Behavioral Health Care Settings Research Articles

Identifying Barriers and Implementation Strategies to Inform TBI Screening Adoption in Behavioral Healthcare Settings.

Identify barriers to the adoption of the Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID) in behavioral healthcare organizations and match these barriers to implementation strategies to inform future implementation efforts. Twenty behavioral health providers. Qualitative study involving individual, semi-structured interviews regarding barriers to adopting the OSU TBI-ID. Data were thematically analyzed around constructs from the Consolidated Framework for Implementation Research (CFIR). Results were matched to strategies using the Expert Recommendations for Implementing Change (CFIR/ERIC) matching tool. Ten barriers were identified across 4 CFIR domains. Inner-Setting barriers were inadequate leadership engagement, priorities, resources, and organizational incentives. Individual-Characteristics barriers were insufficient knowledge about the connection between TBI and behavioral health and how to conduct the OSU TBI-ID with fidelity, low self-efficacy to conduct screening, and inadequate motivation and buy-in to conduct screening. Outer-Setting barriers were lack of state-level mandates and inadequate incentives to conduct screenings. The Process domain barrier was an insufficient engagement of key personnel. Strategy recommendations include: identify and prepare champions; alter incentive and allowance structures; inform local opinion leaders; build a coalition; access new funding; conduct local consensus discussions; involve executive boards; capture/share local knowledge; conduct educational meetings; assess for readiness and identify determinants; identify early adopters; fund and contract for the clinical innovation; create a learning collaborative; and conduct a local needs assessment. This is the first study to examine barriers to adopting the OSU TBI-ID in real-world practice settings. Our results suggest that multilevel implementation strategies addressing mechanisms of change are necessary at the provider, organizational, and systems levels to overcome the complex barriers affecting TBI screening adoption and implementation. Future research is needed to test these strategies and their mechanisms of action on the adoption, implementation, and sustainment of TBI screening, as well as their effect on client-level outcomes.

Care challenges and silver linings in HIV and behavioral health service delivery for individuals living with HIV and severe mental illness during the COVID-19 pandemic: a qualitative study

BackgroundThere has been a longstanding effort to integrate behavioral health and HIV care for people with comorbid HIV and behavioral health needs, including those with severe mental illness (SMI). As this population frequents both behavioral health and HIV care settings, they were likely to experience new obstacles to the quality and availability of care during the COVID-19 pandemic. This study aims to describe how clinics for HIV services or behavioral healthcare—as well as co-located sites providing both—sought to rapidly shift protocols to maintain a standard of patient care for people with comorbid HIV and SMI while adapting to the unprecedented circumstances of the pandemic.MethodsWe interviewed HIV and behavioral healthcare providers, clinic leaders, and support service agencies that served clients impacted by both HIV and SMI. Seventeen key informants across three settings (HIV care settings, behavioral health care settings, and integrated or co-located care settings) were interviewed in 2022. Interviews focused on changes in clinical services, protocols, and care provision strategies during and at the onset of the COVID-19 pandemic. Interviews were transcribed and coded using thematic analysis.ResultsCommonly endorsed themes included both positive and negative changes in care and care provision during the pandemic. Negative impacts of the pandemic included the loss of physical space, exacerbated mental health needs and disengagement in HIV care, patient barriers to telehealth and the digital divide, and increased healthcare workforce burnout. Positive changes included improved healthcare delivery and care engagement through telehealth, new opportunities to provide a wide range of social services, paradoxical increases in engagement in HIV care for certain patients, and broad institution of workforce wellness practices.ConclusionsThough COVID-19 presented several complex barriers to care for providers serving patients with comorbid HIV and SMI, the increased flexibility afforded by telehealth and a greater focus on collaborative approaches to patient care may benefit this patient population in the future. Additionally, the focus on workforce wellness may serve to increase retention and avoid burnout among providers. The strategies and lessons learned through adapting to COVID-19 may be invaluable moving forward as healthcare systems respond to future pandemics.

Improving self-efficacy in behavioral health through interprofessional education.

