Topic: Measurement-based Care (MBC) gap in mental health care
The field of clinical psychology
has been and still is facing a serious dilemma termed the
scientist-practitioner gap. This gap refers to the disagreement between
scientists/researchers and practitioners on how clinical care should be
informed. The first believes that clinical care should be
informed by scientific evidence, whereas the latter validates the necessity of
clinical judgment (Cautin, 2011). The literature suggests that
measurement-based care (MBC), a framework that bases clinical care on client
data systematically collected throughout the treatment process, significantly
improves client outcomes compared to traditional approaches such as one-time
screening, infrequent symptom assessment, and clinical judgment (Fortney et al., 2017; Scott & Lewis, 2014). For example, an
early meta-analysis of six studies that includes around 300 practitioners and
over 6,000 patients found that patients randomly assigned to MBC had
significantly better outcomes than patients assigned to usual care (Shimokawa,
Lambert, & Smart, 2010). Other notable studies show similar positive
effects of MBC on couples’ therapy (Anker, Duncan, & Sparks, 2009), and
child mental health care across 144 providers and 28 clinics in 10 states
(Bickman et al., 2011). In addition to the strong empirical evidence on the
efficacy of MBC, there is mounting evidence from large-scale trials
demonstrating the feasibility of the implementation of MBC and its
acceptability among patients and providers (e.g., Pomerantz et al., 2014;
Unützer et al., 2012). Yet, MBC is not commonly used in psychological clinical
settings due to reasons such as increased paperwork, time needed for training, cost, and
lack of personnel sources (Hatfield & Ogles, 2007; Fortney et al., 2017).
Failure to adopt MBC could yield consequences such as but not limited to
decreased precision in treatment plan, less client engagement, inaccurate
assessment of improvement, lower quality of care, and potentially additional
cost on client for an unnecessarily longer treatment plan (Fortney et al., 2017;
Scott & Lewis, 2014).
References:
Anker, M. G., Duncan, B. L., & Sparks, J. A. (2009). Using client feedback to improve couple therapy outcomes: A randomized clinical trial in a naturalistic setting. Journal of consulting and clinical psychology, 77(4), 693.
Bickman, L., Kelley, S. D., Breda, C., de Andrade, A. R., & Riemer, M. (2011). Effects of routine feedback to clinicians on mental health outcomes of youths: Results of a randomized trial. Psychiatric Services, 62(12), 1423-1429.
Cautin, R. L. (2011). Invoking history to teach about the scientist-practitioner gap. History of psychology, 14(2), 197.
Fortney, J. C., Unützer, J., Wrenn, G., Pyne, J. M., Smith, G. R., Schoenbaum, M., & Harbin, H. T. (2017). A tipping point for measurement-based care. Psychiatric Services, 68(2), 179-188.
Hatfield, D. R., & Ogles, B. M. (2007). Why some clinicians use outcome measures and others do not. Administration and policy in mental health and mental health services research, 34(3), 283-291.
Pomerantz, A. S., Kearney, L. K., Wray, L. O., Post, E. P., & McCarthy, J. F. (2014). Mental health services in the medical home in the Department of Veterans Affairs: Factors for successful integration. Psychological Services, 11(3), 243.
Scott, K., & Lewis, C. C. (2015). Using measurement-based care to enhance any treatment. Cognitive and behavioral practice, 22(1), 49-59.
Shimokawa, K., Lambert, M. J., & Smart, D. W. (2010). Enhancing treatment outcome of patients at risk of treatment failure: meta-analytic and mega-analytic review of a psychotherapy quality assurance system. Journal of consulting and clinical psychology, 78(3), 298.
Unützer, J., Chan, Y. F., Hafer, E., Knaster, J., Shields, A., Powers, D., & Veith, R. C. (2012). Quality improvement with pay-for-performance incentives in integrated behavioral health care. American Journal of Public Health, 102(6), e41-e45.