It is time for a measurement-based care professional practice guideline in psychology

Psychological services are broadly effective, on average. However, no one treats the average patient. Patients’ psychotherapy response rates vary among clinicians as well as among an individual clinician’s patients, even when the clinician uses research-supported interventions. In addition, clinicians struggle to predict at the start of or during treatment which patients are likely to benefit from the intervention being offered versus which patients may be at risk for a negative response. How can clinicians provide more personalized and responsive care to their patients? The authors of a recent article in Psychotherapyopens in new window argue that one critical step in achieving this goal is the adoption and implementation of measurement-based care (MBC).

MBC is the evidence-based practice of systematic and routine assessment using patient-generated data throughout the course of care to monitor and tailor behavioral health treatment. MBC is an option for a wide range of clinicians because it is not tied to a particular theoretical orientation or presenting problem. This clinical process consists of three essential elements: (a) routinely collecting patient-generated data throughout the course of treatment, (b) sharing timely feedback with the patient about these data and observed or predicted trends over time to engage patients in their treatment, and (c) acting on these data in the context of the clinician’s clinical judgment and the patient’s experiences (i.e., shared decision making).

The positive effect of MBC adoption has been supported in approximately 12 rigorous evidence reviews. Relative to treatments that do not involve MBC, the use of MBC is associated with significantly greater symptom reduction and reduced treatment dropout rates. In addition, survey and interview study results convincingly demonstrate that patients hold favorable views of MBC.

Despite these positive findings, barriers to MBC adoption persist and a formalized professional practice guideline (PPG) for MBC does not exist in psychology. PPGs are intended to promote a high level of professional practice and serve as an educational resource, providing pragmatic guidance in a particular clinical area for psychologists. Generally, PPGs play a critical role in promoting quality care by increasing standardization and consistency, improving clinical decision making and efficiency, and recommending best practices that are based on systematic reviews of existing research. The authors make the case for the development of a new MBC PPG based on expected effects such as public benefit, improved service delivery, and compliance with ethical principles.

The authors lay the conceptual and empirical groundwork for MBC in the article, building to an early draft of a PPG. The primary PPG statement is that “psychologists aim to routinely assess treatment process and outcomes and integrate that information in ongoing collaboration with their patients” (Boswell et al., 2023, p. 9). In addition, suggestions for best practice applications of MBC based on existing evidence are provided.

This article represents an initial step toward the formal development and dissemination of an MBC PPG. The American Psychological Association Board of Professional Affairs is presently convening a formal working group on this topic. Future work is needed to further develop and refine the MBC PPG, as well as to identify the critical components of MBC and the contexts in which MBC would be most beneficial for diverse patient populations.

This article is in the Clinical Psychology topic area. View more articles in the Clinical Psychology topic area.

Boswell, J. F., Hepner, K. A., Lysell, K., Rothrock, N. E., Bott, N., Childs, A. W., Douglas, S., Owings-Fonner, N., Wright, C. V., Stephens, K. A., Bard, D. E., Aajmain, S., & Bobbitt, B. L. (2023). The need for a measurement-based care professional practice guideline. Psychotherapy, 60(1), 1–16. https://doi.org/10.1037/pst0000439opens in new window

James F. Boswell, PhD, is an associate professor of clinical psychology and graduate program director at the University at Albany, State University of New York, and is president of the North American Society for Psychotherapy Research. His research focuses on psychotherapy processes and outcomes, science–practice integration, and measurement-based care.

Kimberly A. Hepner, PhD, is a licensed clinical psychologist and senior behavioral scientist at the RAND Corporation. Hepner previously served on the American Psychological Association Advisory Steering Committee for Development of Clinical Practice Guidelines (2016–2019). Her research focuses on approaches to assess and improve quality of care for mental health and substance use problems.

Kathleen Lysell, PsyD, worked in the Department of Veterans Affairs Office of Mental Health and Suicide Prevention as the director of informatics until retiring in 2018. She currently is in independent practice in Austin, Texas. Her areas of interest include measurement-based care and mental health informatics.

Nan E. Rothrock, PhD, is a professor in the Department of Medical Social Sciences, the Department of Psychiatry and Behavioral Sciences, and the Ken and Ruth Davee Department of Neurology in the Feinberg School of Medicine at Northwestern University. She is a health outcomes researcher with a focus on patient-reported outcomes measurement development and application.

Nick Bott, PsyD, is the global head of bioethics and technology ethics at Takeda Pharmaceuticals. A clinical and research neuropsychologist by training, Bott focuses on the ethical and responsible use of emerging health technologies, the philosophy of health technology, and health care systems delivery design. He currently serves on the National Academy of Neuropsychology Professional Affairs and Information Committee.

Amber W. Childs, PhD, is an assistant professor of psychiatry in the Yale School of Medicine and is codirector of the Division of Quality and Innovation within Yale New Haven Psychiatric Hospital. Her research examines the role of measurement in enhancing patient and family engagement and collaboration in treatment services, with a specific focus on improving outcomes among historically and currently oppressed, underresourced, and otherwise disadvantaged individuals.

Susan Douglas, PhD, is an associate professor of practice in the Department of Leadership, Policy, and Organizations at Vanderbilt University. Her research concentrates on practice improvement and organizational learning in health care, with a particular focus on implementing and sustaining measurement-based care in community mental health settings.

Nicole Owings-Fonner, MA, PMP, is the director of the American Academy of Pediatrics National Center on Social Media and Youth Mental Health. Her work focuses on health communications and evidence-based practices around technology to improve mental health. Previously, she was the director of operations and innovation at the American Psychological Association.

C. Vaile Wright, PhD, is a licensed psychologist and senior director of health care innovation at the American Psychological Association. Her research focuses on developing strategies to leverage technology and data to address issues within health care, including increasing access, measuring care, and optimizing treatment delivery at both individual and system levels.

Kari A. Stephens, PhD, is an associate professor and director of clinical research informatics in family medicine at the University of Washington. Her current research focuses on electronic health record data sharing and integration and dissemination of behavioral treatments into integrated care settings to improve population health, particularly among disadvantaged populations.

David E. Bard, PhD, is a professor of pediatrics and chief research informatics officer at the University of Oklahoma Health Sciences Center. His research areas include quantitative statistical analysis and methodology, pediatric epidemiology, childhood adversity and resiliency, and program evaluation.

Syed Aajmain, BA, is a doctoral student in the clinical psychology program at the University at Albany, State University of New York. His research interests include psychotherapy outcomes, social determinants of health, and measurement-based care.

Bruce L. Bobbitt, PhD, LP, is a licensed psychologist in independent practice in Mendota Heights, Minnesota. He has formerly held executive leadership positions at Optum and is the former chair of the American Psychological Association MBHR/MBC Oversight Committee. His professional interests include quality improvement, measurement-based care, and career mentoring. He is also an APA Fellow of Divisions 29, 31, and 42.