Reaching Better Behavioral Health Outcomes
with Mental Health Tools

Chapter 2:

Overview of Mental Health Assessment Tools

It’s essential to understand the main components of mental health assessments to better ensure you select the ideal evidence-based tools for your organization and effectively leverage these helpful solutions. 

What Are the Five Main Components of Mental Health Assessments? 

Mental health assessments are examinations used to ascertain whether a person is healthy psychologically and socially and is generally developing and/or living well. Critical at every stage of life, assessments are often used to screen for mental health disorders like depression or neurological diseases such as Alzheimer's. 

What Is Included in a Mental Health Assessment 

A "mental status evaluation" (MSE) is commonly used to assess a patient's behavioral and cognitive functioning and helps ensure an accurate psychiatric evaluation. When performed effectively, an MSE illuminates signs and symptoms of a mental illness or its risk factors. An MSE can also help determine a working diagnosis and establish areas of potentially worthwhile intervention. 

Let's look at the five main areas of focus for performing an effective MSE. 

1. General appearance and behavior

   A patient’s appearance may provide clues about their mental state. Key factors include whether patients look appropriate for their chronological age, including how they dress, and whether they can maintain eye contact. In addition, assessing a patient’s appearance and behavior can help identify problems with alcohol and substance use.

2. Mood and affect

   A patient’s mood and their affect — which refers to expressions reflected in movements or changes in voice tone, posture or stance — are related to emotion, and both should be aligned. The subjective and objective aspects of mood must be assessed. 

3. Thought content

   A health provider must ask direct questions to better determine a patient's train of thought. Are their thoughts logical or consistent? Are they blocking any thoughts? Through this process, providers can often detect negative feelings, such as hopelessness.  

4. Cognitive functioning

   Cognitive functioning relates to intellectual abilities. Assessing a patient’s capacity to read, write and immediately remember significant events in the recent past can help a provider determine if a patient can recognize familiar people and places. Cognitive functioning also includes the ability to focus or perform simple calculations.  

5. Judgment and insight

   Judgment is determined by how well a patient solves problems and makes informed choices. Insight is evaluated by gathering as much information as possible from the patient’s perspective. Topics covered can include the reasoning for a visit to a behavioral health specialist and an understanding of the challenges that have led to the visit.

Building on the Mental Status Examination (MSE): Cognitive Assessment  

After an MSE is used, a health provider can conduct a more thorough investigation using a cognitive evaluation in which neurological and psychological functions are assessed. The cognitive assessment evaluates:  

• Attention

• Language  

• Memory

• Praxis (i.e., the process by which a skill is enacted or the performance of an action)

• Prosody (i.e., rhythm, stress, and intonation of speech)

• Thought content 

• Visuospatial proficiency (i.e., ability to perceive and manipulate objects and shapes in space) 

• Executive function

• Orientation

• Thought process

• Gnosia (i.e., ability to recognize and identify)

The cognitive assessment may also include a brief standardized tool, such as the mini-mental state examination (MMSE). The purpose of an MMSE can be better understood by comparing it to the MSE.

What Is the Difference Between MSE and MMSE?

Initially, a clinician will use an MSE for evaluation. Other standardized assessment tools may be used if more comprehensive examination is needed. Enter the MMSE. Whereas the MSE is a brief neuropsychological screening test, the MMSE is used for more detailed testing in the cognitive section of MSE to help remove ambiguity in the initial screening.  

Now let's examine the different types of assessment tools in more detail. 

Standardized Mental Health Assessment Tools, PDFs and Checklists  

Professionals use various approaches to understand mental health and evaluate the extent of a mental disorder. Assessment tools are among the most reliable tools available to mental health professionals for gathering patient information.  

What Are the Different Types of Mental Health Assessments?

The most common standardized mental health assessment tools used to diagnose mental disorders include the following: 

1. Clinical assessments and mental health screening questionnaires

   These tools evaluate patients’ medical, physical, psychological, cognitive and behavioral history as well as their current conditions to diagnose the presence of mental disorders. The assessment can be initiated by a mental health expert or patient. 

