Outcome Measures and Their Role in Mental Healthcare

If you want to know how far you’ve gotten, you need to know where you started. And to make sure that you stay on the right path, it’s important to track your progress over time.   

This is the case with nearly any transformational effort that you undertake including changing your diet to improve your health, engaging in sleep hygiene to reduce your insomnia, practicing mindfulness to lower your stress, or seeking mental health support to cope with anxiety.

Mental health outcome measures are brief, standardized questionnaires, checklists, and worksheets that monitor client progress, facilitate communication between clinician and client, and improve the quality of mental health care. 

Outcome Measures in Mental Healthcare

Tracking client progress with outcome measures is a well-established precept of high-quality mental healthcare. 

Outcome measures serve multiple purposes including improving the provision of behavioral health services, evaluating clinical effectiveness, supporting better health outcomes, and providing comparisons to specific benchmarks.

Demonstrating the impact of your services also offers an advantage in procuring competitive funding and accessing reimbursement via new and existing CPT codes (96127, 96136, 96138, etc.)

What’s more, mental health outcome measures are amenable to a variety of mental health settings from large hospitals and schools to mental health nonprofits and private practices.

What Are Outcome Measures?

Mental disorders and behavioral health issues present in a variety of ways and can impact a client’s life in several different domains. For example, a person who is depressed may have strained relationships, difficulty getting up in the morning or completing their work, insomnia, and general feelings of sadness.  

Mental health outcome measures are tools that evaluate changes in mental health by capturing metrics across multiple areas of client functioning, symptoms, and treatment experiences at baseline as well as at one or more points after treatment has begun. 

They can be administered weekly, bi-weekly, or monthly. And in order to be effective, the measures must

• accurately and consistently capture a particular outcome
• be sensitive to change, and
• be comparable across specific populations (e.g.,  adolescents), types of treatment (e.g., cognitive behavioral therapy), and treatment settings (e.g., an intensive outpatient program)

Types of Outcome Measures

There are hundreds of outcome measures that can capture clinician, client, and/or third-party perspectives. They may focus on wellbeing, recovery, cognition, emotions, relationships, life satisfaction, or general functioning.

More specifically, the measures can monitor

• clinical outcomes related to changes in symptoms for specific diagnoses like the Patient Health Questionnaire 9 (PHQ-9) for depression, the Generalized Anxiety Disorder 7 (GAD-7) for anxiety, or the Posttraumatic Stress Disorder Checklist (PCL-5) for PTSD
• global mental health status that is not tied to a specific diagnosis using scales like the Pediatric Symptom Checklist, the Health of the Nation Outcome Scales (HoNOS), the Daily Living Activities Scale (DLA), or the Outcome Questionnaire-45 (OQ-45), and
• treatment specific measures like the Cognitive Fusion Questionnaire (CFQ) for Acceptance and Commitment Therapy (ACT) and the Difficulties In Emotion Regulation Scale (DERS) for treatment of emotion dysregulation 

Patient-Reported Outcome Measures

Patient-reported outcome measures (PROMs) are a subset of mental health outcome measures that capture information from the client’s perspective. Like all outcome measures, they are standardized, validated, and usually take only a few minutes to complete. 

The main function of PROMs is to promote person-centered care by better understanding what matters to patients and tracking their

• perspectives on the care that they’re receiving
• perceptions of their progress towards reaching treatment goals, and
• experience of specific symptoms related to their diagnosis or behavioral health issues  

Patient-reported outcome measures have been shown to facilitate communication and promote client proactivity, in part by offering space to gather client input. They also detect important reference points, allow for the celebration of small victories, elucidate contributors to symptom improvement, and identify barriers to further progress.   

How to Select the Right Outcome Measures

If you’re overwhelmed by the profusion of mental health outcome measures, the Kennedy Forum created five short lists of core measures that are validated and related to specific populations, diagnoses, and general issues. When making your selection, be sure that you are focusing on outcome measures that are feasible to capture and illustrative of your aim.

Investing the upfront time to delineate your goals and select your outcome measures strategically will pay off by ensuring that your practice focuses on measures that are scientifically validated and meaningful to you and your clients.

Outcome Measures Play a Role in Measurement-Based Care

The systematic implementation of outcome measures is called measurement-based care (MBC), which is essential to high-quality healthcare. 

More than just capturing information to check a box, MBC involves the regular administration of outcome measures that are then used to optimize diagnostic accuracy, detect treatment nonresponse early, strengthen the therapeutic alliance, adjust care as necessary, and improve treatment outcomes. 

To simplify the implementation of measurement-based care, the US Department of Veteran’s Affairs came up with the process of collect, share, act. After using outcome measures to systematically and routinely collect data, the clinician then shares that information with the client and other providers on the care team. Together, the clinician and client dyad act by being responsive to the results. This might mean a change in medication dosage, more frequent meetings, genetic testing, an adjustment in the therapeutic model, or rethinking a diagnosis. 

At the practice level, an organization can collect and aggregate data, share the information back with the team, and act by collaboratively developing improvement initiatives that support organizational goals. 

At Blueprint, we’ve added an additional component between share and act, examine, which reminds clinicians and practices to pay attention to trends, appreciate what’s going well, uncover pain points, and consider improvements as needed. 

How Outcome Measures Can Improve Mental Healthcare

Outcome measures have been shown to improve diagnostic accuracy, create stronger communication between client and clinician, enhance treatment monitoring, and help clients maintain positive effects of treatment for longer periods.

As an example, a therapist from Columbus, Ohio who implemented measurement-based care using an anxiety scale (among other outcome measures) stated, 

One of my clients scored off the charts on the anxiety assessment. I’ve been working with him for a while and didn’t think anxiety was an issue so thought the test was wrong, but I brought it up with him anyway. Turns out it was correct and that totally changed our approach in terms of what we chose to focus on in therapy.

For clients who are either stagnating or deteriorating during treatment, the feedback derived from outcome measures can support adjustments in treatment early enough to promote better outcomes.

Benefits of Incorporating Outcome Measures Into Your Practice

As a busy mental health practitioner, it’s hard to imagine adding anything else to your plate, especially when it’s already overflowing. But what if the thing you are adding actually clears away some of the mess and ultimately creates more space in your schedule? 

The benefit of using outcome measures in mental healthcare is straightforward and intuitive. If you monitor patient symptoms, wellbeing, and care experience, you’ll make the most accurate diagnoses from the outset and provide the highest quality of care to yield the best health outcomes.

These findings are robust and consistent across client age groups and demographics, clinician types (e.g. psychiatrist, psychologist, LCSW, LMFT), and treatment settings.

High-Quality Care Includes Outcome Measures

With technology, mental health practices of any size can feasibly select, gather and analyze outcome measures while reducing the logistical challenges of integrating them into clinical workflows.

By selecting the right mental health outcome measures and engaging in measurement-based care, your practice will be better able to secure funding, evaluate your services, adjust your treatment appropriately, promote professional growth, engage clients, provide person-centered care, and improve mental health outcomes. And there’s really no significant downside.