9/22/2021
Water Runs Downhill:
Outcomes and Measurement Based Care in
Behavioral Healthcare
John Dyben, DHSc, MCAP, CMHP
Chief Clinical Officer
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How Do We Know?
How do we know if a treatment that we use is
generally safe and effective?
Evidence Based Practice
How do we know that the work we are doing
with a given patient is effective in that moment?
Measurement Based Care
How do we know if the work we do has any
lasting effects?
Outcomes Studies
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How Do We Know?
In healthcare it is expected that we:
Establish safety and efficacy of interventions
Measure how patients respond to
interventions while in treatment and
adjust treatment accordingly
Measure long-term,
after treatment, outcomes
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9/22/2021
Evidence Based Practice in Medicine
Blood Pressure Medication “Pressureprove”
• Researched, designed and tested in clinical trial with
a specific population.
• Demonstrates efficacy and safety with that general
population.
• FDA approved
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Measurement Based Care in Medicine
Blood Pressure Medication “Pressureprove”
• Medical professional measures patient BP, diagnoses
hypertension, and decides to try Pressureprove.
• Continues to measure BP at regular intervals and
changes, maintains, or stops the medication based
on those measurements.
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Important to Remember
Measurement Based Care is critical because individuals
are…individuals. Though a person’s demographics might
suggest they should respond to Pressureprove, their
individual body may not.
EPB is good but MBP is perhaps even more important. This
gives medical professionals the ability to use medications off
label when necessary.
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9/22/2021
Outcomes in Medicine
Blood Pressure Medication “Pressureprove”
Patients who used Pressureprove are tracked over a
long period of time, generally 1-5 years to better
understand long-term outcomes.
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Evidence Based Practice
in Behavioral Healthcare
Dialectical Behavioral Therapy (DBT)
• Researched, designed and tested in clinical trial with
a specific population.
• Demonstrates efficacy and safety with that general
population.
• Published and replicated.
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Outcomes in Behavioral Healthcare
Dialectical Behavioral Therapy (DBT)
Patients who complete a DBT program may be tracked
at intervals over a long period of time in order to try to
understand the lasting impact of DBT.
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9/22/2021
Measurement Based Care
in Behavioral Healthcare
Dialectical Behavioral Therapy (DBT)
• Therapists use psychometric testing repeated during
course of treatment to measure effectiveness.
• Changes, maintains, or stops the intervention based
on those measurements.
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Process
Individual Sessions
Treatment Plan
Biopsychosocial
Identify problems
to work on.
Use results as a tool
to monitor progress
and inform treatment.
Include weekly
(or otherwise)
measurements as
interventions
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Examples of MBC Assessments
PHQ-9 (Depression)
GAD-7 (Anxiety)
URICA (Readiness to change)
BARC-10 (Recovery capital)
PID-5-BF (Personality)
EDDS-5 (Eating disorder)
NSSESS (PTSD symptoms)
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Process
This information is discussed in session and informs
the treatment.
e.g.
“Reviewed results from PHQ-9 and GAD-7 taken today. Patient’s
GAD-7 score dropped from a 14 last week to a 6 this week. He
reports CBR exercises have been very helpful in decreasing
anxiety. His PHQ-9 score increased from 8 last week to 17 this
week. He reports his positive visualizations seem ineffective in
improving his mood. Patient agreed to change intervention and
to begin CBT exercise as well as participate in consult with
psychiatrist.”
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Outcomes
What population am I studying?
What do I want to measure?
How will I collect the data?
What will I do with the data when I have it?
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Outcomes
What population am I studying?
What group?
What timeframe?
What qualifiers?
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Outcomes
What do I want to measure?
What is our mission?
Who are our stakeholders?
What questions do we want to answer?
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Outcomes
How will I collect the data?
What is our budget?
What resources do we have available?
What expertise do we have available?
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Outcomes
What will I do with the data when I have it?
Be impeccable with your word.
Hold a higher standard than minimum.
Have external auditors.
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Outcomes
Research Team
John Dyben, DHSc, Origins Behavioral Healthcare
Megan Davidson, PhD, OMNI Institute
Jason Wheeler, PhD, OMNI Institute
“The OMNI Institute is a 501c(3) non-profit social science consultancy that accelerates positive
social change by supporting the public, nonprofit, and philanthropic sectors with integrated
research and evaluation, capacity building, and data utilization services.” (www.omni.org)
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Outcomes Study Design
•
Study used self-report data collected from electronic surveys.
•
Emailed unique invitations all 2017- May 2021 alumni for whom we had email addresses
(final N=2553).
•
Incentive to optionally enter drawing for one of thirty $20 Amazon gift cards (opted in final
N=296 [269 valid entries (71%)].
•
Invitations were sent to alumni through email, and they were asked to complete the survey
and informed that their answers would remain confidential.
•
Consent received in the first question and required to complete the survey.
•
Six reminder emails sent during the month to unfinished respondents.
•
439 people started the survey. 380 people completed the survey to the end.
•
Overall response rate of 17% and individual question response rates in the range of 13%
to 18%.
