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Implementing a Measurement Feedback System: A Tale of Two Sites
Leonard Bickman1, Susan R Douglas2, Ana Regina Vides De Andrade2
1Vanderbilt University, Nashville, USA. leonard.bickman@vanderbilt.edu.
Administration and Policy in Mental Health
|April 17, 2015
Summary
Contextualized feedback systems improved youth mental health outcomes in one clinic, but not the other. Implementation fidelity, not feedback frequency, appeared to drive the positive results in the successful clinic.
Area of Science:
- Child and Adolescent Psychiatry
- Health Services Research
- Mental Health Interventions
Background:
- Measurement feedback systems can support clinical decision-making.
- The effectiveness of contextualized feedback systems in youth mental health requires further investigation.
Purpose of the Study:
- To evaluate the impact of a contextualized feedback system on mental health symptom severity and functioning in youth aged 11-18.
- To compare the outcomes of feedback delivered at fixed intervals versus event-triggered feedback.
Main Methods:
- A randomized experiment was conducted in two outpatient clinics with 257 youth.
- Participants received feedback on mental health symptoms and functioning either every 6 months or event-triggered.
- Intent-to-treat (ITT) analysis was used to compare outcomes between feedback schedules and clinics.
Main Results:
- Only one clinic (Clinic R) showed enhanced outcomes, specifically in clinician ratings of youth symptom severity (SFSS).
- A dose-response effect was observed in Clinic R for both client and clinician ratings.
- Clinic R demonstrated significantly higher implementation fidelity, including clinician questionnaire completion and feedback viewing rates, compared to Clinic U.
Conclusions:
- Implementation fidelity is a critical factor influencing the effectiveness of measurement feedback systems in youth mental health care.
- Contextualized feedback systems may enhance outcomes, but successful implementation is essential for realizing benefits.
- Differences in implementation strategies between clinics likely explain the varied outcomes observed in the study.
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