A Measurement Feedback System (MFS) Is Necessary to Improve Mental Health Outcomes

Abstract

This article takes the position that mental health (MH) services for youths are unlikely to improve without a system of measurement that is administered frequently, is concurrent with treatment, and provides feedback. The system, which I characterize as a measurement feedback system (MFS), should include clinical processes (mediators), contexts (moderators), outcomes, and feedback to clinicians and supervisors. In spite of the routine call to collect and use outcome data in realworld treatment, progress has been painstakingly slow. 1Y3 For example, Garland and colleagues 4 found that even when outcome assessments were required, more than 90% of the clinicians surveyed used their own judgment and paid little heed to the data. A more recent national survey of MH service organizations serving children and families indicated that almost 75% reported collecting some standardized outcome data. 5 However, just collecting data on an annual basis will not result in improvement. MEASUREMENT IS NOT ENOUGH Feedback from clients and families naturally occurs in treatment, but it is highly filtered, biased, and subject to distortions caused by the use of cognitive heuristics and schemas. 6 This informal and flawed feedback needs to be supplemented by an MFS that uses valid, reliable, and standardized measures. This system is central to quality improvement, professional development, as well as enhancing accountability. Feedback has been successfully applied outside MH for several decades. 7,8 However the application of a fully implemented MFS is in its infancy in MH. An MFS has been shown to improve outcomes in adult MH, especially for those clients who were either not