Our Ethical Obligation to Practice Outcome Monitoring
Why Did You Become a Therapist?
Many people say that they went into therapy in order to help people, yet despite this initial goal, they report that they actually spend most of their “office time” writing notes and completing paperwork. With complicated EHRs, large caseloads, and increasing administrative responsibilities, some of these duties are inevitable. Fortunately, however, new tools and technologies are emerging to help clinicians to not only fulfill their job duties, but also more effectively treat their patients and ensure that they are providing quality care and utilizing best practices.
One of the best practices that has been demonstrated repeatedly to improve outcomes is using Measurement-Based Care. Measurement-Based Care is a system that utilizes patient-reported symptom rating scales to inform clinical decisions about patient care. Similar to Measurement-Based Care, outcomes monitoring or progress monitoring, is the routine collection of self-report data from patients to evaluate their progress in treatment and perception of the therapeutic alliance.
In both Measurement-Based Care and outcomes monitoring, clinicians use the self-report data provided by their clients to objectively assess their progress and make adjustments to their treatment plan or therapeutic approach in accord. Therapists have been slow to adopt routine progress monitoring or Measurement-Based Care, but the time has come for that to change.
In addition to standard measures of symptoms (e.g. PHQ-9, GAD-7), there are several published measures that can effectively provide feedback to the clinician (e.g. OQ, ROM, PCOMS). With a wide variety of validated measures available to assess one’s patients, there is little reason not to develop a thoughtful plan for evaluating one’s practice.
Providers’ desire to offer the highest quality of care possible is not the only reason to practice outcomes monitoring or Measurement-Based Care.
Monitoring can help patients to stay more engaged in their treatment and more participatory, both in sessions and with between-session assignments. They are less likely to stop treatment if they feel heard by their clinician.
Structured measures provide another opportunity for the therapist to listen to the client and get a better understanding of his/her emotions, experiences and feelings about therapy itself. Therapists often report having a strong desire to meet their clients where their clients are ready to be met. Providing an additional channel for communication (i.e. other than informal queries in session) will help them move towards this goal.
Some patients may feel more comfortable disclosing a symptom or therapeutic rupture on a form than directly to the clinician; the use of objective, validated measures can allow therapists to be aware of these issues without requiring the client to bring them up on their own.
Clients are also less likely to drop out of treatment if they feel that their therapist is responsive to their needs. This factor means it’s important to be aware of both the client’s symptoms and the degree to which he or she is suffering, and being cognizant of the therapeutic relationship and ensuring that it is productive.
Studies have repeatedly demonstrated that there is often a disconnect between how the client feels and how the provider thinks the client feels, and therapists who are able to minimize this gap and flexibly respond will find that their clients stay in therapy longer and get well more quickly.
The Time is Now
Advances in technology have led to the development of a number of different methods for administering, scoring and integrating clients’ responses to both symptoms and outcomes measures into the EHR, to minimize the burden on providers and administrative staff. Patients are increasingly interested in using technology tools to manage their health care, and the use of such devices and programs to monitor treatment progress is an excellent application of such technology.
Many clinicians have been proactive and excited about implementing empirically-supported treatments and have been outspoken advocates for the use of proven therapies.
Why are we so resistant to outcome monitoring and Measurement-Based Care? While behavior change is never easy, as healthcare providers, we are obligated to do it when we know there are effective, proven strategies we can implement to improve our care delivery. This process includes doing progress monitoring and adjusting treatment plans and interventions based on our clients’ feedback.
Mental health providers are also health care consumers, and I challenge them to imagine seeing a physician who does not routinely make objective measurements such as blood tests and weights while crafting and managing a treatment plan. Why should mental health be any different when it comes to tracking progress?
Moberg,, C. (2017). Our Ethical Obligation to Practice Outcome Monitoring. Psych Central. Retrieved on February 18, 2018, from https://pro.psychcentral.com/our-ethical-obligation-to-practice-outcome-monitoring/