February 10, 2023

Measurement-based care reduces client dropout, study finds

Recently published data show that using symptom scores to inform treatment predicts lower rates of premature dropout

Mental health care has a client retention problem. 

Evidence-based treatments for common mood disorders like depression, for example, only lead to full and sustained remission in around half of the clients who receive them, and outcomes are predictably even worse for clients who drop out of treatment prematurely. And, in the case of depression, asking clients to conjure up sufficient motivation and attention to engage in treatment can feel like an insurmountable hurdle. Dropout risk is reflective of the very nature of the disorder. 

Therefore, when clinicians want to reduce the likelihood of dropout, it makes sense that they would take steps to ensure that therapy is low-burden right from the start. It also makes sense, then, why clinicians might worry that adding in a step like measurement-based care (MBC) might be a deterrent for clients. 

But, new empirical findings show that MBC is one of the most effective tools for reducing client dropout. 

A peer-reviewed study recently published in Behavior Research and Therapy set out to test whether three therapist tools - a treatment plan, a list of goals, and a plot of symptom scores - predicted dropout from care. In this study, symptoms were assessed via the Beck Depression Inventory and the Beck Anxiety Inventory. These measures were administered, scored, plotted, discussed, and used to inform the session that day. Sound familiar? 

Not only did plotting symptom scores significantly predict lower premature dropout, clients whose care involved plotting symptom scores showed significantly greater symptom improvement compared to clients whose clinicians did not plot symptom scores. 

If, as you’re reading this, you’re thinking to yourself that treatment trials don’t often translate to real-world practice, you’re right! But because this study was conducted using data collected in a private practice setting between 1981 and 2009, we can be confident in the validity of these findings.  

The authors of the study weren’t surprised. Here’s what they made of their findings: 

Of the three tools we studied in our sample, the one that most aligned with our predictions was the plot of symptom scores, which predicted reduced end-of-treatment Beck Depression Inventory score…and predicted lower rates of dropout. This observation is consistent with a growing body of studies showing that measurement-based care and routine outcome monitoring are associated with improved outcome and reduced dropout.

It’s important to note that all clinicians in this study were delivering CBT, so we can’t chalk these findings up to differences in treatment modality. So, why can measurement have such a powerful effect on clinical care? 

  1. MBC pulls clients in and keeps them invested in care. Measurement implicitly communicates to clients that there is a path forward in reducing their suffering. For clients who are experiencing depression and may have difficulty feeling hopeful, this message may make the difference between retention and dropout. Administering self-report questionnaires at the start of each session also allows clients to reflect on their symptoms, thus facilitating their active participation in care.
  2. MBC helps you to deliver individualized treatment. Administering a questionnaire and taking interest in the specific symptoms endorsed in the questionnaire is the difference between measurement and measurement-based care. When you devote sessions to addressing the particular symptoms that matter most to your clients, you convey to your clients that you take their progress seriously. And, you help debunk the myth that evidence-based treatments are a one-size-fits-all approach! 
  3. MBC helps you make changes before dropout occurs. Observing changes, or lack thereof, is much easier to do by using a symptom plot than noticing changes in your client’s presentation week-to-week. Even a flat line indicating no symptom change is valuable information because it allows you to change course before your client decides to leave treatment. 

Remember, MBC is a catalyst, not a barrier, to providing great care. And, Blueprint can help make it easier for your practice to use tools like MBC that protect against dropout. Click here to find out how by starting your free trial.