Symposia
Dissemination & Implementation Science
Jill Donelan, Psy.D.
University of Massachusetts
Springfield, Massachusetts
Background: Measurement-based care (MBC), the practice of systematic evaluation of patient symptoms before or during patient encounters to inform behavioral health treatment, is associated with significantly improved clinical outcomes. During the COVID-19 crisis, many behavioral health services quickly transitioned to a telehealth platform raising concerns among clinicians about their ability to effectively engage and monitor patients. Within the context of acute treatment settings for youth where virtual treatment best practices were not well-established, clinicians were concerned about their ability to effectively engage and monitor patients through telemedicine.
Methods: This mixed-methods case study of a Partial Hospitalization Program for children and adolescents reviews 18 months of implementation data covering the timeframe leading up to and following the pandemic emergency and subsequent transition to telehealth care. Over the course of 18 months, an interdisciplinary staff of approximately 20 behavioral health professionals provided partial hospitalization level of care to 633 (39% in-person, 61% telehealth) youth from ages 5 to 18 years old. Analysis of quantitative implementation data from this timeframe is overlaid with descriptive reconstruction to evaluate the success of MBC implementation, the utilization of MBC as a tool to support telehealth service provision, and the impact of MBC practices on the provision of telehealth in this setting.
Results: Implementation data and qualitative observation from this case study support the feasibility of MBC in acute care settings for youth, whether in person or via telehealth. In this case example, leadership support was quickly tapered from supervisor directed, high-touch supervision to team-driven, peer-supported utilization of MBC. An iterative implementation approach based on layered feedback loops (at family, clinician, program, and organizational levels) supported successful and sustained implementation of MBC throughout the transition to telehealth. Feedback loops also led to refinement of the virtual treatment model for this population. Lessons learned from this case study point to strategies that can be applied to various other treatment settings.