Below is a conference presentation by Dr Ben Buchanan for the 2022 Australian Psychological Society’s College of Clinical Psychologists Conference. We’ve share it so practitioners and mental health services can use it as professional development and to learn the basics of measurement based care.
History shows that over time, health outcomes for many physical ailments have improved dramatically, partially attributable to technological advances in medicine. Precision in measuring physiological characteristics such as heart rate and temperature in the 19th century and blood pathology and MRIs in the 20th century are today mainstays of medical practice. Parallel advances in methods of measurement in psychology have been slower, as has the lack of dramatic improvement in mental health outcomes.
Among the mental health workforce, psychologists are the only group with advanced training in psychometrics, which creates an opportunity to lead a measurement-based care revolution. Measurement-based care refers to two processes: routine assessments, such as measuring the severity of symptoms with rating scales, and the use of assessments in decision-making.
Clinical Psychologist & CEO of NovoPsych
Professional Development Learning Outcomes
At the conclusion of this event, attendees will be able to:
· appreciate the advances in assessment practices in psychology and compare them with assessment paradigms in the history of medicine
· understand the theoretical and empirical basis for measurement-based care
· apply measurement-based care principles and techniques to standard clinical practice
· evaluate the technological and scientific advances in psychometric assessment, and how these might impact possible futures for psychology practice
· analyse how psychologists could use measurement-based care to propel the psychology profession forward
This presentation will examine the state of psychometric measurement in psychology practice in the context of history, and especially compared to measurement paradigms in medicine. The presentation explores an emerging paradigm in mental health care known as measurement-based care (MBC). MBC is defined as the practice of informing clinical care with client data collected throughout treatment. MBC includes two processes: routine assessments during the course of treatment, such as measuring the severity of symptoms with rating scales, and the use of assessments in decision-making.
Published literature unequivocally shows that psychological therapy is effective and research shows that augmenting standard therapy with techniques associated with MBC can enhance outcomes even further. The routine assessment component of MBC is already considered a core component of numerous evidence-based practices (e.g. CBT) yet actual implementation lags behind.
The benefits that MBC provides are explored, including providing insights into treatment progress, identifying at risk clients, providing a relatively objective assessment of symptoms, functioning and satisfaction with life. Evidence will be examined showing that no matter what a psychologist’s theoretical perspective or treatment approach, augmenting standard therapy with MBC processes can enhance psychotherapy outcomes.
Finally, this presentation will review the state of measurement in psychology practice and conclude that the field is undergoing a revolution not seen since IQ assessments were developed in 1912. A combination of factors are intersecting to propel MBC forward, including technological and scientific advances in psychometrics and an emphasis on evidence based practice. This presentation examines the risks and benefits of MBC and contests that the field of psychology would benefit from proactively harnessing MBC to ensure it empowers psychologists and the clients we serve.
The measurement-based care framework, also known as routine outcome monitoring or progress monitoring, has a well-established evidence base. Routine outcome monitoring is considered a core component of evidence-based practices such as CBT (Beck & Beck, 2011) and there is emerging empirical support showing it improves outcomes when augmented with other treatment paradigms in psychology (Brattland et al., 2018). In fact, a meta-analysis found that two-thirds of the studies concluded that psychotherapy augmented with routine outcome monitoring was superior to treatment-as-usual offered by the same practitioners (Lambert, Whipple & Kleinstäuber, 2018. Despite this, evidence shows that there are several barriers to implementation (Chung & Buchanan, 2019), with some psychologists questioning the value of standardised assessments. Below is a reference list showing a wide-ranging evidence base including a paper published by the presenter.
Aboraya, A., Nasrallah, H. A., Elswick, D. E., Ahmed, E., Estephan, N., Aboraya, D., Berzingi, S., Chumbers, J., Berzingi, S., Justice, J., Zafar, J., & Dohar, S. (2018). Measurement-based Care in Psychiatry-Past, Present, and Future. Innovations in clinical neuroscience, 15(11-12), 13–26.
Bartels-Velthuis, A. A., Visser, E., Arends, J., Pijnenborg, G. H., Wunderink, L., Jörg, F., … & Bruggeman, R. (2018). Towards a comprehensive routine outcome monitoring program for people with psychotic disorders: the pharmacotherapy monitoring and outcome survey (PHAMOUS). Schizophrenia research, 197, 281-287.
Beck, J. S., & Beck, A. T. (2011). Cognitive behavior therapy: Basics and beyond.
Boswell, J. F., Kraus, D. R., Miller, S. D., & Lambert, M. J. (2015). Implementing routine outcome monitoring in clinical practice: Benefits, challenges, and solutions. Psychotherapy research, 25(1), 6-19.
Brattland, H., Koksvik, J. M., Burkeland, O., Gråwe, R. W., Klöckner, C., Linaker, O. M., … & Iversen, V. C. (2018). The effects of routine outcome monitoring (ROM) on therapy outcomes in the course of an implementation process: A randomized clinical trial. Journal of Counseling Psychology, 65(5), 641.
Chung, J., & Buchanan, B. (2019). A Self-Report Survey: Australian Clinicians’ Attitudes Towards Progress Monitoring Measures. Australian Psychologist, 54(1), 3-12.
Lambert, M. J., Whipple, J. L., & Kleinstäuber, M. (2018). Collecting and delivering progress feedback: A meta-analysis of routine outcome monitoring. Psychotherapy, 55(4), 520.
Pinner, D. H., & Kivlighan III, D. M. (2018). The ethical implications and utility of routine outcome monitoring in determining boundaries of competence in practice. Professional Psychology: Research and Practice, 49(4), 247.
Scott, K., & Lewis, C. C. (2015). Using Measurement-Based Care to Enhance Any Treatment. Cognitive and behavioral practice, 22(1), 49–59. https://doi.org/10.1016/j.cbpra.2014.01.010