A Qualitative Examination of Facilitators and Barriers to MBC Utilization in Post-Graduate Clinicians

Abstract

Measurement-Based Care (MBC) is an evidence-based practice involving the systematic collection of data via Patient Reported Outcome Measures (PROMs), sharing of that data, and collaboratively acting on that data to guide decision making in the therapy room. These three components are well described and widely accepted as the Collect-Share-Act model of MBC. Despite strong evidence for its effectiveness, implementation remains rare. Implementation of full fidelity MBC, that is, MBC with all components being utilized, is even more rare. Often, MBC is limited to the initial collection of measures without consistent feedback or action. The present qualitative study explored how post-graduate clinical psychologists trained in MBC during their doctoral program sustain, adapt, or discontinue its use in clinical practice. Fourteen clinicians were interviewed about their experiences using MBC within the context of the CSA model after graduation, and their responses were analyzed through reflexive thematic analysis. Five overarching themes emerged from the data: 1) Sharing is Where MBC Lives or Dies, 2) Systems Make MBC Possible (or Not), 3) Make Measures Serve the Person, 4) Learning by Doing Turns Data Into Action, and 5) Why Clinicians Still Believe in MBC. Our findings suggest that MBC's effectiveness may depend on simple, repeatable conditions such as usable data, session ready visuals, collaborative discussion, and concrete next steps, supported by appropriate organizational and training infrastructures. Implications are discussed for improving MBC fidelity, clinician training, and implementation within diverse real world mental health settings through future research studies.