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Getting started with measurement-based care

Getting started with measurement-based care

Our integrated screening and progress monitoring tools can simplify the way you provide measurement-based care. You can now automatically send scored measures like the GAD-7, PHQ-9, and PCL-5 to your clients on a recurring basis. When a measure is completed, the score will be calculated for you, and you’ll be able to view the client's progress over time on the Measures tab of their profile.

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In this guide, we’ll cover:


Understanding scored measures

Scored measures are self-report assessment tools that can be used to screen for mental health conditions and evaluate treatment progress. The following scored measures are available in SimplePractice:


Enabling scored measures

To add a scored measure to your account:

  • Navigate to Settings > Documentation > Template library
  • Select View pre-built templates
  • Click + Add next to the scored measure you’d like to add

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Note: Only Account Owners, clinicians with entire practice access, and practice managers can manage templates in a group practice account. To learn more, see Team member roles and access levels.

The scored measure will be added to your Template library page. While there’s no way to edit a scored measure, you can preview it by clicking the eye icon.

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Note: A template must be enabled on the Template library page to be available to share with clients. If you previously removed a scored measure, you can navigate to Settings > Documentation > Template library and check the box for the template you’d like to reenable.


Scheduling recurring measures

To schedule measures to be automatically sent to clients on a recurring basis:

  • Navigate to the client’s Overview page
  • Click Share
  • Check the box next to the scored measure(s) you want to share
  • Choose the Frequency
    • Once
    • Before every appointment
    • Before every other appointment
    • Every 2 weeks
    • Every 4 weeks

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Note: Only scored measures can be scheduled to send automatically.

  • Click Continue to Email
  • Follow the prompts to schedule the recurring item(s)

Note: You can edit the Recurring measure request email template at Settings > Client notifications > Email. For an overview of the paperless intake process, see Sending intake forms and documents to clients.

If you choose Before every appointment or Before every other appointment, the measure will be automatically sent 24 hours before the client’s next appointment. If the appointment is less than 24 hours away, the first measure will be sent immediately. Clients who haven’t completed a scored measure will also receive an email 1 hour before their appointment.

If you choose Every 2 weeks or Every 4 weeks, the measure will be sent at that time, regardless of whether the client has an appointment scheduled for that week. You have the option of editing the date of the First share when you schedule the measure, if needed.

To remove a scheduled recurrence:

  • Navigate to the client’s Overview page
  • Select the Files tab
  • Locate the scheduled measure
  • Select the 3 horizontal dots next to it > Delete

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  • Select End recurrence

To change the frequency of a recurrence, you can delete the scheduled measure and reshare it with the desired frequency.

Note: To learn more about using the Files tab, see Managing the client Files Overview page.


Completing scored measures on behalf of a client

If your client doesn’t use the Client Portal, or if you’d like to complete a measure while in session, you can complete the measure from the client's profile. To do this:

  • Navigate to the client’s Overview page
  • Select New > Scored measure

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  • If the client is part a couple or has a contact, you’ll be prompted to select whom you want to complete the measure for
  • Select Continue to Scored measure
  • From the dropdown, select the measure you’d like to complete

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  • After completing the measure, click Save

The completed measure will be added to the client's profile, with a caption indicating that it was completed by a clinician on behalf of the client.

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Note: To learn how to share measures with clients to complete via the Client Portal, see Scheduling recurring measures.


Viewing scores and completed measures

Measures completed by clients will be scored automatically. You can review the client's score and responses from their Overview page. To do this:

  • Click All Items
  • Select Scored measure from the dropdown menu

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  • Click the completed measure you’d like to view

Along with the client’s responses to each question, you’ll see a Score and a Scoring interpretation. You can click View scoring guide for more information:

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Important: Some scored measures, like the PHQ-9, include questions about suicidality and self-harm. If a client answers affirmatively, a high-risk flag will display when you view their results. To learn more, see How is the high-risk flag generated on scored measures?


Visualizing scores over time

Routinely administering scored measures can help you track a client’s progress over time and identify patterns or trends. To view this data:

  • Navigate to the client’s Overview page
  • Select the Measures tab

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If the client has completed a measure multiple times, each score will be displayed on the graph, along with the change since the first measure they completed (since baseline) and their most recently completed measure (since last).


FAQs


What is the GAD-7?