Interprofessional education (IPE) is important in preparing health profession students to practice in a workforce dependent on teamwork and collaboration. Many health profession students graduate without ever having active shared learning experiences in the academic setting. Opportunities for students to participate in activities that promote self-efficacy in competencies related to interprofessional collaborative practice are essential. The purpose of the project was to assess health profession students' perception of self-efficacy related to the core competencies of IPE. The project used a pre/post quantitative survey research design comprising a sample of students enrolled in clinical practicums in behavioral health care settings. Using standardized patients, students participated in timed simulated encounters. Participants ( n = 36) completed the 16-item Interprofessional Education Collaborative Competency Self-Assessment Tool on conclusion of the learning activity. Survey responses were scored on a 5-point Likert-type scale, with high scores indicating a stronger level of agreement of perceived self-efficacy. On the postsurvey, most items were rated as "agree" or "strongly agree." Item means ranged from 4.64 to 4.81. A positive association was found between students' self-efficacy and the utilization of standardized patients within an interprofessional experiential learning activity. The intervention contributed to improving self-efficacy in interprofessional competencies related to collaborative interaction and values.

Implementing traumatic brain injury screening in behavioral health treatment settings: results of an explanatory sequential mixed-methods investigation

BackgroundTraumatic brain injury (TBI) is a complex condition common among individuals treated in behavioral healthcare, but TBI screening has not been adopted in these settings which can affect optimal clinical decision-making. Integrating evidence-based practices that address complex health comorbidities into behavioral healthcare settings remains understudied in implementation science, limited by few studies using theory-driven hypotheses to disentangle relationships between proximal and medial indicators on distal implementation outcomes. Grounded in the Theory of Planned Behavior, we examined providers’ attitudes, perceived behavioral control (PBC), subjective norms, and intentions to adopt The Ohio State University TBI Identification Method (OSU TBI-ID) in behavioral healthcare settings.MethodsWe used an explanatory sequential mixed-methods design. In Phase I, 215 providers from 25 organizations in the USA completed training introducing the OSU TBI-ID, followed by a survey assessing attitudes, PBC, norms, and intentions to screen for TBI. After 1 month, providers completed another survey assessing the number of TBI screens conducted. Data were analyzed using structural equation modeling (SEM) with logistic regressions. In Phase II, 20 providers were purposively selected for semi-structured interviews to expand on SEM results. Qualitative data were analyzed using thematic analysis, integrated with quantitative results, and combined into joint displays.ResultsOnly 25% (55/215) of providers adopted TBI screening, which was driven by motivations to trial the intervention. Providers who reported more favorable attitudes (OR: 0.67, p < .001) and greater subjective norms (OR: 0.12, p < .001) toward TBI screening demonstrated increased odds of intention to screen, which resulted in greater TBI screening adoption (OR: 0.30; p < .01). PBC did not affect intentions or adoption. Providers explained that although TBI screening can improve diagnostic and clinical decision-making, they discussed that additional training, leadership engagement, and state-level mandates are needed to increase the widespread, systematic uptake of TBI screening.ConclusionsThis study advances implementation science by using theory-driven hypothesis testing to disentangle proximal and medial indicators at the provider level on TBI screening adoption. Our mixed-methods approach added in-depth contextualization and illuminated additional multilevel determinants affecting intervention adoption, which guides a more precise selection of implementation strategies.

Texas tobacco quitline knowledge, attitudes, and practices within healthcare agencies serving individuals with behavioral health needs: A multimethod study

Patients with behavioral health conditions have disproportionately high tobacco use rates and face significant barriers to accessing evidence-based tobacco cessation services. Tobacco quitlines are an effective and accessible resource, yet they are often underutilized. We identify knowledge, practices, and attitudes towards the Texas Tobacco Quitline (TTQL) within behavioral healthcare settings in Texas. Quantitative and qualitative data were collected in 2021 as part of a statewide needs assessment in behavioral healthcare settings. Survey respondents (n = 125) represented 23 Federally Qualified Health Centers, 29 local mental health authorities (LMHAs), 12 substance use treatment programs in LMHAs, and 61 standalone substance use treatment centers (26 people participated in qualitative interviews).Over half of respondents indicated familiarity with the TTQL and believed that the TTQL was helpful for quitting. Qualitative findings reveal potential concerns about inconsistency of services, long wait time, and the format of the quitline. About half of respondents indicated that their center promoted patient referral to TTQL, and few indicated that their center had an electronic referral system with direct TTQL referral capacity. Interview respondents reported overall lack of systematic follow up with patients regarding their use of the TTQL services.Findings suggest the need for (1) increased TTQL service awareness among healthcare providers; (2) further investigation into any changes needed to better serve patients with behavioral health conditions who use tobacco; and (3) electronic health record integration supporting direct referrals and enhanced protocols to support patient follow up after TTQL referral.

