Adolescent Client and Clinician Predictors of Measurement-Based Care Fidelity in Community Mental Health Settings

Regularly administering outcome measures, measurement-based care (MBC), informs clinical decision-making and improves youth mental health. Understanding predictors of high-fidelity MBC delivery helps ensure all youth can benefit from this evidence-based practice. Research on client and clinician predictors of MBC fidelity has mixed findings.

Participants included 53 clinicians and 115 adolescents from a randomized controlled effectiveness trial with MBC only and MBC + Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders in Adolescents (UPA) conditions. Clients and clinicians reported demographic information. Clinicians completed broad- and narrow-band attitude measures. MBC fidelity was operationalized using the implementation index, combining rates of administering and viewing questionnaires, using objective MBC data.

The average MBC fidelity was 56.75% (SD = 30.36) and was significantly higher in the MBC only condition (M = 67.46%, SD = 27.63%) than in MBC + UPA condition (M = 46.58%, SD = 29.52%; p = .012). Clients identifying as White received significantly higher MBC fidelity than youth not identifying as White. Youth ethnicity, family income, age, severity, and number of sessions did not significantly predict MBC fidelity. Clinicians with less experience at their agency, less confidence, and who found manualized treatments less appealing, had significantly higher MBC fidelity than other clinicians. These results can inform future efforts to increase fidelity and equity in MBC delivery.