Standardized Versus Tailored Implementation of Measurement Based Care for Depression

Depression remains among the nation's top 10 chronic illnesses, costing over $80 billion
annually. Depression has been called the "Common Cold" of mental illness, but one with
serious risk of morbidity and mortality. There are now many evidence-based practices for the
treatment of depression, but unfortunately these practices remain largely unavailable to
clients receiving services in community mental health centers. Measurement Based Care (MBC)
is a relatively simple evidence-based intervention framework. MBC, by definition, is the
practice of using symptom measurement to inform mental health care. Physicians who routinely
measure the patient's blood pressure when the treatment target is high blood pressure
demonstrate the medical corollary of MBC. When MBC is used in the treatment of depressed
adults, it has been shown to improve outcomes by identifying clients who are not making
progress and reducing the likelihood that clients will deteriorate in treatment. However,
despite the demonstrated effectiveness of MBC, the majority of community mental health
counselors (i.e., clinicians) do not regularly assess target problem symptoms to guide their
work over the course of treatment. To our knowledge, no studies to date have focused on the
process of implementing MBC in community mental health settings. The long-term goal of this
research project is to provide generalizable and practical recommendations about
implementation approaches that promote MBC use and fidelity in community mental health
centers. Specifically, this study will test a standardized versus a tailored approach to
implementing MBC in one of the nation's largest not-for-profit providers of behavioral health
services. Although touted as superior, tailored implementations have rarely been compared to
standardized approaches. Moreover, recent research has demonstrated an apparent need to adapt
evidence-based practices to fit the specific context in which they are being implemented,
particularly if they are to be sustained. This proposal reflects a movement in the field of
implementation science in which planned adaptations are being tested and compared to
standardized versions. The proposed research is a three-phase, mixed methods
(quantitative/qualitative) study to investigate the effect of these two different approaches
to MBC implementation on both clinician-level (e.g., MBC fidelity) and client-level
(depression symptom change) outcomes. We will focus on contextual factors (e.g., attitudes,
resources, process, etc.) that may influence the implementation process with the goal of
identifying a generalizable and practical way of bringing MBC to community mental health
centers treating depressed adults.

Inclusion Criteria:

- (a) age 18 and above; (b) depression is one of the primary treatment foci based on
diagnosis made by clinicians using usual care interview methods to reflect major
depressive disorder, dysthymic disorder, depressive disorder NOS, adjustment disorder
with depressed mood; (c) significant depressive symptom severity (PHQ-9 total score >
9); (d) receipt of individual psychotherapy; (e) fluency in English; and, (f) new
client beginning treatment (g) with an enrolled study clinician during the proposed
funding period

Exclusion Criteria:

- an inability to sign the consent due to lack of competence or inability to read