As the substance abuse treatment field embraces evidence-based practices, one of the techniques gaining strong support is to systematically provide counselors with information about how their clients are feeling that can be used to inform clinical care. Variously referred to as progress monitoring, measurement-based care, outcome monitoring, and feedback systems, this article summarizes the research which shows how this technique improves outcomes.
The vast majority of studies measuring the impact of progress monitoring have focused on treating patients with mental health issues. Carlier et al. did a meta-analysis of 52 randomized control trials studying the impact of progress monitoring that were published between 1975 and 2009. Of the 45 trials that focused on mental health, 65% found that progress monitoring had a significant, positive impact on patient outcomes. The impact of progress monitoring was even higher for the studies that narrowed their focus to specific mental disorders. 76% of the 21 studies using progress monitoring for specific disorders such as depression or anxiety found better outcomes among patients whose therapists were monitoring their progress. And while Carlier found only 3 studies that used progress monitoring in addiction treatment, it is important to note that all three of them reported positive effects from the monitoring.
A separate study by Brodey et al. further confirms the usefulness of tracking the severity of depression and anxiety symptoms. Patients of clinicians who received a report of patient-reported symptom severity from the start of treatment showed 28% greater improvement at 6 weeks than those whose clinicians did not receive feedback.
Progress monitoring appears to make the biggest difference for patients who are not responding as expected to treatment. Research by Michael J. Lambert showed that psychotherapists have a strong tendency to overestimate client improvement and often fail to recognize patients who plateau or worsen during treatment. Confronted with graphical evidence that their patient is not making the expected progress, therapists are more likely to modify treatment to make it more effective. In a separate meta-analysis of three large-scale studies, Lambert et al. found that among the patients who initially responded poorly to treatment, those whose therapists were using Progress Monitoring had better outcomes.
This was confirmed in the only rigorous study to date of the effect of progress monitoring on patients in community-based substance abuse treatment programs. Crits-Christoph et al. found that among patients who weren’t progressing as expected during treatment, those whose counselors were receiving progress monitoring data had significantly better outcomes than those whose counselors did not. Even though patients whose progress went “off-track” had somewhat higher levels of alcohol use before treatment, the alcohol use of those using progress monitoring declined substantially over time. In fact, by the end of 12 treatment sessions, this group’s alcohol use was similar to that of patients who progressed as expected throughout treatment. By comparison, the off-track patients who were not receiving Progress Monitoring showed very little improvement over 12 treatment sessions.
Drs. Goodman, McKay and DePhilippis summarized their research findings in a 2013 journal article titled Progress Monitoring in Mental Health & Addiction Treatment: A Means of Improving Care as follows:
“The research described above demonstrates that progress monitoring can have significant positive effects on treatment outcomes. In particular, studies found better drug outcomes, faster rate of improvement, and greater likelihood of experiencing reliable change, indicating symptom improvement or remission. More rapid improvement could translate into greater cost effectiveness of treatment. Studies found that improvement using progress monitoring was especially notable for those at risk for negative outcomes.”
In response to the growing body of research showing its effectiveness, several national organizations such as the Institute of Medicine, the American Psychological Association and the Kennedy Forum have begun encouraging the use of progress monitoring for mental health and substance use disorders. In December 2015, the Kennedy Forum issued the following recommendation in their issue brief A National Call for Measurement-Based Care in the Delivery of Behavioral Health Services:
“All primary care and behavioral health providers treating mental health and substance use disorders should implement a system of measurement-based care whereby validated symptom rating scales are completed by patients and reviewed by clinicians during encounters. Measurement-based care will help providers determine whether the treatment is working and facilitate treatment adjustments, consultations, or referrals for higher intensity services when patients are not improving as expected.”
One challenge for clinicians wanting to implement progress monitoring has been the absence of inexpensive, easy-to-use tools to collect appropriate data from patients and report it back to their counselors in real-time. In response, Vista Research Group has developed the INSIGHT Addiction and INSIGHT Mental Health programs, which collects the following information from patients on a regular basis and summarizes it for their therapists in graphical form:
Centers interested in learning more about the INSIGHT research should click here.