2. Clinical interview

   In a clinical interview, the mental health professional can observe the patient’s behavior and reactions to real-life situations — information that cannot be gleaned through a formal test. 

3. Psychometric testing

   Formal personality, cognitive, psychological, behavioral and emotional function tests are examples of psychometric testing. Although critical for diagnosing mental health disorders, these tests require specialized training to assess, score and interpret. 

4. Physical and laboratory testing

   Physical and laboratory tests are meant to verify that the patient doesn’t have physical problems causing a mental disorder. Areas covered can include a patient’s genetic profile, hormone levels, immune system, energy metabolism and nutritional status. 

5. Multidisciplinary assessment

   Based on techniques from multiple disciplines, this type of assessment helps to develop a clearer picture of the whole person. Some of the professionals who can assist include audiologists, speech therapists, religious specialists and vocational rehabilitation specialists. 

Putting together a comprehensive list of assessment tools is a great step, but it's imperative that you follow this effort by determining the effectiveness of the tools you are considering before you select them. 

Chapter 3:

Improving Mental Health Care: The Move to Measurement-Based Care

It’s become generally accepted that to deliver optimal mental healthcare services, organizations must pursue evidence-based practices, measure progress and outcomes, and adapt care plans as needed.  

What Is Quality Improvement in Healthcare? Role of QI in Mental Health

What can be done to help behavioral healthcare providers accomplish these crucial goals that contribute to better mental health diagnoses and outcomes for patients? Enter quality improvement. 

What is Quality Improvement in Healthcare? 

The Centers for Medicare & Medicaid Services (CMS) defines quality improvement as “the framework used to systemically improve care.” Quality improvement in healthcare aims to standardize processes and structure to: 

• reduce variation;

• achieve predictable results; and

• improve outcomes for patients.

Measurement is critical in developing systems that will decrease variation and strengthen outcomes. Within behavioral health, clinicians must be able to measure initial symptom levels, changes in treatment, and outcomes to inform best practices and identify opportunities for improvement. 

Quality Improvement Tools in Healthcare: Systems of Measurement 

Behavioral health lacks the observable and quantifiable vital signs available to other medical specialties focused on physical health (for example, measuring cardiac health through heart rate and blood oxygenation levels). As a result, behavioral health measures largely rely on self-reported assessments. 

Examples of widely accepted self-reported data in behavioral health measurement may include information gathered through tools like screeners, diagnostic interviews and monitors that track behavioral experience or frequency of behaviors. Combined with consistent care practices that include clinical follow-up, this self-reported data should help predict outcomes at the patient population level. By using such data, clinicians can also take the most appropriate steps that will lead to better decisions and healthier minds. As such, data collection must be reliable, interpretable and scalable. 

Measurement-based care (MBC) in behavioral health includes four components:

1. Administration of validated self-report measures to patients before treatment sessions

2. Clinician review of numerical and graphical scores over time

3. Feedback on this data back to patients

4. Collaborative evaluation of the results to determine maintenance or change in treatment course

How to Measure Quality Improvement in Healthcare  

When measurement-based care is put into practice, the results can be powerful. MBC has been shown to affect the course of treatment through symptom monitoring, which enhances clinical judgments and patient-provider communications. 

As researchers have demonstrated, when MBC is embedded into existing technologies and incorporated into the culture of treatment settings, significant improvement occurs in the quality of care provided. MBC offers insight into treatment progress, highlights ongoing treatment targets, reduces symptom deterioration and improves patient outcomes. When behavioral healthcare providers adopt the same measures and systems for measurement, developing evidence-based practices across patient populations becomes easier and more effective. 

