publication of DSM-5 (American Psychological Association, 2013); in the past several years, new measures may have been developed to match updated diagnostic criteria and new diagnostic categories (e.g., avoidant/ restrictive food intake disorder, disruptive mood dysregulation disorder).…”