Measurement-Based Care – Standardized Tools and Instruments

What are the key elements when utilizing a standardized tool to monitor progress towards treatment goals?

Any examples are for illustrative purposes only.

Guidelines for selecting a standardized tool to monitor progress towards treatment goals          
Based on its setting, scope, and services, the organization selects measures that are meaningful to the organization and that address the needs of the individuals served. The Joint Commission standard CTS.03.01.09 requires that outcomes of care, treatment, or services be monitored over the course of service using a standardized instrument – a practice generally known as measurement-based care.

Most measurement-based care instruments monitor progress from the individual’s perspective, however, depending upon the population served outcomes may be assessed from alternate perspectives (e.g., parent/guardian, clinician). The tool or instrument may be focused on a population or diagnostic category (such as depression or anxiety), or the tool or instrument may have a more global focus such as general distress, functional status, quality of life (especially in regard to intellectual/developmental disabilities and other physical and/or sensory disabilities), well-being, or permanency (especially in regard to foster care). Multiple tools or instruments can be selected that are relevant to different populations served, settings and services to ensure that a tool is utilized to measure progress on every individual served.

Criteria for a tool to be considered a standardized instrument
The choice of an instrument(s) belongs to the accredited organization; however, any instrument used must meet the criteria listed below for routine outcome measures: 
  • Well-established psychometric properties (i.e., reliability and validity) 
  • Documented sensitivity to change (i.e., the ability to detect true/meaningful changes over time) 
  • Use as a repeated measure (i.e., can reliably detect change from administration to administration) 
  • Has established norms (i.e., the instrument can distinguish between populations that need or do not need services) 
Frequency of administration and guidelines for aggregating data 
In order to use a standardized measure to monitor progress, and to use the data to potentially make changes to the treatment process, the organization is expected to 
  • administer a standardized instrument at multiple intervals throughout the care process
  • use feedback derived through these standardized instruments to inform goals and objectives, monitor individual progress, and inform decisions related to individual plans for care, treatment, or services  
  • aggregate data from the tools for organizational performance improvement efforts and evaluate outcomes of care, treatment, or services provided to the population(s) served
The goal of the standard is to use the data being collected to explore opportunities to provide higher quality care, treatment, or services.  In the aggregate, the data from these instruments can be used to identify specific programs, service areas, units, or practitioners that could benefit from additional resources or education (or to identify exceptional performers who can mentor others or take on the most difficult cases). Organizations may also choose to use aggregate data to demonstrate the value that the organization is providing to the individuals and populations it serves by making continuous improvement in efficacy of treatment interventions.

Resources:
The Joint Commission: Behavioral Healthcare Instruments Listing
Webinars on Measurement-Based Care Updates 
Screening and Assessment Tools of Substance Use Disorders by SAMHSA:  
The Kennedy Forum:   A Core Set of Outcome Measures for Behavioral Health Across Service Settings
Last updated on June 30, 2020
Manual: Behavioral Health
Chapter: Care Treatment and Services CTS

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