Nuestra Recuperación [Our Recovery]: using photovoice to understand the factors that influence recovery in Latinx populations

BackgroundPhotovoice is a form of visual ethnography intended to engage impacted communities in research followed by action to ameliorate the injustices under study. Photovoice has increased in use, especially in collaboration with Latinx communities addressing health inequities. The Latinx population comprises nearly 18% of the overall United States population and according to the census is projected to reach just under 30% by 2060. This diverse panethnic community faces significant structural barriers in accessing services. Racism and the resulting marginalization, specifically, contributes to limited access to recovery services and treatment. Making meaningful advances in substance use disorder training, intervention and policy necessitates learning alongside the Latinx community.MethodsWe partnered with a Latinx serving integrated behavioral health and primary care setting in Boston Massachusetts to explore barriers and facilitators to recovery using photovoice. Spanish-speaking Latinx adults with a substance use disorder participated. The group met for three photovoice sessions over a six-week period. Together group members critically analyzed photographs using the SHOWeD method.ResultsFindings indicate a sense of purpose and meaning, security, faith and housing are important elements of recovery. The results illustrated the importance of sources of connection in maintaining sobriety. Through this photovoice project, Latinx Spanish speaking participants highlighted barriers and facilitators to their substance use disorder recovery which spanned individual, community, and structural levels.ConclusionsThe experiences and voices of the Latinx community are crucial to drive discussions that advance policy (e.g., housing stability and access), enhance providers’ understanding of Latinx Spanish-speakers' substance use disorder recovery, and inform culturally and linguistically appropriate services. This study demonstrated that photovoice is highly acceptable and feasible among Latinx clients receiving substance use disorder services. Visual images related to housing, faith, etc. communicate challenges, power structures, as well as hopes to policymakers at multiple levels (e.g., institution/ agency, state).

Improving maternal mental health: assessing the extent of screening and training about peripartum depression

Objective Peripartum depression (PPD) is a common mental health complication of pregnancy and increases risk for maternal mortality and poorer outcomes for children. Despite its importance, screening rates vary across organizations and care team members. The goal of the current study was to explore the perspectives from care team members in both behavioral health and acute care settings about how they screen and refer pregnant and post pregnant women for PPD, what training around PPD is currently offered by their organization, and if they could benefit from additional PPD training. Methods Data were collected from an online self-report survey of care team members from behavioral health and acute care settings in the US. Questions focused on (1) when/if the care teams had a screening protocol for PPD, (2) beliefs about the efficacy of their organization’s PPD screening, identification, and referral process, and (3) if their organization currently offered or needed training around the topic of PPD. Results A total of 794 care team members in behavioral health and acute care responded to the survey between December 2021 and May 2022. Nearly, all (96.7%) reported having a specific protocol for screening for PPD when they know a patient is pregnant; however, only 69.6% of respondents routinely screen regardless of symptoms being reported by the patient. While 93.3% of the sample believed their organization does a good job screening for and identifying PPD, gaps in the referral processes were described, especially in acute settings. 95.3% of the sample reported their organization currently gives training in screening, identifying, or treating PPD or in the process for establishing outpatient referrals for PPD care for care team members who have direct contact with pregnant patients; however, 96.5% also reported their organization would benefit from additional training in one or more of these areas. Conclusion High rates of self-reported PPD screening and training indicate that care team members in both behavioral health and acute care are aware of the importance of maternal mental health issues. However, other research indicates that high rates of screening may not lead to improved outcomes, and there are still high rates of maternal suicide and suicidal ideation in the US. It is possible that high self-reported screening rates may indicate a false sense of security such that care team members feel the issue is addressed while problems remain. Alternatively, many respondents felt their organizations would benefit from further training, perhaps indicating an awareness of this gap. Care team members in behavioral health and acute care settings should increase collaboration to ensure high rates of screening lead to improved maternal mental health care.

Counselors’ challenging experience in integrated behavioral healthcare: A qualitative exploration

AbstractUsing a consensual qualitative research method, we interviewed 16 counselors on the challenges that they experienced when working in integrated behavioral healthcare settings. We identified five domains and 13 core ideas among all domains. We also discussed the implications for future counselor training and research.

2.61 Preliminary Outcomes of Integrating Pediatric Care Services Into a Children’s Mental Health Clinic

Vigorous efforts have been made to integrate mental health into pediatric primary care in the past decades, and many studies have found improved clinical outcomes after the integration. In this study, instead of integrating mental health into pediatric primary care, we incorporated pediatric care services into a behavioral healthcare setting. The study attempted to determine whether incorporating pediatric care services into a behavioral healthcare setting could improve the mental health of patients.

