(PS9-20) Enhancing Measurement-based Care Implementation in Low-resource Communities: Insights from Community Stakeholders

Measurement Based Care (MBC) is the systematic use of patient-reported data to inform care decisions and monitor treatment progress. MBC has been associated with a faster reduction in mental health symptoms, lower likelihood of clinical deterioration, and lower costs of care. Despite the known efficacy of MBC, multiple barriers exist to effective implementation which can vary significantly based on clinical setting, contextual factors, and patient population. Thus, strategies to address barriers must be tailored to each unique setting and service line. The implementation of MBC in low resource, community-based clinical settings, in particular, has been understudied. The purpose of the present study was to identify barriers to the use of a web-based, HIPAA compliant, MBC platform that delivers MBC, as well as implementation strategies to address these barriers, within a state-funded, low resource, community mental health setting that serves a highly diverse patient population. Significant community stakeholder input was gathered to inform this work.

The study sample (n = 57) included 30 clinicians, 20 supervisors, and 7 administrators who work at a state funded, low-resource, community mental health center. Most identified as White (58%), non-Latino/a/x (86%), and female (88%). Participants worked across following service lines: adult behavioral health (outpatient, SUD recovery programs) (n=32), youth behavioral health (outpatient, school, court-involved, home-based programs) (n=15), supportive living services (for SMI, ID/DD) (n=4), psychiatry services (n=3), and case management (n=3).

Participants completed qualitative interviews and focus groups via zoom. Prompts were developed using the Consolidated Framework of Implementation Research and the Health Equity Implementation Framework. Rapid qualitative analyses were conducted, guided by modified grounded theory. Research staff double-coded transcripts to identify themes in MBC implementation barriers and map these onto implementation strategies.           

Initial themes were identified across three levels of determinants: organization-level (e.g., access to technology), client-level (e.g., motivation), and clinician-level (e.g., perception of burden). Implementation mapping produced an array of 26 customizable strategies to aid with implementation at these levels. For example, at the organization-level, clinic staff can provide tablets to patients to complete measures on in the waiting room; at the client-level, psychoeducation can be used to enhance client motivation to complete measures; and at the clinician-level, technical features of the web-based MBC platform can automate logistical tasks.

This study showcases a systematic method of mapping implementation strategies using community stakeholder input. Findings suggest a need to tailor strategies to address organization, client, and clinician-level needs across each service line. Some types of services are associated with particularly unique needs, such as supportive living services and court-involved care, given the patient and setting complexities. Our results may aid future work focused on implementing MBC in low-resource, community settings.