Quality Improvement Process in Practice

Government organizations like the U.S. Department of Health & Human Services’ Substance Abuse and Mental Health Services Administration (SAMHSA) and private companies like Proem Behavioral Health are working to identify quality measures in behavioral health and create a framework for improvement. The Office of Management and Budget (OMB) has approved technical specifications and data-reporting templates to collect the 32 quality measures listed in the certified community behavioral health clinics' (CCBHCs) certification criteria. CCBHCs and their states are required to collect 21 of the measures for SAMHSA’s demonstration program. The program is designed to integrate behavioral health with physical healthcare and improve access to care. 

Much of this work is still being shaped. Some organizations, such as the National Committee for Quality Assurance (NCQA), believe that the measures still fall short. In Behavioral Health Quality Framework: A Roadmap for Using Measurement to Promote Joint Accountability and Whole-Person Care, the NCQA notes the following:

• Federal programs, especially those focused on behavioral healthcare, rely heavily on metrics and non-standardized quality measures, limiting use for benchmarking and value-based payment models.

• Standardized behavioral health quality measures used in federal programs focus on narrowly specified conditions or processes and are misaligned and used variably across programs.

• Behavioral health integration is inconsistently and insufficiently measured by current standardized measures. 

Even though there is work left to be done, clinicians can and should be moving toward launching and supporting quality improvement projects at their own organizations. 

Clinician's View of Quality Improvement

As the industry continues to identify the best metrics and framework to use for behavioral health quality improvement, clinicians can prepare by taking the following steps: 

1. Incorporate the constructs of measurement-based care into their processes. 

   By adopting universally accepted self-report screeners and structured assessment interviews, clinicians will become more comfortable with using data to screen, monitor and communicate treatment progress.

2. Use outcomes-based measures to track progress. 

   The main benefit of outcome measures is they are results focused. Clinicians should look for measures that support standardization, comparability, availability, timeliness, relevance, validity, stability and credibility.

3. Seek electronic solutions for tracking and monitoring progress. 

   QI efforts depend on clinicians’ ability to track and analyze large quantities of data over time. Organizations that can do so will not only be better positioned to bring about meaningful improvement, but they will also be able to manage the digital requirements for participation in the increasing number of payer quality improvement and value-based programs.

What to Know About Outcome Measures: Examples in Behavioral Health

Importance of Outcome Measures in Healthcare

Outcome measures, including behavioral health therapy outcome measures, play an important role in assessing the effects and results of interventions. With outcomes data, clinicians find themselves in a better position to:

• communicate progress objectively;

• identify whether interventions are improving the patient’s health status; and

• make evidence-based decisions on current and future interventions.

When patients receive feedback on outcome changes, studies show an increase in accuracy of diagnosis, better communication between patient and clinician, enhanced treatment monitoring, strengthened patient engagement and improved preservation of the positive effects of treatment. 

With measurable outcomes, a behavioral health care team can share knowledge of patient health status whether they are based in a primary care, mental health practice, school, hospital or other setting. When applied at a population health level, outcome measures can help identify best practices and predict which patients might benefit most from particular interventions.   

On the provider and payer side, outcome measures and measurement-based care are taking on greater significance because of the ongoing shift toward value-based care. As Proem Behavioral Health's Dr. Thomas Young notes, "Under a value-based model, If I'm going to make a stake in the ground for what is considered a valuable treatment for depression and expect a payer to pay for the care, I must see that the patient got better in 12 weeks. And then I must subsequently see that the patient maintains this improvement for up to 12 months. The ability for people to do that is through measurement-based outcomes."  

Let’s compare how outcome measures stack up to process-based measures to gain further insights into the importance of outcomes measurement. 

Self-report screeners and assessments can provide data that measures progress and wellness. For example, scales like the Sheehan Disability Scale or Sheehan Suicidality Tracking Scale can monitor patients’ state-of-mind and provide effective treatment progress indicators. Patient-reported outcome performance measures (PRO-PMs) include pain, functional limitations, energy and emotional distress. 

Both clinicians and patients can track outcome measures. Patient reports are particularly important because improvements or declines in mental health can be difficult for clinicians to actually “see.” 

