Implementation and utilisation of measurement-based care in mental health services

This thesis consists of two chapters. The first chapter presents a systematic review
report evaluating the effectiveness of strategies which have been introduced to various
mental health services in an attempt to increase an important evidence-based practice
amongst therapists, namely Measurement Based Care (MBC). MBC refers to the ongoing
assessment and monitoring of patient symptoms throughout psychological intervention. The findings of the systematic review highlighted variability in how clinician MBC behaviour has been measured across the included studies and differences across the strategies used. Overall, it could not be concluded with confidence which strategies demonstrated the greatest effectiveness due to the above-described variabilities. Nevertheless, a strategy aimed at the organisational and leadership levels demonstrated the most robust evidence for its effectiveness over a long period of time. Future studies should focus on identifying a unified measure of MBC behaviour amongst clinicians and consider the importance of detailed reporting of the strategies used which would allow other researchers or practitioners to replicate them.

The second chapter summarises an empirical research study which explored the
associations between therapist characteristics and therapists' use of MBC, specifically
progress feedback. This element of the MBC practice refers to a feedback report or a graph which therapists are provided with in services where electronic patient records and specific feedback tools are used. The sample in this study consisted of 45 clinicians working in NHS Talking Therapy services across England. In the current study, participants provided subjective reports of their progress feedback use and objective measures were collected from an online patient record system. The main findings provided evidence for therapists’ regulatory focus and feedback propensity in predicting their use of progress feedback. In addition, there was an observed difference between therapists’ self-reported feedback use and the objective measure.