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So, you’ve started to incorporate measurement-based care (MBC) into your routine practice. Congratulations! There is no doubt that step will make it easier for you to provide high quality care. Here are some tips to make sure that your clients are just as excited as you are about MBC:
#1 Create a pitch
Clients trust their provider to determine the best treatment approach, but they may need you to spell out the rationale for completing outcome measures at regular intervals. In the spirit of collaborative care, this is an important question to be able to answer. Here’s a sample pitch to get you started:
Client: “My old therapist didn’t use questionnaires. Why do we need to do this every week?”
Therapist: “It’s very important for me to stay connected to your progress during our work together. One way I do this is by routinely asking you to complete a set of assessments that captures what you want to change. Not everyone experiences symptoms the same way, so this allows me to use a person-centered approach. You and I will review your results together each time we meet and use this information to guide our session. I don’t take the results personally, but I do take them seriously, so please be honest and accurate. These assessments are an important way I make sure you’re getting the most out of therapy.”
When therapists ask clients to complete outcome measures from the start of treatment, they are demonstrating to clients that MBC is an integral part of their care. But longtime clients might need extra convincing. After all, clients who are introduced to outcome measures later on in their care journey may be more likely to perceive MBC as a burden more than an aid. Address this skepticism head-on:
Client: “We never used these outcome measures before, and I’ve felt like things were going just fine. Why are we changing things up?”
Therapist: “I’m so glad you felt like our treatment has been working for you. It’s important for me to clarify that MBC isn’t actually changing WHAT we do in therapy, it’s only giving us more information as to WHY what we do is working. I will make sure we work together to pick measures that take just a few minutes to complete and that reflect the symptoms that feel relevant to you. By measuring your symptoms each week, we will be able to monitor the effectiveness of the interventions much more specifically than we have in the past, which will help us make a plan for the rest of your treatment.”
#2 Address questions about confidentiality
It’s good practice to ensure clients understand that Blueprint is a HIPAA-compliant platform, meaning data are highly secure and confidential. But, there are some clients for whom a more detailed conversations about confidentiality might be warranted, such as those who experience suicidal ideation and minors. After all, you’ve just asked your clients to be honest and accurate. Here’s how talking about MBC can fit into your existing conversation about confidentiality:
Client: “What will happen if I endorse suicidal ideation on my questionnaire?”
Therapist: “Just like your other symptoms, suicidal ideation is a symptom that we can monitor to help keep you safe and ensure it decreases over time. When you endorse suicidal ideation on a questionnaire that you fill out between sessions, you will be directed to a page with crisis resources. These are important because I will not be notified of your responses in real time. This built-in safety net will help get you connected to resources when you need them the most.”
Client: “My child is under 18. Will I be able to know about their survey results and progress?"
Therapist: “Measurement-based care actually makes it even easier for me to keep you apprised of your child’s progress. Each week, I will share with you a summary of your child’s symptoms including how these symptoms have changed over time. Ultimately, you are the expert in your child and so I'll make sure to ask you about any results or trends before forming any final opinions about your child's progress."
#3 Keep measures personalized and brief
If clients are asked to answer a long list of questions that aren’t relevant to them and their therapy, their motivation will diminish over time. A winning engagement strategy is to link specific assessments to the specific symptoms your client wants to change. The good news is that many well-validated assessments (e.g., the GAD-7 or PHQ-9) can be completed in just a few minutes. You can try framing it to your client like this:
Client: “You had me complete a ton of assessments when we first met. Is this what I should expect at each session?”
Therapist: “Definitely not. The assessments at the beginning of treatment help give me a holistic picture of your symptoms to make sure that I’m not missing anything. Now that we’ve had a chance to speak about your goals for treatment, there are two measures that we’ll rely on more frequently to track your progress. These two measures shouldn’t take you longer than a few minutes to complete.”
#4 Consider the timing of assessments
Although you might ask that a new client complete a longer battery of assessments at intake, you’ll need to consider how often you’d like these measures to be repeated. It’s not always the case that more data is better. Instead, tailor assessments so that they are best positioned to capture symptom change while minimizing time burden for clients:
Client: “Am I going to be completing measures at each weekly therapy appointment?”
Therapist: “The two shorter measures that we’ve been using, the PHQ-9 and the GAD-7, are designed to capture changes in your depression and anxiety, respectively. I’d like you to fill out the two measures weekly for the first four weeks of treatment, as this is often when the most change happens in therapy. After that, we’ll move to completing them biweekly. This will help ensure consistent data points for us to use to monitor progress. At your intake appointment, you completed several longer questionnaires. Because these measure symptoms that are unlikely to change from week-to-week, those will be repeated at the midway point of treatment ”
#5 Reference results at each encounter
Once clients understand the value of MBC, therapists play a critical role in sustaining motivation for MBC over time. After all, clients aren’t completing measures for their own benefit; they expect results to be used to enhance care. So, make sure you reference each of your client’s assessments at each encounter so clients see the value in MBC:
Therapist: “Thanks for completing your measures this week. I see that your PHQ-9 score is 10 out of 27 this week, which is down from the past 3 weeks. As a reminder, for the PHQ-9, lower scores mean you’re feeling less depressed, so this is great news! When I dig into this a little more, I see that the main reason for this drop score was that you reported fewer days of having low energy and fewer days with trouble sleeping. I’d love to hear about whether you feel like these changes are due to trying those sleep strategies we’ve been talking about in session. Let’s take a look at your self-monitoring form to see how your sleep looked this week…”
Ultimately, therapists should find their own voice when describing the value of MBC to their clients. Just remember: preempting hesitations by addressing them head-on with your clients will only result in increased motivation and, therefore, better outcomes.
