A Pilot Project to Integrate Individualized Measurement Into Measurement-Based Care in a Child Partial Hospitalization Program

Abstract

Measurement-based care (MBC), or the regular use of progress measures to inform clinical decision-making, improves quality of care and clinical outcomes. MBC typically focuses on standardized rather than individualized outcome measurement. In this pilot study, we examined the clinical utility of integrating individualized measurement with existing standardized outcome monitoring in a children’s partial hospitalization program. Participants were 48 youth (M age 10.13 ± 1.39; 54.2% male, 41.7% female, 4.2% transgender or nonbinary). Comorbidity was common; 83.4% of youth had more than one diagnosis at intake. Using the Youth Top Problems for individualized outcome measurement, we examined Top Problem content and clinical improvement over time. Finally, we examined completion rates and describe implementation issues. Top Problems were heterogeneous and sensitive to change. Of the 144 problems, 107 (74%) had a focus consistent with measures used in program, while 37 (26%) were not captured by standardized measures used in program. Effect sizes from admission to final measurement ranged from Cohen’s d = .75 – 1.00. Initial adoption of the MBC was strong, but sustained use of the system over the treatment course was challenging. Individualized outcome measurement in children’s partial hospitalization programs is feasible to administer and sensitive to clinical change that is unique from change captured in standardized measures. Parents were able to self-identify clinically meaningful, highly individualized Top Problems. Challenges of implementation and clinical assessment in acute settings and potential strategies for improving implementation are discussed.