Interprofessional Training: Preparing Graduate Counseling and Social Work Students for Integrated Behavioral Healthcare Settings

ABSTRACT Purpose This study presents the evaluation of a Health Resources and Services Administration (HRSA) workforce development initiative focused on preparing master’s level social work and counseling students to work in integrated behavioral healthcare settings. Method Seventy-nine trainees attending a large urban university in the southeastern United States participated in an interdisciplinary program that included a combination of field experience, exposure to interdisciplinary professional settings, readings, and experiential-didactic sessions. Results Differences across trainee areas of study, race, gender, and urban or rural origins were assessed utilizing pre/posttest measures on cultural competency, team skills, and attitudes toward family involvement. Conclusions Results suggest that trainees demonstrated overall growth in team skills. Potentially an overlooked but positive outcome of the training program was the modeling of effective interprofessional teamwork through collaboration among the counseling and social work faculty. Implications for social work and counselor educators and future research are discussed.

Electronic Screening to Support Measurement Based Care: Examples from the Field

Background Measurement-based care (MBC) is associated with improved patient outcomes, but is seldom fully implemented. Electronic self-report screening systems may help overcome some obstacles associated with implementing MBC. One such program, eScreening, provides customized and automated self-report mental and physical health screening via mobile tablet for veterans seen in Veterans Health Administration (VHA) settings and by web browser for patients seen remotely by telemedicine. We aimed to describe how electronic health screening systems can support the implementation of measurement-based behavioral healthcare. Methods We collected descriptive data on the use of eScreening, including clinical settings, measures used, and frequency of use; and present a brief case composite example. Results eScreening was used in multiple VHA clinical programs to administer validated symptom severity measures at baseline and regular intervals during treatment. The case composite example describes a Veteran referred to the PTSD clinic where he was treated with Cognitive Processing Therapy. eScreening was used routinely to track mental health symptoms, promote collaborative dialogue, and inform treatment progress. Conclusion Electronic self-report screening systems can support the implementation of MBC by facilitating the process of routine symptom collection/monitoring, informed decision-making, objective evaluation of treatment outcomes, and collaborative care in behavioral healthcare settings.

Identifying Common and Unique Barriers and Facilitators to Implementing Evidence-Based Practices for Suicide Prevention across Primary Care and Specialty Mental Health Settings

Objective We identified common and unique barriers and facilitators of evidence-based suicide prevention practices across primary care practices with integrated behavioral health services and specialty mental health settings to identify generalizable strategies for enhancing future implementation efforts. Method Twenty-six clinicians and practice leaders from behavioral health (n = 2 programs) and primary care (n = 4 clinics) settings participated. Participation included a semi-structured qualitative interview on barriers and facilitators to implementing evidence-based suicide prevention practices. Within that interview, clinicians participated in a chart-stimulated recall exercise to gather additional information about decision making regarding suicide screening. Interview guides and qualitative coding were informed by leading frameworks in implementation science and behavioral science, and an integrated approach to interpreting qualitative results was used. Results There were a number of similar themes associated with implementation of suicide prevention practices across settings and clinician types, such as the benefits of inter-professional collaboration and uncertainties about managing suicidality once risk was disclosed. Clinicians also highlighted barriers unique to their settings. For primary care settings, time constraints and competing demands were consistently described as barriers. For specialty mental health settings, difficulties coordinating care with schools and other providers in the community made implementation of suicide prevention practices challenging. Conclusion Findings can inform the development and testing of implementation strategies that are generalizable across primary care and specialty mental health settings, as well as those tailored for unique site needs, to enhance use of evidence-based suicide prevention practices in settings where individuals at risk for suicide are especially likely to present. HIGHLIGHTS We examined barriers and facilitators to suicide prevention across health settings. Common and unique barriers and facilitators across health-care settings emerged. Findings can enhance suicide prevention implementation across health-care settings.

Behavioral Health Training to Address the Needs of Adolescents: Outcomes of the GLOBE Youth Program

ABSTRACT This article outlines the outcomes of a specialized master’s of social work (MSW) training program on students’ (N=96) ability to work effectively in behavioral health care settings with adolescents and transitional age youth from diverse racial, ethnic, and linguistic backgrounds. Program design, curriculum development, and associated activities for the 3-year MSW training program at a large southern urban university are described. The results of this training program were assessed using a one-group pretest–posttest design across three cohorts to assess change with regard to interprofessional competencies, interprofessional attitudes, and cultural competency. Overall, the GLOBE Youth program was associated with increased interprofessional competence and self-reported readiness to work in interprofessional settings with diverse adolescents and transitional age youth experiencing mental health concerns. Implications for social work education and future research in this area are discussed.

