Abstract
Regularly administering outcome measures to clients to inform clinical decision making (measurement-based care [MBC]) has the potential to improve mental health treatment broadly, but only about 20% of clinicians regularly use MBC. The current study will assess predictors of high-fidelity MBC implementation such as client and clinician demographic/background predictors, clinician attitudes towards MBC, and the time clinicians spent in consultation on use of MBC. Participants included 31 clinicians and 56 youth in the MBC condition of a randomized controlled trial. Use of MBC was measured using the Implementation Index, which combines the rates of administering and viewing questionnaires, using objective data from the online MBC system. Multi-level modeling was used to examine the proposed aims controlling for research site. Cases with youth identifying as Latinx/Hispanic (p = .007), youth who identify as White (p = .012), and youth whose families have higher incomes (p = 0.029) had significantly higher MBC fidelity. Clinicians being trainees predicted a higher MBC fidelity (p = .039). Clinicians having more positive attitudes towards EBPs score (p = 0.007) and EBPAS Appeal subscale score (p = 0.017) were significantly associated with a lower MBC fidelity. Clinician MBC-specific attitudes were not significantly associated with the MBC fidelity (ps > .05). More time spent discussing a case in consultation significantly predicted a higher Implementation Index (p < .001). For every 30 minutes spent discussing a case in consultation, the case’s MBC fidelity increased by 7.8%. More time spent discussing a case in consultation significantly predicted higher rates of administration (p = 0.030) and feedback report viewing (p < .001). This study contributes to the mixed literature surrounding client and clinician- predictors of MBC fidelity, though may be underpowered to detect effects. More consultation at the case level predicts greater MBC use using objective measures. The results of this study can help inform future efforts to increase the fidelity with which MBC is delivered.