Measurement-informed care is a collaborative process that advances service excellence

Measurement-informed care is a practice that involves the systematic use of standardized tools/measures to track symptoms, outcomes, and functional status of persons served over time. It is a collaborative process that involves the patient and provider regularly monitoring progress to identify areas for improvement and make better-informed decisions about treatment plans and interventions.

The standard requires the program to implement written procedures for measurement-informed care that:

1. Identify the tools to be used. The type of tool used should be appropriate to the person served and based on their needs and goals. Consideration should be given to cultural and linguistic backgrounds as well as reading level (when given to the person served to complete). Common examples of tools used in behavioral health include, but are not limited to: general mental health, substance use disorders, specific disorders, and quality of life.
2. Prescribe intervals for administration of the tools. The effectiveness of measurement-informed care relies on regular administration of the identified tools. The optimal frequency of assessments can vary depending on the person’s condition, treatment phase, and individual needs. However, common intervals include:
   • Baseline Assessment: Before starting treatment to establish a baseline.
   • Regular Monitoring: At specific intervals during treatment, such as weekly, bi-weekly, or monthly.
   • Critical Transition Points: At key moments, like the end of a treatment phase or before transitioning to a new phase of care.
   • As-Needed Assessments: When there are concerns about a person’s condition or when significant life events occur.
3. Specify how results will be shared with persons served. Sharing the results of screening/assessment tools with the persons served can have a significant treatment impact. Examples include: enhanced engagement, improved treatment adherence, enhanced therapeutic alliance, improved treatment outcomes, and increased satisfaction.
4. Identify personnel training required. Considerations for personnel training may include reasons for implementation of MIC, training on the scoring and meaning of tools selected, expectations for frequency of administration, information technology or data requirements related to the administration of tools, and clinical training on responding to results.

Discussion with two of CARF’s Managing Directors about the new standard.

From Senior Managing Director of Behavioral Health Michael Johnson.

Q: Why did CARF decide to establish the Measurement-Informed Care Standard?

A: CARF has historically supported measurement-based care initiatives as part of performance measurement and management activities. As measurement-based care has become more widely adopted in the health and human services arena, we felt it was time to clearly define activities that support measuring the impact of services to persons served.

CARF uses the naming of “measurement-informed care” rather than “measurement-based care.” The reason is that in much of medicine, there are standard protocols for care based on the tests, labs, etc. Although there is still provider judgement in how to proceed, the results of the tests are what the protocols are based on. In behavioral health, often there are not clear protocols to implement in response to the results of the scale or instrument used to determine the impact of services for a person. So, the interventions implemented for persons served are informed by the results, not based on the results.

Q: What is the key factor of measurement-informed care and why is it worthwhile to implement?

A: The key factor to MIC is selection of the tool(s) an organization will use with their population served—and these tools should be standardized, reliable, and psychometrically sound.

There are a number of reasons to implement measurement-informed care. It is becoming a standard practice in healthcare and accredited organizations should utilize sound methods to be able to articulate the value of their care delivery systems using common tools. This helps the person served know what is and what isn’t working for them. It can signal early signs of decompensation or relapse and allow clinicians to intervene earlier in the process. This process of care enhances engagement in treatment because it informs the person served about their progress in an objective manner and supports them to more frequently monitor themselves—which often can lead to faster improvement of symptoms and functioning.

Q: What are the essential steps in implementing MIC?

A: Organizations will need to evaluate tools for their populations, select the one(s) they are going to use for their programs/services, update their EHR to capture the data collected, train staff, and review results. It could take an organization several months from start to initial data collection. Implementation (when effective) could take significant time, yet it is worth the overall investment.

From Managing Director of Child and Youth Services Theresa Lindberg.

Q. Why is MIC important and worthwhile?

A. MIC is important because it can be used in conjunction with qualitative and biometric information to inform treatment decisions and service planning. It is valuable and worthwhile because it can help to show clinical progress, efficiency of the care/services, and be an indicator of accountability to all stakeholders.

Q. What does MIC look like for a child and youth services organization?

A. MIC is similar to what would be used in adult serving programs, except the tools would likely be different or modified for child and youth populations. Family involvement and feedback should also be considered and collected, when appropriate.

Q. What kind of tools are used for MIC in child and youth services? How do you get the person served, family, and support system’s response?

A. There are tools that the child/youth can answer themselves, and there are also tools that incorporate both the child’s/youth’s feedback as well as from family and other significant support systems (school, child welfare, etc.). Organizations should consider the following when choosing tools: developmental stage, comprehension level, use of age-appropriate language, and the time it takes to complete the tool.

Advancing service excellence

The new MIC standard is in Section 2.A. of the 2025 Behavioral Health, Child and Youth Services, and Opioid Treatment Program Standards Manuals to enhance the clinical treatment process. CARF strives to continuously advance service excellence through a consultative peer-review survey process that affirms conformance to evolving, international consensus standards.