Consultation Content and Techniques for measurement-Based Care Implementation in Youth Community Mental Health Settings

Elizabeth Casline*, Grace S. Woodard, Elizabeth Lane, Scott Pollowitz, Susan Douglas, Jill Ehrenreich-May, Golda S. Ginsburg, Amanda Jensen-Doss

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Measurement-based care (MBC) is an evidence-based practice (EBP) focused on regularly administering outcome measures to clients to inform clinical decision making. While MBC shows promise for improving youth treatment outcomes, therapist adoption remains low. Clinical consultation is one strategy that improves MBC implementation, but our limited understanding of consultation hinders the ability to optimize its impact. This research explored the content of, and techniques used during MBC consultation calls. Therapists (N = 55) in a randomized controlled trial treating adolescents with anxiety and/or depression were trained to utilize MBC with usual treatment using the Youth Outcome Questionnaire (YOQ) through an online measurement feedback system (MFS). Weekly ongoing consultation followed an initial workshop training in MBC. Case discussions (N = 294) during consultation calls were coded using a developed codebook, including 12 content and 10 consultant techniques. Results indicated that content focused predominantly on interpretation of client symptom and alliance report, planning for YOQ administration, and discussion of data with clients in session. Common consultant techniques included modeling and eliciting report viewing and interpretation, making clinical suggestions, and didactics about clinical and technical issues. Notably, role-play/behavioral rehearsal was not used. The prevalence of passive consultation techniques (suggestions, didactics) suggests a focus on teaching rather than active techniques (behavioral rehearsal, modeling), potentially influenced by the novelty of MBC and MFS. Technical aspects of MBC, such as measure administration and system usage, emerged as key consultation content, highlighting an unanticipated emphasis on logistics over clinical implementation. These findings underscore the evolving role of consultation in supporting MBC implementation and suggest that addressing technical challenges early in training might enhance adoption.

Funding

This research was supported by the National Institute of Mental Health (NIMH) of the National Institutes of Health (NIH) under Award Grant Nos. R01MH106536 & R01 MH106657. Vanderbilt University and Susan Douglas, Ph.D. receive compensation related to the Peabody Treatment Progress Battery; and Susan Douglas has a financial relationship with MIRAH, and both are Measurement -Based Care (MBC) tools. The author declares a potential conflict of interest. There is a management plan in place at Vanderbilt University to monitor that this potential conflict does not jeopardize the objectivity of Dr. Douglas\u2019 research. Jill Ehrenreich-May, Ph.D. receives a royalty from the sales of the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents from Oxford University Press. She also has grant funding related to this intervention from the National Institute of Health, Patient Centered Outcomes Research Institute, Institute of Education Sciences, the Children\u2019s Trust, and the Batchelor Foundation. She is also paid for clinical training and implementation support services related to this intervention by a variety of institutions. Golda Ginsburg, Ph.D. serves as a consultant for the National Association of School Nurses. No other potential conflicts of interest were reported by the authors.

Keywords

  • Anxiety
  • Community Mental Health
  • Consultation
  • Depression
  • Evidence-based Practice
  • Implementation Science
  • Measurement-based care
  • Youth

ASJC Scopus subject areas

  • Phychiatric Mental Health
  • Health Policy
  • Public Health, Environmental and Occupational Health
  • Psychiatry and Mental health

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