3 - (IOP 19) Barriers to Measurement-based Care Implementation: Clinician Behavioral Determinants

Measurement-Based Care (MBC), which involves integrating routine assessments into treatment to improve client outcomes, has demonstrated efficacy across a variety of mental health disorders, populations, and settings. Despite evidence of effectiveness, success of MBC depends on fidelity of delivery, which has been found to be quite low on average. MBC fidelity may be influenced by clinician factors. The Theoretical Domains Framework (TDF) offers insight into clinician behaviors that impact MBC use (Atkins et al., 2017). Key TDF domains such as beliefs about capabilities, consequences, behavioral regulation, and social influences impact MBC fidelity. This study explored these domains to identify clinician-level barriers to MBC implementation. Data was collected from a randomized controlled trial assessing unidimensional (client outcomes) and multidimensional (client outcomes & therapy process indicators) MBC implementation. Clinicians (N = 59; 88.1% female; 76.3% White Non-Hispanic) from four community mental health clinics serving youth ages 11-17 in inpatient, intensive outpatient, and intensive in-home services settings used an online Measurement Feedback System (MFS) to implement MBC with their clients (N = 955; 53.4% female; 72.7% White Non-Hispanic). Clinician behavioral determinants assessed at baseline included measures of self-efficacy, comfort with technology, comfort with numbers and graphs, attitudes toward MBC, openness to feedback, and team psychological safety. We predicted that higher scores on these measures would be associated with increased fidelity across outcomes. Fidelity was measured as percentage of measures completed and percentage of feedback reports viewed. Covariates included number of sessions, MBC condition, and office. Hierarchical Linear Modeling revealed significant clinician-level variability in MBC fidelity (ICCs 0.15-0.20). Overall MBC fidelity was low (42% completion rate, 44% viewing rate). Most predictors were not significantly related to fidelity; the only significant predictor, self-efficacy, was negatively associated with viewing rate (B = -0.10, SE = 0.04, t(44.99) = -2.44, p = .02; R2 = 0.13), which was the opposite of the study hypotheses. Across all models, number of sessions consistently positively predicted higher completion and viewing rates. Additionally, offices significantly differed in their viewing rates. Findings suggest that factors beyond clinician determinants, such as client and organizational factors, might impact MBC use. Implications for future research exploring multi-level barriers to support MBC implementation across diverse community settings will be discussed.