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Participants Demographics
75 - 84
3%
Age Identification
65 - 74
• Most participants were between
11%
25 and 74 years of age
55 - 64
24%
45 - 54
Answer
21%
35 - 44
20%
%
Count
18 - 24
3.5%
15
25 - 34
17.4%
35 - 44
20.5%
45 - 54
21.2%
91
55 - 64
24.2%
104
65 - 74
10.7%
75 - 84
25 - 34
17%
18 - 24
75
88
46
2.6%
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85 or older
0.0%
0
Total
100%
430
3%
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Participants Demographics
Gender Identification
• 54% of participants identified as
male
• 1 participant identified as
“other” and 2 preferred not to
Female
45%
answer
Male
54%
Answer
%
Count
Male
53.8%
231
Female
45.5%
Other (please specify):
0.2%
I prefer not to answer
0.5%
2
Total
100%
429
195
1
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Participant Treatment Experiences
44%
> 2 yrs
Time Since Treatment Episode
19 to 24 mo
• The majority of participants had
5%
been out of treatment for over 6
9%
13 to 18 mo
10 to 12 mo
7 to 9 mo
Answer
4%
7%
4 to 6 mo
23%
1 to 3 mo
< 1 mo
months.
3%
%
Count
Less than one month
3%
14
1 to 3 months
23%
99
4 to 6 months
7%
31
7 to 9 months
4%
19
10 to 12 months
3%
13
13 to 18 months
9%
19 to 24 months
5%
23
More than 2 years
44%
186
Total
100%
425
40
3%
24
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9/22/2021
Participant Treatment Experiences
Overall Program Completion
No
7%
• 93% of all participants
completed treatment in full.
• Total “Yes” count across
all programs / Total
responses.
Yes
93%
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Participant Treatment / Continuing Care
Family Participation
• 61% had family members
participate in the family
program.
No
39%
Answer
Yes
61%
%
Count
No
39%
148
Yes
61%
232
Total
100%
380
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Participant Treatment / Continuing Care
I followed the continuing care
plan after leaving Origins.
No
25%
• After leaving Origins, 75% of
participants reported following
the continuing care plan.
Answer
No
Yes
75%
%
Count
25%
102
Yes
75%
299
Total
100%
401
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9/22/2021
Participant Treatment / Continuing Care
Have you participated in any 12Step Fellowship program(s)
No
15%
since leaving treatment.
• Most (85%) participated in 12Step Fellowship programs(s)
since leaving treatment.
Answer
No
Yes
85%
%
Count
15%
62
Yes
85%
342
Total
100%
404
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Participant Treatment Outcomes
Which best describes your use
3%
of substances since leaving
4%
Abstinent (I have not used
any substances since
leaving treatment)
19%
treatment?
• Most participants (74%)
Using - less than when I
went to treatment
reported being abstinent from
Using - same as when I
went to treatment
treatment.
substance since leaving
Using - more than when I
went to treatment
74%
Answer
Abstinent (I have not used any substances since leaving treatment)
Using - less than when I went to treatment
Using - same as when I went to treatment
Using - more than when I went to treatment
Total
%
74.42%
18.60%
3.10%
3.88%
100%
Count
288
72
12
15
387
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Participant Treatment Outcomes
Have you had to return to
Yes
14%
treatment due to relapse?
• Since their last treatment
experience, 86% of participants
reported not returning to
treatment due to relapse.
Answer
Yes
No
Total
%
13.85%
86.15%
100%
Count
54
336
390
No
86%
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9/22/2021
Participant Treatment Outcomes
Since your treatment
experience, how would you
describe the follow:
• Quality of Life
79%
85%
88%
• 88% reported that their
quality of life had improved.
• Relationships
• 85% reported that their
relationships had
improved.
13%
Better
Same
Worse
6%
8%
8%
6%
6%
Physical Health
79%
13%
8%
Important Relationships
85%
6%
8%
Quality of Life
88%
6%
6%
• Physical Health
• 79% reported that their
health had improved.
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Participant Treatment Outcomes
2% 1%
Over the last 30 days, how many days
did you visit the hospital or ER,
related to your substance use or
recovery?
• Most participants (97%) reported no
visits to the hospital or ER in the last
0 Days
30 days.
1 to 2 Days
3+ Days
Minimum
97%
Maximum
1
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Mean
1.24
Std Deviation
2.18
Variance
4.77
Count
377
Answer
0
1
2
3
5
6
7
28
30
Total
%
96.55%
1.06%
0.80%
0.27%
0.27%
0.27%
0.27%
0.27%
0.27%
100%
Count
364
4
3
1
1
1
1
1
1
377
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Statistically Significant Findings
 Following the continuing care plan (a specific, individualized plan for
actions a patient will take after leaving Origins) was associated with
abstinence.
 Abstinence was associated with:
o Improved physical health.
o Improvements in most important relationships.
o Improved overall quality of life.
 Being involved in a 12-step fellowship was also associated with
improved overall quality of life.
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Statistically Significant Findings
(n = 383, p = > .001, φc = .33)
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Statistically Significant Findings
(n = 387, p = > .001, φc = .42)
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Statistically Significant Findings
(n = 387, p = > .001, φc = .33)
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9/22/2021
Statistically Significant Findings
(n = 387, p = > .001, φc = .38).
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Outcomes
Looking towards the future.
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Questions?
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