December 30, 2022

Challenging case? Measurement-based care can help with that

Incorporating objective assessment should help, not hinder, your sessions.

Imagine you’re rowing a boat, and someone pulls up next to you and hands you a motor. If you treat the motor as a piece of cargo and plop it in the back of the boat, it will only weigh you down. But, if you attach it to the back of the boat, you can travel further with less effort than before. In other words, if you spend a little extra time ensuring you are using this tool to its full potential, the payoff is extraordinary.

Measurement-based care works the same way. If objective assessment feels like just one more item on your checklist each session, it’s going to feel like you’re adding a weight, not a tool. But, if you dread using objective assessment, you probably haven’t tapped into its full potential. 

Maybe your group practice recently instituted measurement-based care protocols, but the thought of adding one more thing to your busy agenda feels overwhelming. Or maybe you’ve been a fan of measurement-based care from early on, but it’s been feeling like a chore lately. 

The key to using measurement-based care more consistently is to use it more strategically.

Consider how, in these scenarios sure to be familiar to seasoned and newly-minted clinicians alike, incorporating measurement-based care (MBC) can move the needle towards progress:

The problem: Your client has a new problem-of-the-week…every…single…session.

Before MBC: It’s difficult to know if you’re making progress because there is limited continuity across sessions. Sessions feel disjointed and, frankly, chaotic. Both you and your client leave feeling like you just ran a marathon. You’re not sure if your client is getting much out of sessions and you’re worried they might drop out of treatment.

After MBC: Together, you and your client choose one measure that they agreed to complete at the start of the session each week. You notice that this consistency has helped sessions feel more grounded and makes it easier to set an agenda, which sets the tone for a collaborative, productive session. You no longer have to guess whether your client is getting their needs met each week, or whether they are getting better overall. You feel relieved and notice you feel excited to work with them again.

The problem: It’s been a month of treatment, and your new adolescent client is still quiet as a mouse during sessions.

Before MBC: Your client seems to have a master’s degree in symptom minimization. You get long emails and phone calls during the week from their parents, but when it comes time for a session, your client’s lips are sealed. The seconds tick by. The pressure to make progress is starting to burn you out. You have no idea how to get your client to tell you what’s been going on so that you can make the session useful for them. 

After MBC: You explain that you’d like to start measuring your client’s symptoms from week to week in between sessions. Kind of like homework in school, you say, but this is homework that doesn’t have a right answer and shouldn’t take more than a few minutes to do. Next time in session, your teen returns with a few data points scribbled down. Now, measurement-based care is a launchpad for your sessions. When you point to tricky spots over the past week, your client elaborates and, voila, your session agenda unfolds. 

The problem: Your client has shown tremendous gains in treatment but they have a hard time seeing their progress.

Before MBC: You’ve been seeing your client for years. They still come into sessions with problems they want help addressing, but they are leaps and bounds ahead of where they started treatment. You wish your client had an easier time appreciating this progress to help build up their self-efficacy.

After MBC: You dig up that measure you administered once at the intake and forgot about. You re-administer this assessment for the next few weeks, and then surprise your client by sharing this objective data on a graph. Their face lights up. This prompts a conversation about what the client has done to help make these low scores a reality. Maybe, they say, they are even ready to graduate treatment soon. 

Because delivering mental healthcare can be challenging enough, it’s important to make sure that all the tools at your disposal are working for you. The next time you’re feeling stuck in session, try leaning on measurement-based care.