Monitoring Treatment Progress - Are Providers Actually Doing It?
Kristina Dale | September 20, 2019 | Care Providers
In this post we will be summarizing and discussing the peer-reviewed article, Monitoring Treatment Progress and Providing Feedback is Viewed Favorably but Rarely Used in Practice, by Jensen-Doss, Becker Haimes, Smith, Lyon, Lewis, Stanick, and Hawley. This article was published in the Administration and Policy in Mental Health Journal in 2018.
What did they do?
The authors of this study collected data from 504 mental health clinicians regarding their general attitudes toward and use of monitoring and feedback in their practice.
Why did they do it?
The authors highlight monitoring client progress during therapy as an “integral component of evidence-based practice.” We couldn’t agree more - and the data supporting this comment is widespread.
As mentioned by the authors, collecting session-by-session progress data utilizing standardized rating scales gives clinicians information that can be used to vastly improve client outcomes. But, the question remains - amidst the evidence that monitoring progress is critical, are providers actually taking part in this process?
How did they do it?
This study used a national sample of 504 practicing clinicians within the United States. There were three primary goals for this study:
- Develop new, psychometrically sound, attitude measurement tools.
- Gather data regarding the real-life use of monitoring and feedback in clinical practices.
- Identify and examine professional characteristics that are predictive of more positive attitudes toward monitoring and feedback, as well as characteristics that are predictive of increased use of standardized measures.
What did they find?
The first goal of this study was to develop measures of attitudes. The measures that were developed (MFA and ASA-MF) were found to have adequate factor structure and internal consistency. Overall, the measures appear to be promising tools for the use of measuring attitudes on monitoring and feedback in future studies.
Data obtained from the MFA suggested that generally, clinicians have positive opinions regarding the use of monitoring client progress. Specifically, clinicians agreed that the practice is beneficial and does not have harmful effects on any aspect of psychotherapy. Results from the ASA-MF revealed more neutral attitudes toward the use of standardized assessment.
This leads us to discuss the second goal of the study, which was to assess the rates of use of standardized measures in practice. Of the 504 clinicians included in the sample, less than 14% reported the use of any standardized tracking or monitoring of patient progress. However, 25% of participants reported the desire to gather more frequent progress data, with 6.8% of clinicians reporting that they would prefer to administer progress reports every 1-2 sessions. 45% said that they would prefer to gather no progress data.
Lastly, while there were strong links identified between attitudes and real-life use, there were differences found in characteristics of providers with similar attitudes. Providers with CBT orientations were less likely to view monitoring and feedback as harmful, and more likely to find standardized progress measures clinically useful and practical. Clinicians with a psychodynamic orientation were also more highly associated with more negative attitudes on two of the ASA-MF scales. Providers with more years of professional experience were less likely to engage in progress monitoring. The study found that the most consistent predictors of attitudes and use of standardized measures were related to work setting.
What does it all mean (our take)?
What an interesting study. We understand that the sample size is relatively small, particularly when thinking about how the results generalize to the larger population; however, other studies have reported similar rates of outcome measurement by providers.
Quite frankly, the results are somewhat scary. But, we understand why this is likely occurring. We think that for many providers the decision of whether or not to use ongoing progress measurement comes down to economics - do they have enough time and money to spend on data collection, scoring, plotting, etc. The typical answer here is no...and thus we see less than 14% of folks doing an adequate job.
So what do we do about it? The solution here seems to be the development of a system that helps providers track patient progress and engage in measurement-based care without adding demands to their workload. That’s what we here at Mindyra specialize in, which is why this article hits so close to home. Many providers want to track progress regularly...they just need an efficient and validated way to do it.