Entrando na Medição: Implementando Cuidados de Saúde Mental Baseados em Medição

In most areas of medicine, consistently measuring and reviewing symptoms and functioning is routine. It would be unusual, for example, to visit a primary care physician and not hear your blood pressure reading. Yet, the mental health care field has been slower to apply the regular use of measurement in treatment. In late 2022, SAMHSA released a brief report outlining the landscape of measurement-based care in mental health settings and emphasized its potential benefits for treatment quality and outcomes.

Identifying a Flexible Approach to Measurement

Last year, with funding support from the NARBHA Institute, IHI released an Innovation Report about adoption and implementation of measurement-informed care in mental health. The report differentiates between measurement-based care, “an evidence-based practice that involves systematic and routine assessment of the patient’s symptoms throughout the course of mental health treatment,” and measurement-informed care, a more flexible approach to tracking symptomology and treatment progress through measurement rather than protocols. The report identifies five key drivers to implementing measurement-informed care:

1. Make measurement-based care the standard of care at the organization.
2. Select measures that matter to clinicians and patients.
3. Implement technology and workflows that make MBC as easy as possible.
4. Work with payers to determine appropriate financial models and incentives.
5. Establish leadership behaviors that facilitate implementation.

Accelerating Improvement

In 2024, leadership champions within the IHI Leadership Alliance answered the call to spread the adoption of measurement-informed care by forming a Mental Health Accelerator. Leadership Alliance Accelerators are designed to bring together select organizations to collaborate with IHI and one another, advancing health care improvement by incubating emerging theories of change or developing testable innovation models. The Mental Health Accelerator started in June 2024 and aimed to support Leadership Alliance organizations with advancing implementation of measurement-informed care in one department or service area over a period of six months.

The Mental Health Accelerator included five diverse health care organizations from across the US. Leaders met monthly, accompanied by two IHI faculty advisors, to design and launch improvement projects focused on spreading the use of measurement in mental health treatment. Projects ranged from surveying mental health clinicians about barriers to measurement-informed care, to enhancing technological workflows to better enable use of data from an inpatient violence risk assessment for psychiatric patients, to using patient-reported outcome measures at a point of care transition, to changing the administration of the PHQ-9 in primary care.

Learning in Action

While the organizations focused on different measures and different service areas, several cross-cutting themes emerged in the Mental Health Accelerator.

• First and foremost, clinicians need to buy into the benefits of measurement-informed care. Trainings or supervisory conversations with clinicians can help to elucidate perceptions of measurement-informed care and barriers to implementation.
• Secondly, once clinicians see the value of measurement-informed care, they need support to actively use the data to inform treatment plans. This means making data easily accessible in the electronic health record, for clinicians and patients, and teaching clinicians how to use the data to guide case formulation.
• Finally, organizations need a clear plan for how to communicate about the implementation of measurement-informed care, both internally with staff and clinicians, and externally with patients.

Pamela Mattel, LCSW, CEO of Coordinated Behavioral Care, one of the five organizations, reflected on the experience: “While our key takeaways seem common sense, it is profound to experience mutual learning amongst clients, staff and supervisors. Our commitment to co-design shifted the process from a staff-imposed task to an engaging and supportive activity with clients.” The work strengthened interactions with both staff and patients (clients). Mattel explains, “Using data to track outcomes and guide improvements accelerated data-informed decision-making with and for clients. We modeled [the approach that] ‘all communication is valuable feedback,’ which helped everyone be curious rather than feeling judged. This approach brought to light greater perspective on person-centered care!”

Through the advising of IHI faculty Alexia Jaouich, PhD, and Ben Miller, PsyD, the Accelerator introduced Expert Recommendations for Implementing Change (ERIC) strategies to assist with spreading measurement-informed care. This collection of over 80 strategies helps inform implementation across different contexts. Leaders learned how to select a particular ERIC strategy to address their implementation challenges, such as identifying early adopters of measurement-informed care to help with clinician buy-in or distributing educational materials to patients to illustrate what to expect from measures and data.

Jaouich says, “The implementation drivers identified by IHI's Innovation Report were key to understanding how to advance the implementation of measurement-informed care. The group discussion became, ‘What are the strategies or tactics that can enable or activate these drivers?’” Next, she says, the teams focused on the ERIC strategies: “The organizations involved in the Accelerator used many of the strategies listed and reviewed and discussed amongst the group, which stimulated new ideas for testing.”

Spreading Results

The Accelerator wrapped up in December 2024, igniting participating leaders to champion and spread measurement-informed mental health care. They called for health care delivery organizations to take action by integrating training on measurement-informed care into mental health graduate internship and practicum programs and in-services. Such education would help communicate to clinicians the value of measurement-informed care and how to use it within treatment. Based upon the Accelerator learnings, these are the next steps necessary to bring more rigorous measurement and evaluation to mental health care.

Natalie Martinez, MPH is an IHI Project Manager. Nikki Tennermann, LICSW, MBA is an IHI Senior Project Director.

You might also be interested in:

• Advancing Measure-Informed Care in Mental Health
• Publications and resources from the IHI Leadership Alliance
• Tips for Bringing Trauma-Informed Care into Practice