Measurement-Based Care at Two Chairs: Leveraging Client-Reported Data to Provide Exceptional Care

Victoria Bangieva, PhD
Former Clinical Program Lead at Two Chairs

There are many facets to effective mental health care. Industry experts suggest some of the most important facets include clinician expertise that matches the unique needs of the client, mutually agreed upon treatment goals, and clinician-deployed processes to prompt amelioration of the client’s presenting difficulties. At Two Chairs, we are striving to not only provide therapy that is effective, but also exceptional through a thoughtfully designed matching process for connecting clients to the most qualified clinicians to meet their needs and preferences, and data to inform care throughout the therapeutic process using Measurement-Based Care (MBC).

What is Measurement-Based Care?

MBC is a core component of our approach to care. It’s the practice of using self-reported client data to tailor care and track progress in therapy over time. In practice, clients complete clinically-validated questionnaires on the day of their session and that data is used by their clinician to inform care. Questionnaires are not intended to replace clinical judgment, but rather equip clinicians with more accurate and efficient measures for optimizing treatment. Combining the art of therapy with the science of the practice enables clinicians to deliver personalized, high-quality care that is rooted in precision.

There is strong evidence supporting MBC, as numerous randomized clinical trials have demonstrated that when routine client data is used to inform care it results in better outcomes, achieved faster than usual care alone. In fact, it has been estimated that clients who engage in care that incorporates MBC fare 76% better than clients in usual care, and they benefit from care in about half of the time as usual care¹. Overall, the benefits of MBC are indisputable, and yet it is estimated that less than 20% of mental health providers in the U.S. incorporate measures into their care and only 5% do so based on industry best practices².

MBC at Two Chairs

At Two Chairs we have developed and implemented an MBC approach that is based on rigorously studied best practices, while also providing a favorable experience for our clients and clinicians.

Just like getting vitals checked at the start of a doctor's appointment, clients complete a Wellness Survey before each session. They report on symptoms and reflect on their experience and therapeutic alliance with their clinician—this enables clinicians to identify changes in well-being that require further assessment and track progress over time. It also ensures that measurement isn’t just focused on symptoms, but also on the quality of the relationship between a client and a clinician, which is core to the therapeutic process.

Our internal research has shown that our MBC approach is effective at identifying changes in clients’ wellbeing and tracking progress throughout the care journey. We’ve also received positive feedback from our clients, who report that MBC provides them an opportunity to reflect on their own wellbeing week-to-week and see progress in care, which they find hugely empowering. As a result of completing routine questionnaires, clients are able to develop a better understanding of their wellbeing, feel more inclined to better communicate with their clinician, and take a more involved role in their care.

Benefits of MBC

MBC provides significant, proven benefits at each level of care: for clients, clinicians, and the system as a whole. In addition to the aforementioned benefits observed at the client level, MBC is beneficial to clinicians who are able to provide targeted care with objective feedback mechanisms in place, ultimately allowing clinicians to improve the quality of care that they provide. There are also broader MBC benefits at the system level that proponents of the practice have been advocating for over the last two decades. When data is aggregated across an entire mental health organization, it can provide invaluable information about the effectiveness of mental health services. This data can be used to demonstrate the value of mental health services to insurance payers, which can inform reimbursement policies and improve funding allocated towards mental health care across the U.S. The solution to quality, accessible mental health services is multimodal, and MBC holds an important role in improving how care is currently delivered.

At Two Chairs, we are working towards meeting the nation's need for high-quality mental health care through thoughtfully-designed clinics that aim to support growth and healing. Innovation lies in the way in which technology and data enable care, but do not replace what we consider core to addressing mental health needs – in-person psychotherapy treatment.

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¹Lambert, M.J. (2017). Maximizing psychotherapy outcome beyond evidence-based medicine. Psychotherapy and Psychosomatics, 86, 80-89.

²Lewis, C.C., et al. (2019). Implementing measurement-based care in behavioral health: A review. JAMA Psychiatry, 76(3), 324-335.