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Quality Counts: Behavioral Health Care Services with Youth Should be guided by Outcome Metrics

Robert D Friedberg*, Erica Rozbruch M

Center for the Study and Treatment of Anxious Youth at Palo Alto University

Corresponding Author:
Robert D Friedberg
Center for the Study and Treatment of Anxious Youth at Palo Alto University, USA
Tel: 650-961-9300 x3617
E- mail: [email protected]

Received Date: February 01, 2016; Accepted Date: February 03, 2016; Published Date: February 05, 2016

Citation: Robert D Friedberg, Erica Rozbruch M. Quality Counts: Behavioral Health Care Services with Youth Should be guided by Outcome Metrics. Clin Psychiatry. 2016, 2:1. doi: 10.21767/2471-9854.100015

Copyright: © 2016 Robert D Friedberg This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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The Affordable and Accountable Care Act (ACA) challenges psychiatrists, psychologists, and other behavioral health care providers in the United States to “step up their game.” The behavioral health care ecosystem is changing from an environment that in the past emphasized volume of care to now one that is driven by value-added benefits. Clinical accountability will be prized and behavioral health care providers are well-advised to develop ways to transparently demonstrate good clinical outcomes.

The pivotal task for those who provide and manage psychiatric services is not whether to monitor outcomes but how to account for quality services. Measurement-based practice transcends mere pre-post testing of treatment effects. Rather, measurement based clinical work requires regular repeated monitoring over time with real-time feedback delivered to providers and patients [1]. The advantages of meaningful outcome measurement are well- recognized. Clinicians who closely monitor their patients’ treatment outcome on a session-to-session basis receive immediate feedback about treatment gains, losses and ties. In this way, clinical decision making is driven by individualized data collection and analysis [2]. Providers and patients alike are able to see what are linked to spirited progress, stalled improvement, and deteriorating functioning. Sharing progress data with patients and families facilitates greater treatment engagement and insures informed consent throughout the course of treatment. Fortunately, there are a number of nomothetic and idiographic measurement options for tracking clinical outcomes. While some well-known progress tracking instruments are relatively costly such as the Children’s Depression Inventory, Beck Depression Inventory, and Conner’s Rating Scales, other nomothetic tools are inexpensive. Most recently, Beidas [3] listed various free and reliable nomothetic measures for treatment monitoring. Instruments should be brief, psychometrically solid, responsive to change, and linked to patients’ goals for care.

Clinical dashboards are data management tools that guide provider decision making. Robust clinical dashboards include information on treatment progress as well therapeutic processes. Contextualized Feedback Intervention and Training provides state of the art tools for clinical measurement [4].

CFIT is rooted in several theories of change and contains multiple assessment measures which assess both treatment progress as well as treatment processes.

The Managing and Adapting Practice platform (MAP) [5] enables clinicians to build customized evidence-based treatment packages for individual patients. MAP incorporates the well-studied and highly regarded Modular Approach to Therapy with Children with Anxiety, Depression, Trauma, and Conduct problems (MATCH) [6].MAP incorporates selfcontained progress metrics and is flexible enough to allow clinicians to add their own instruments to the measurement mix.

Functional improvements are the most powerful and compelling indicators of change. Quality of life indices are quite useful in this regard. However, providers might measure more personalized functional markers such as number of days missed at school, decreased suspensions, and reductions in medication dosages.

Regardless of the measurement procedures and processes used, the time has come for greater accountability and measurement-based clinical practice. Frankly, the demand for greater quality is overdue! Meaningful measurement of clinical effectiveness propels our profession forward. First and most importantly, patient care is improved. Second, outcome metrics demonstrating effective care documents behavioral health services’ value-added benefits to individual patients and the general public. Finally, measurement based care is most likely to yield greater reimbursements for psychiatric services. Quality counts; so let’s embrace measurement based psychiatric practice [7-9].


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