BHCS is very lucky to have Kenzie share her work on our blog. Kenzie is seeking her master's in counseling at Montana State University and will be joining our team as a counseling intern in September. In this article Kenzie evaluates our assessment process and identifies additional assessment tools we can add to support our patients. We are excited for her to join our team and share her work with you.
Behavioral Health Consulting (BHC) is based in Bozeman, MT and was founded to address growing suicide rates in the state of Montana with the use of evidenced-based practices and diagnostic tools to best understand and address client's needs. BHC serves individuals of all ages, families, and healthcare providers to provide assessments, treatment, and consultation.
Outcomes are tracked through a software database called Seidr, where initial and follow up assessments are reviewed to track changes and trends in client progress. Seidr was designed for BHC and is currently used exclusively within this practice to track twelve main screening tools to include PHQ-9, GAD-7, DAST-10, MDQ, PCL-C, ASRS, AQ-10 and WHO-5. BHC staff create custom questionnaires to gather family information, developmental history, medication history, basic needs, and social history in addition to the evidence-based tools. Follow up assessments may happen as frequently as every 1-2 times per month or a minimum every 6-months.
The current screening, assessment, validation, and outcome tracking at BHC is rather robust. Each client is given a tailored bundle of assessments that most align with their symptoms, history, and current complaint. Additional tools such as AQ50, CATQ, PTQ, ASRS v1.1, PTQ, ITQ or PMDD may be used to validate scores, check for masking or additional information not captured in the original bundled assessment. Scores are entered into Seidr which calculates each client's severity and risk which produces a recommended intervention report to guide clinicians' intervention and treatment plan. Current research is consulted prior to meeting with the client to discuss a treatment plan and physical health and comorbidities are discussed to best understand what else may be contributing factors to the client's mental health.
As BHC implements a vast battery of assessments, the focus of this research was on what may be missed in formal assessments and what tools may be implemented at BHC to best capture a holistic picture of each client's needs and well-being.
There is a growing body of research, primarily completed in Europe, looking at the value of qualitative information that formal assessments may not capture. The idea behind this research is every client has unique difficulties and priorities with a vast array of contributing factors. To accurately capture individual needs, it may be helpful to gather open-ended questions through individualized patient-reported outcome measures (I-PROMS) to capture the context in which each client is living. These questionnaires are often referred to as Phycological Outcome Profiles (PSYCHLOPS) (Sales et al. 2013).
The research found clients reported at least one item that was not found on their formal assessments such as CORE-OM or PHQ-9 (Sales et al, 2013). PSYCHLOPS assessments were able to capture information about sleep disturbances, academic problems, treatment concerns, depression, and anxiety information in eating disorder clients that EDE-Q and CIA did not capture (Austin et al. 2020).
PSYCHLOPS help clinicians and clients better understand unique needs, contributing factors and context for mental health concerns. The more robust picture the client and clinician have, the more informed, accurate and timely the treatment may become. As BHC already has a database to track outcomes and is asking questions about physical health, family history, social support, medical history, basic needs, and developmental questions in addition to formal assessments, there is an opportunity to add in a PSYCHLOPS questionnaire when asking about other contributing factors in the clients' life to verify any missing information.
During the initial creation of bundled assessment, a PSYCHLOPS questionnaire may be added to all initial bundles to begin to capture qualitative information that may be missed in their formal assessments. A pathway for PSYCHLOPS data will need to be created in Seidr to be considered when generating individual client risk and recommendations in the triage process and tracked throughout treatment. Ideally, by capturing more qualitative data in the initial assessment, clinicians will have a clearer picture of client needs and tailor additional assessments and treatments to best serve the client.
Austin, A., Potterton, R., Flynn, M., Richards, K., Allen, K., Grant, N., ... & Schmidt, U. (2021). Exploring the use of individualized patient-reported outcome measures in eating disorders: Validation of the Psychological Outcome Profiles. European Eating Disorders Review, 29(2), 281-291.
Sales, C. M., Neves, I. T., Alves, P. G., & Ashworth, M. (2018). Capturing and missing the patient's story through outcome measures: A thematic comparison of patient-generated items in PSYCHLOPS with CORE-OM and PHQ-9. Health expectations : an international journal of public participation in health care and health policy, 21(3), 615-619. Link