Feedback-informed care is helping Kaiser Permanente Northern California therapists maximize the results of treatment, with a control group of adult patients showing a 20 percent increase in therapy effectiveness between 2011 and 2018.
John Peters, PhD, is a believer in feedback-informed care, the process in which a therapist and patient together monitor treatment to assess how well it is working.
“In my own practice, using this process has on the one hand taught me humility, and on the other hand been gratifying,” said Dr. Peters, a 33-year therapist at Kaiser Permanente Redwood City and associate director of Outcomes & Technology in Regional Mental Health. “What’s gratifying is having seen the amount of positive change my patients achieved double over the course of the first 3 years I used the process with them.”
Feedback-informed care (FIC) is not a new concept. It traces back to the mid-1980s when a research team at Northwestern University first began tracking therapists’ effectiveness.
By the late 90s, the first FIC measures such as surveys and questionnaires were being created: short enough for therapists to use during sessions yet thorough enough to indicate how well the patient was doing — and how big a part the therapist had in it.
Dr. Peters likes how brief questionnaires can really mine the patient’s experience.
“Are we working on what is important to them? Do they agree with the goals and methods for reaching them? Do they feel that we understand them? Those factors are important and have been found to dramatically influence the outcome of treatment. What FIC does is keep the patient’s voice at the center of all decisions about their care.”
FIC at Kaiser Permanente
Work on tracking and improving mental health outcomes in Kaiser Permanente first began in Northern California in 2006.
Piloted measures started with adults, then children and adolescents, in outpatient Mental Health departments. In recent years, Kaiser Permanente Southern California has begun to train providers in FIC, using an advanced software platform called Tridiuum. Northern California is about to launch Tridiuum as well, including Addiction Medicine in the process.
About two-thirds of Kaiser Permanente Northern California’s 1,900 therapists have been trained in using the FIC questionnaires by Barry Duncan, PsyD. Dr. Duncan helped create one of the original outcomes management systems in the 90s. Today, therapist champions help spread the practice of FIC at every Kaiser Permanente Northern California medical center, and Tridiuum is expected to help them facilitate and expand upon the method.
“Feedback-informed care is increasingly being recognized as an evidence-based standard,” Dr. Peters said. “For instance, at the beginning of this year, The Joint Commission began requiring that mental health treatment be monitored in a systematic way.”
Kaiser Permanente is the largest system in this country — outside of the Veterans Administration — to be using FIC.
‘Incredibly Rewarding for Patients’
James Ballenger, PhD, a psychologist at Kaiser Permanente Oakland, acknowledged that patients and providers are sometimes reluctant to try FIC, but then see the benefits.
“If we are going to improve as people, we have to practice giving and getting feedback from others,” he said. “FIC identifies a set of explicit behaviors that we can use and practice to get over any barriers with feedback. Participants almost unanimously come to rely on FIC and have trouble remembering practicing without it.”
FIC is not just for adult patients, according to Sherrilyn Westbrook, PhD, a child and adolescent psychologist at Kaiser Permanente Roseville.
She said it is “particularly helpful with children and adolescents who may not otherwise be able to verbally express their emotional experience.”
“When a patient feels that they are meeting their mental health goals, and then visually sees their emotional health improvements charted on a graph, it validates all the effort that they have put into making positive changes in their life. This can be incredibly rewarding for patients. When I ask a patient how it is to see their improvements charted on the graph, I often hear, ‘It is sooo awesome!’”