Digital Assessment in Schools: Lessons for Implementing Measurement-Based Care

"A tool is only as good as the hand wielding it”

Improving access to quality mental health services is becoming an increasingly important area of focus for educational systems, with roughly 70% of mental health services among school-aged youth currently being provided through counseling centers on school campuses. While large organizations have increasingly embraced measurement-based care (MBC) to promote evidence-based assessment and treatment at scale, this practice remains underutilized among community-based mental health providers. This is especially the case for those who work in schools, largely due to the various factors that have traditionally been barriers to implementation, such as time and financial constraints as well as organizational difficulties that come with paper and pencil assessment reporting.

However, contemporary research has indicated that the use of technology can provide a viable way to enhance the implementation of MBC in order to improve treatment outcomes for youth and families seeking treatment in school settings. For example, a recent study published in Administration and Policy in Mental Health and Mental Health Services Research explored the user experience of electronic measurement feedback systems implemented in middle and high school mental health services. More specifically, researchers explored the topic of user preferences and perceptions of electronic measurement feedback systems in counseling by collecting both quantitative and qualitative data from interviews with middle and high school students who were receiving care in school-based counseling centers.

Using a randomized controlled design, providers were randomized to one of two conditions: an experimental group who was given access to an electronic measurement feedback system and received training on how to integrate MBC practices into their clinical work, and a control group that did not use electronic feedback systems or practice MBC. The measurement feedback system used in the study was an adaptation of the Mental Health Integrated Tracking System (MHITS), a web-based, HIPAA-compliant caseload management system that includes abilities to administer standardized instruments (e.g., screening questionnaires, outcome measures), display graphical results on progress over time, and provide data-driven recommendations based on severity or inadequate progress, among other features.

Interestingly, results of the study suggested that the impact of measurement feedback systems may have less to do with specific technology than it does with the way providers introduce and implement it with their clients. Although the middle and high school students interviewed generally had positive attitude about the technology, they were largely equivocal about the benefits of electronic measurement as part of their care. Rather, researchers noted “student experiences with and perceptions of assessment and measurement feedback systems were largely provider mediated.” Student experience of the technology was shaped by the way that their provider did (or did not) implement it within the course of care. Most providers failed to fully utilize the measurement feedback system or share potential benefits of the technology with their clients. As a result, student awareness of potential benefits was limited by a lack of exposure. However, when providers did make use of these potential benefits, student perceptions were significantly more favorable. For instance, only 20% of the study participants were shown a graph of their progress - but all who were shown this reported that seeing the graph to visualize their progress was helpful in their care.

Although there is wide support for the use of technology-enabled mental healthcare in general, results such as these point to the fact that simply having the technology isn’t where the magic happens. Researchers noted that, “there is an opportunity for improved provider training and support on the process and implementation of MBC,” and while this is certainly true in the context of school-based mental health, the truth is that many areas of mental healthcare are in need of additional resources for learning how to effectively integrate technology-enabled measurement into practice. This point is particularly important as results such as this show that client experience of MBC depends largely on the implementation and adequate knowledge and understanding from the provider. In this way, as counseling centers, clinics, and healthcare organizations increasingly add technologies to their treatment toolbox, it is essential that these technology companies provide not only the platform itself, but the knowledge, clinical guidance, and resources needed to effectively integrate these practices into routine clinical care. Such tools need to be developed and implemented in a manner that works for everyone involved in treatment - clients, providers, and organizations at large.

This examination of middle and high school student attitudes toward technology-driven care is invaluable to developing and implementing tools that are appropriate and effective for child-serving mental health contexts. Technology-enabled measurement can improve both the accessibility and effectiveness of mental health care throughout the field. Thoughtful product design is essential, but providers are just as vital to successful integration of new tools. While the study’s focus on younger users is particularly relevant to conversations about MBC in school mental health settings, its findings on the role of provider engagement will be of interest to practices across the discipline.

Mayworm, A. M., Kelly, B. M., Duong, M. T., & Lyon, A. R. (2020). Middle and High School Student Perspectives on Digitally-Delivered Mental Health Assessments and Measurement Feedback Systems. Administration and Policy in Mental Health and Mental Health Services Research.

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