Manage Your Behavioral Health Clients Based on Treatment Trajectories

By the Tridiuum Clinical Science and Innovation (CSI) team, with guide by Cori McMahon, PsyD, NCCE (VP of Clinical Services)

View the complete version of our guide to treatment trajectories in PDF format.

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When it comes to measurement-based care, what exactly are we talking about? To put it simply, it is the process of conducting routine assessments and using those results in-session to drive treatment discussions and plans.

Measurement-Based Care is a collaborative process of engaging patients in discussion about outcome, the therapeutic alliance, and all aspects that impact their care. It connects symptoms and other variables to what the client wants from their care, and uses measurement to inform and help focus clinical conversation. Principally, it privileges the patient’s voice about what is working for them and what is not.

Key Components of MBC
Measurement-Based Care includes four components: routine assessment, clinician review of the results, sharing those results and eliciting feedback from the patient, and then applying those results to treatment planning in a collaborative effort between patient and provider. Formal feedback of measurement-base care allows us to  appreciate improved outcomes, identify those at risk for treatment failure or dropout, decrease the chance of deterioration, and improve therapeutic alliance.

Watch Dr. Cori McMahon’s detailed walkthrough to leverage measurement-based care and treatment trajectories with the Tridiuum ONE® platform.

Patient Treatment Trajectories: Positive Outcomes

It’s important to know that patients who progress usually do so early in treatment. Recognizing which pattern your patient is following can maximize the effectiveness and efficiency of care. This one is showing gradual improvement, the most common one we’ll see. It’s most helpful to look at the overall trend.

The fast improvement trajectory shows early change, which is well established in the literature, and is predictive of later positive outcomes. Most change will occur prior to the fifth session.

This last positive outcome shows slow traction, a slow rate of change through session three, followed by a quickened pace. This might suggest the need for greater treatment intensity prior to session five. This pattern may make you and your patient feel frustrated. In this case, it will be helpful to manage expectations and focus on education and social support.

Patient Treatment Trajectories: Negative Outcomes

Even with the best treatment, not all patients get better. Treatment failure is a difficult subject, but research suggests that 30–50% of patients do not improve by the end of treatment. Approximately 5–20% show deterioration (left) during treatment, and another third or so will show no change at all (right).

Treatment failure can be hard to detect without objective data from routine assessment. Unfortunately, only 1 in 5 mental health providers detect deterioration. With formal outcome monitoring, 85% of these patients can be determined by the third session and the appropriate steps can be taken. In the case of deterioration, consider whether it is due to treatment emergent reactions, effects of life events, or maybe new symptoms. You might begin by addressing lack of progress with your patients and consider alternate treatment options.

Patient Treatment Trajectories: Low Information

Low information trajectories are so named because the data does little to inform the treatment process. A subclinical trajectory (left) shows that the patient has been maintaining a low level of severity since treatment began. The need for treatment is in question. You might offer lower intensity resources like wellness apps or coaching. Maybe this patient’s specific presenting problem is not represented on the assessment. This would require further assessment.

A fluctuating trajectory (right) is a “red flag” pattern that may mean that a client does not fully understand the assessment questions, or they have answered them in response to short-term immediate stressors as opposed to longer-term problems. In this case, you might refocus discussion on the reasons for seeking treatment and relate the assessments to tracking longer-term issues.

View the complete version of our guide to treatment trajectories in PDF format.

View guide