Therapy Outcome Measures Examples

Assessing a patient’s baseline and determining the effect of an intervention can depend on the patient’s view of their symptoms or health. Thus, patient-report outcomes (PROMs) are often used, sometimes in combination with patient data reported by another individual. PROMs depend on self-report evaluations that often use rating scales or questionnaires. These outcome measurement tools can be generic or specific to conditions. 

When tracking therapy progress, most tools will measure one or more of the following four types of outcomes to some degree: 

1. Symptom and symptom burden

2. Health-related quality of life (including functional status)

3. Experience with care

4. Health behaviors

Therapy outcome measure examples include a patient with obsessive-compulsive behavior reporting the frequency of repetitive handwashing or a patient with anxiety being tracked for severity based on how often they are irritable and whether this impacts their ability to work. Developing and selecting suitable PROMs requires consideration of validity, sensitivity, reliability, suitability for generalization and feasibility.  

Now let’s explore how these concepts look when they are put into application in a clinical setting. 

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Chapter 4:

Incorporating Measurement-Based Care in Practice

How to Measure Progress Toward Mental Health Outcomes

Monitoring and measuring progress can be a major hurdle for mental health providers. Although most clinicians support these efforts, few employ them in practice. As an article published in Administration and Policy in Mental Health and Mental Health Services Research notes, “Numerous trials demonstrate that monitoring client progress and using feedback for clinical decision-making enhances treatment outcomes, but available data suggest these practices are rare in clinical settings.”  

For some clinicians, using outcome-focused progress measures requires shifting from measuring process to measuring outcomes. What does this mean? 

Getting Started with the Use of Outcomes-Focused Measures 

There is a wide range of outcome measurement tools for mental health that clinicians can use to help choose the best solutions to support patients with mental illness. The Kennedy Forum, for instance, has published “A Core Set of Outcome Measures for Behavioral Health Across Service Settings.” 

Healthcare organizations and their providers should consider the different types of patients they treat based on specific diagnoses as well as the desired outcomes and methods of evaluating those desired outcomes through physician and patient reporting. In addition, patients can offer input as to the types of outcomes they would consider signs of their own improvement. Clinicians can then incorporate these measures into care plans.  

What do clinical providers think about outcome measurement? Let's take a look.  

Understanding Outcome Measurement:  Mental Health Experts Share Insight

Proem (formerly nView Health) hosted a webinar on "Impact of Outcome Measurement in Mental Healthcare: A Panel Discussion." This webinar, available as an on-demand recording, brought together behavioral health experts to discuss outcome measurement and measurement-based care and the role healthcare providers can and should play in behavioral healthcare. The panelists were Dr. Jennifer Birdsall and Dr. Joseph Shonkwiler. The program was moderated by Dr. Thomas Young, a board-certified family physician and the chief medical officer and founder of Proem.

The following is an excerpt from the webinar. It has been edited for length and clarity. 

Improving Behavioral Health Outcomes with the Right Mental Health Tools 

For clinicians to provide the most effective and personalized care, behavioral health experts like Drs. Birdsall and Shonkwiler agree that using data to inform patient treatment plans is a critical step. But many providers have felt hampered by the lack of clinically reliable and easily accessible screening and diagnostic solutions that cover a broad spectrum of behavioral disorders. The inability to adequately track patient outcomes has also led to poor follow-up and coordination of services. That's where Proem Behavioral Health comes in. It offers evidence-based software and tools that address these challenges so providers can make more accurate, effective decisions. Simply put, Proem can help providers make more accurate decisions so their patients can lead healthier lives. 

Is your organization looking to strengthen how you support the behavioral health needs of your patients? Contact Proem today. You'll learn about our solution and how the supporting behavioral health questionnaires, screening solutions, structured diagnostic interviews, severity measurement scales and post-diagnosis outcome monitors are simplifying the complex process of delivering mental healthcare. 

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