The Generalized Anxiety Disorder 7-item scale, or GAD-7, is a tool designed to measure the presence and severity of anxiety. It includes the following questions:

Over the last 2 weeks, how often have you been bothered by the following problems?
1. Feeling nervous, anxious, or on edge Not at all (0) Several days (1) Over half the days (2) Nearly every day (3)
2. Not being able to stop or control worrying Not at all (0) Several days (1) Over half the days (2) Nearly every day (3)
3. Worrying too much about different things Not at all (0) Several days (1) Over half the days (2) Nearly every day (3)
4. Trouble relaxing Not at all (0) Several days (1) Over half the days (2) Nearly every day (3)
5. Being so restless that it’s hard to sit still Not at all (0) Several days (1) Over half the days (2) Nearly every day (3)
6. Becoming easily annoyed or irritable Not at all (0) Several days (1) Over half the days (2) Nearly every day (3)
7. Feeling afraid as if something awful might happen Not at all (0) Several days (1) Over half the days (2) Nearly every day (3)
If you checked off any problems, how difficult have these made it for you to do your work, take care of things at home, or get along with other people? Not difficult at all Somewhat difficult Very difficult Extremely difficult

The GAD-7 is calculated by assigning a score of 0, 1, 2, or 3 to the answers to questions 1-7, and the total score ranges from 0 to 21.

Score Anxiety severity
0-4  None-minimal
5-9  Mild
10-14 Moderate
15-21 Severe

This tool was developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues.


What is the PHQ-9?

The Patient Health Questionnaire-9, or PHQ-9, is a tool designed to measure the presence and severity of depression. It includes the following questions:

Over the last 2 weeks, how often have you been bothered by any of the following?
1. Little interest or pleasure in doing things Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)
2. Feeling down, depressed, or hopeless Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)
3. Trouble falling or staying asleep, or sleeping too much Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)
4. Feeling tired or having little energy Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)
5. Poor appetite or overeating Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)
6. Feeling bad about yourself—or that you are a failure or have let yourself or your family down Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)
7. Trouble concentrating on things, such as reading the newspaper or watching television Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)
8. Moving or speaking so slowly that other people could have noticed? Or the opposite—being so fidgety or restless that you have been moving around a lot more than usual Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)
9. Thoughts that you would be better off dead or of hurting yourself in some way Not at all (0) Several days (1) More than half the days (2) Nearly every day (3)
If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people? Not difficult at all Somewhat difficult Very difficult Extremely difficult

The PHQ-9 is calculated by assigning scores of 0, 1, 2, or 3 to answers for questions 1-9, and the total score ranges from 0 to 27.

Score Depression severity
0-4  None-minimal
5-9  Mild
10-14 Moderate
15-19 Moderately Severe
20-27 Severe

This tool was developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, and colleagues.


What is the PCL-5?

The PTSD Checklist for DSM-5, or PCL-5, is a tool designed to measure the presence and severity of Post-Traumatic Stress Disorder (PTSD) symptoms. It includes the following questions:

In the past month, how much were you bothered by:
1. Repeated, disturbing, and unwanted memories of the stressful experience?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
2. Repeated, disturbing dreams of the stressful experience? Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
3. Suddenly feeling or acting as if the stressful experience were actually happening again (as if you were actually back there reliving it)?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
4. Feeling very upset when something reminded you of the stressful experience? Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
5. Having strong physical reactions when something reminded you of the stressful experience (for example, heart pounding, trouble breathing, sweating)?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
6. Avoiding memories, thoughts, or feelings related to the stressful experience?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
7. Avoiding external reminders of the stressful experience (for example, people, places, conversations, activities, objects, or situations)?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
8. Trouble remembering important parts of the stressful experience? Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
9. Having strong negative beliefs about yourself, other people, or the world (for example, having thoughts such as: I am bad, there is something seriously wrong with me, no one can be trusted, the world is completely dangerous)?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
10. Blaming yourself or someone else for the stressful experience or what happened after it?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
11. Having strong negative feelings such as fear, horror, anger, guilt, or shame?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
12. Loss of interest in activities that you used to enjoy?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
13. Feeling distant or cut off from other people?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
14. Trouble experiencing positive feelings (for example, being unable to feel happiness or have loving feelings for people close to you)?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
15. Irritable behavior, angry outbursts, or acting aggressively?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
16. Taking too many risks or doing things that could cause you harm?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
17. Being “superalert” or watchful or on guard?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
18. Feeling jumpy or easily startled?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
19. Having difficulty concentrating?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)
20. Trouble falling or staying asleep?  Not at all (0) A little bit (1) Moderately (2) Quite a bit (3) Extremely (4)

The PCL-5 is calculated by assigning a score of 0, 1, 2, 3, or 4 to the answers to questions 1-20, and the total score ranges from 0 to 80.

Score PTSD severity
0–31 Below clinical threshold
32–80 Above clinical threshold

This tool was developed by Weathers, F.W., Litz, B.T., Keane, T.M., Palmieri, P.A., Marx, B.P., & Schnurr, P.P.