Evaluating an Implementation Science Training Program: Impact on Professional Research and Practice.

Real-world application and implementation of evidence-based practice continue to be a challenge across multiple sectors, including behavioral health settings. Providing the opportunity for future researchers and practitioners to gain capacity and knowledge through structured experiential learning in implementation science is critical to closing the research to practice gap. The Institute for Translational Research Education in Adolescent Drug Abuse (ITRE) is a graduate certificate program that offers specific coursework, a large-scale service-learning project based in the community, and mentorship related to implementation science research and practice. The purpose of this evaluation was to examine, from the perspective of ITRE scholars, the perceived impact on the development of professional research and practice skills once graduated from the ITRE program. Fifty-eight semi-structured interviews across five cohorts were selected randomly for in-depth thematic analysis (n = 58). Results suggest that the ITRE provides a unique approach grounded in implementation science for building robust and transferable skills for future researchers and practitioners working in a variety of behavioral healthcare settings.

Cost-Effectiveness of a Web-Based Program for Residual Depressive Symptoms: Mindful Mood Balance.

Mindful Mood Balance (MMB) is an effective Web-based program for residual depressive symptoms that prevents relapse among patients with partial recovery from major depressive episodes. This cost-effectiveness analysis was conducted from the health plan perspective alongside a pragmatic randomized controlled trial of MMB. Adults were recruited from behavioral health and primary care settings in a large integrated health system and randomly assigned to MMB plus usual depression care (MMB+UDC) or UDC. Patients had at least one prior major depressive episode; a current score of 5-9 on the Patient Health Questionnaire-9, indicating residual depressive symptoms; and Internet access. Program costs included recruitment, coaching, and MMB licensing. Center for Medicare and Medicaid fee schedules were applied to electronic health record utilization data for psychotropic medications and psychiatric and psychotherapy visits. Effectiveness was measured as depression-free days (DFDs), converted from PHQ-9 scores collected monthly for 1 year. Incremental cost-effectiveness ratios were calculated with various sets of cost inputs. A total of 389 patients (UDC, N=210; MMB+UDC, N=179) had adequate follow-up PHQ-9 measures for inclusion. MMB+UDC patients had 29 more DFDs during follow-up. Overall, the incremental cost of MMB+UDC was $431.54 over 12 months. Incremental costs per DFD gained ranged from $9.63 for program costs only to $15.04 when psychiatric visits, psychotherapy visits, and psychotropic medications were included. MMB offers a cost-effective Web-based program for reducing residual depressive symptoms and preventing relapse. Health systems should consider adopting MMB as adjunctive to traditional mental health care services.

Evaluating the association of adverse childhood experiences, mood and anxiety disorders, and suicidal ideation among behavioral health patients at a large federally qualified health center.

Although numerous studies have examined the relationship between adverse childhood experiences (ACEs) and suicide, research is needed that studies the effects of specific ACEs, including subclasses of ACEs, independent of the effect of other ACEs. We explored the relationship between ACEs and suicidal ideation (SI) with special attention to patterns according to generation cohort (millennials: 22–37 years old, generation X: 38–53 years old, and baby boomers: 54–72 years old), and assessed the extent to which mood and anxiety disorders account for the relationship between ACEs and suicidal ideation. Patients in behavioral healthcare services of a large federally qualified health center (n = 4,392) were assessed at baseline on ACEs, SI, and mood and anxiety disorders. Logistic regression modeling was used to examine the data. Emotional neglect was the strongest predictor of SI among Millennials (OR = 1.59), Generation X (OR = 1.81), and Baby Boomers (OR = 1.88) after controlling for mood and anxiety disorders, race/ethnicity, and gender. Findings suggest ACEs predict an increased likelihood of having SI over and above the influence of mood and anxiety disorders, in models adjusted for gender and race/ethnicity. Across generations, the association with suicidal ideation was strongest for any child abuse and neglect, but not for household dysfunction. The observed association of ACEs with suicidal ideation suggests that ACEs should be considered as a risk factor and incorporated into screening assessments for suicidal ideation. Lastly, additional research on the association of ACEs and suicidality in individuals not actively being managed in behavioral healthcare settings is also warranted.