What is the AUDIT?

The Alcohol Use Disorders Identification Test: Self-Report Version, or AUDIT, is a tool designed to screen for excessive alcohol consumption, consequences of drinking, and alcohol related symptoms. It includes the following questions:

Select the option that best describes your answer to each question:
1. How often do you have a drink containing alcohol? Never (0) Monthly or less (1) 2-4 times a month (2) 2-3 times a week (3) 4 or more times a week (4)
2. How many drinks containing alcohol do you have on a typical day when you are drinking? 1 or 2 (0) 3 or 4 (1) 5 or 6 (2) 7 to 9 (3) 10 or more (4)
3. How often do you have six or more drinks on one occasion?  Never (0) Less than monthly (1) Monthly (2) Weekly (3) Daily or almost daily (4)
4. How often during the last year have you found that you were not able to stop drinking once you had started? Never (0) Less than monthly (1) Monthly (2) Weekly (3) Daily or almost daily (4)
5. How often during the last year have you failed to do what was normally expected of you because of drinking? Never (0) Less than monthly (1) Monthly (2) Weekly (3) Daily or almost daily (4)
6. How often during the last year have you needed a first drink in the morning to get yourself going after a heavy drinking session? Never (0) Less than monthly (1) Monthly (2) Weekly (3) Daily or almost daily (4)
7. How often during the last year have you had a feeling of guilt or remorse after drinking? Never (0) Less than monthly (1) Monthly (2) Weekly (3) Daily or almost daily (4)
8. How often during the last year have you been unable to remember what happened the night before because of your drinking? Never (0) Less than monthly (1) Monthly (2) Weekly (3) Daily or almost daily (4)
9. Have you or someone else been injured because of your drinking? No (0)   Yes, but not in the last year (2)   Yes, during the last year (4)
10. Has a relative, friend, doctor, or other health care worker been concerned about your drinking or suggested you cut down? No (0)   Yes, but not in the last year (2)   Yes, during the last year (4)

The AUDIT is calculated by assigning a score of 0, 1, 2, 3, or 4 to the answers to questions 1-8, and a score of 0, 2, or 4 to questions 9 and 10. The total score ranges from 0 to 40.

Score Risk category Interpretation content
0–7 Zone I Low-risk drinking or abstinence
8-15 Zone II At-risk use
16-19 Zone III Harmful and hazardous use
20-40 Zone IV Possible substance use disorder

The AUDIT can be broken into 3 conceptual domains:

  • Alcohol consumption (items 1-3)
  • Alcohol-related symptoms (items 4-6)
  • Alcohol-related harm (7-10)

Sources

  • Babor, T. F. , Higgins-Biddle, J. C. , Saunders, J. B. , Monteiro, M. G. , & World Health Organization. (2001). AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for use in primary health care (2nd ed.). Geneva, Switzerland: World Health Organization.
  • Saunders, J. B., Aasland, O. G., Babor, T. F., De La Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption-II. Addiction, 88(6), 791–804.

What is the source for the scoring interpretations?

Each measure and the corresponding scoring information are reproduced directly from source material and supporting literature. You can view the Sources on the scoring guide, as well as at the bottom of each completed measure:

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How is the high-risk flag generated on scored measures?

Some measures, like the PHQ-9, include questions related to suicidal ideation. If a client reports that they’ve had thoughts of suicide or self-harm Several days, More than half the days, or Nearly every day, this will be indicated by a high-risk flag when you view their results.

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If a client respond affirmatively to a suicidal ideation question, they’ll see the following modal upon submitting the measure:

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Will scored measures that my clients previously completed as intake forms be scored and graphed?

GAD-7, PHQ-9, PCL-5, or AUDIT intake forms that have been previously completed by clients won't be scored or graphed on the client's Measures tab. To view all completed GAD-7, PHQ-9, or PCL-5 questionnaires:

  • Navigate to the client’s Overview page
  • Select All Items > Scored measure

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Can my client still complete a scheduled measure after an appointment?

If a client didn’t complete a measure before their appointment, they can still do so afterwards. For scheduled measures, clients receive an automated email 24 hours before their next appointment, as well as 1 hour before their appointment if the measure hasn't yet been completed.

Note: You can also manually send clients a reminder to complete Pending documents at any time. For more information, see Sending a reminder for pending forms, documents, or uploaded files.

You can check the status of a client’s scheduled scored measure from the appointment flyout. Under Scored measures, hover over the measure to view its status.

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Note: Only team members with permission to view scored measures will see the Scored measures section when viewing an appointment. To learn more, see Team member roles and access levels.

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