Comparison of DASS-21, PHQ-8, and GAD-7 in a virtual behavioral health care setting

BackgroundValidated depression and anxiety symptom screeners are commonly used in clinical settings. How results from different brief depression and anxiety symptom assessment tools compare to each other is not well established, especially in real world healthcare settings. This study aimed to compare the Depression Anxiety Stress Scales 21 Depression scale (DASS-Depression) and Anxiety (DASS-Anxiety) scale to the Patient Health Questionnaire 8 (PHQ-8) and Generalized Anxiety Disorder 7 (GAD-7) respectively, in a real-world virtual behavioral healthcare setting. MethodsThis was a retrospective comparison study of clinical data from a population of adults who completed a consultation via telephone or secure video with a licensed therapist as part of a standardized, evidence-based, virtual behavioral therapy program for individuals with comorbid medical and behavioral health conditions. The joint distributions and correlations between scores yielded by each depression and anxiety scale were assessed using descriptive and Spearman correlation statistics. ResultsThe DASS-Depression and PHQ-8 were highly correlated (r = .71; p=<.001); the DASS-Anxiety and GAD-7 correlation was also high (r = .61; p=<.001). The PHQ-8 categorized more individuals as having above-threshold depression scores versus the DASS-Depression (71.5% vs. 43.5%; p < .001). The GAD-7 categorized more individuals as having above-threshold anxiety scores versus the DASS-Anxiety (59.0% vs. 45.0%; p < .001). LimitationsThis study compared results yielded by validated screeners, precluding conclusions related to the validity of screener results. ConclusionsThe DASS-Depression and PHQ-8 and the DASS-Anxiety and GAD-7 similarly ranked symptom severity. The PHQ-8 and GAD-7 were more likely than the DASS-21 Depression or Anxiety scales to classify individuals as having above-threshold symptom severity.

Clinician Perspectives on Barriers and Facilitators to Implementing e-Health Technology in Substance Use Disorder (SUD) Treatment Facilities.

Background:Substance use disorders (SUDs) in the United States cause many preventable deaths each year. Finding effective ways to manage SUDs is vital to improving outcomes for individuals seeking treatment. This has increased interest in using e-health technologies in behavioral healthcare settings. This research is part of a larger study evaluating the efficacy of the NIATx coaching intervention for implementing RISE Iowa, an e-health patient recovery app, in SUD treatment organizations and seeks to examine clinician perspectives of the barriers and facilitators to its implementation.Method:Semi-structured qualitative interviews were conducted with 13 clinicians from 9 different intervention sites involved in the study.Results:Major barriers to implementing e-health technology include inability to access the technology, lack of time for both patients and clinicians, and a perceived lack of patient motivation to make changes. Facilitators to implementation include collaboration with other staff using e-health technology and integrating technology use into typical workflows.Conclusions:Implementation of e-health technology in SUD treatment will require integrating the technology into clinical workflows and improving patient access to the technology.

Use of a Model Maturity Matrix to Build a Quality Improvement Infrastructure for Psychiatric Care.

Despite a call to action by accreditation bodies and payers alike, the infrastructure needed to continuously improve the quality and safety of behavioral health care has been slow to develop. The causes of this are complex and multifactorial yet likely include underdeveloped leadership and capacity to sustainably improve the quality of psychiatric care. This article proposes the use of a quality improvement maturity matrix to serve as both an implementation strategy and a self-assessment measure to strategically guide this infrastructure development. The matrix describes six phases of development across three domains that are generalizable to various behavioral health care settings.

Implementation of Measurement‐Based Care in a Child Partial Hospital Program

The routine collection and use of patient data throughout treatment, commonly referred to as measurement‐based care (MBC), holds promise as an effective, evidence‐based practice that has the potential to greatly improve the quality of usual care if implementation were more widespread (Scott &amp; Lewis, 2015). Indeed, nearly two decades of research in behavioral health care settings has demonstrated the value of MBC as a mechanism for improving treatment outcomes and services (see Gondek et al., 2016, for a review). A person‐centered approach to care, MBC facilitates patient engagement and shared decision‐making, which can in turn enhance better outcomes and higher quality of care. Given the potential of MBC to improve the quality of care and demonstrate the value of services to stakeholders, The Joint Commission outlines three standards related to MBC within behavioral health care settings. Though the standards themselves (discussed in more detail below) are relatively straightforward, several practical implications and questions are raised in each.