Feedback-Informed Care (FIC) is an innovative, evidence-based approach to mental health care that uses client feedback to help guide treatment. Because clients and therapists work together to improve results, patients are empowered to take an active role in their treatment.
FIC refines and deepens the therapeutic alliance by fostering client trust and empathy with the provider. It also reduces assessment bias by providing a more accurate picture of how the treatment is progressing. And, as multiple studies, as well as years of clinical practice, have shown, FIC significantly improves client outcomes.
How FIC Works
Before each visit, clients answer questions about their mental well-being. At SonderMind, these are called Clinical Questionnaires (CQs). There are several types of CQs, such as the Patient Health Questionnaire (PHQ-9), a common depression screening tool. Providers will use the CQ that is most appropriate for the client based on presenting concerns, symptoms, or behaviors, and to assess the overall therapeutic alliance.
CQ scores are then tracked over time so providers and clients can see whether progress is being made. If there’s little improvement after six to eight sessions, they can change the treatment plan or decide to stick with the current approach a while longer.
At SonderMind, the process is simple and intuitive:
A robust body of research supports the value of utilizing CQs and client feedback as part of treatment planning. As early as 2004, psychologist and researcher Michael Lambert and colleagues published the results of four controlled studies that used patient-reported outcome measures to assess and monitor treatment. The measures predicted ineffective treatment far more accurately than therapists and improved outcomes for clients who weren’t getting better. More recent studies show providers notice worsening symptoms in clients just 21% of the time. Detection rates are even lower for clients whose progress has stalled.
In 2016, researchers at the University of Washington analyzed 51 randomized controlled trials that used various symptom rating scales to drive clinical decision making. Without exception, FIC produced the best outcomes. What didn’t work were one-time screenings, occasional patient feedback, and feedback outside the therapy session.
Around the same time, French researchers reported that therapists who used FIC the most were far more effective than those who used it the least. Client outcomes trended downward as soon as frequent users stopped including FIC in their sessions.
John Peters, a Kaiser Permanente psychologist, began championing FIC 15 years ago. Outcomes didn’t just improve for his clients – positive changes doubled. By 2017, every mental health professional in Kaiser’s Northern California region was using FIC, and thousands more were training in Kaiser regions across the country. By 2018, most Kaiser mental health clients participating in FIC showed a 20% improvement compared to 2011, before FIC was as widely adopted.
Now, Kaiser Permanente is ramping up FIC, pooling data from more than half a million people to formulate individualized treatment recommendations for depression. Therapists can track how well their clients are doing compared to similar cases. If there are red flags, they can think about changing the treatment plan. Kaiser investigators liken data-rich FIC to GPS. It describes the best route to the destination, lets users know when they’ve taken a wrong turn, and helps them get back on track.
FIC Jumpstarts Meaningful Change
Clients usually make the most progress at the beginning of treatment, so it’s important for them to have a subjective sense of meaningful change in the first few sessions. Many studies have shown that FIC is extraordinarily effective at providing positive changes early in the course of treatment. In part, that’s because FIC takes the guesswork out of therapy. It replaces the traditional trial-and-error approach with quantifiable symptom ratings and encourages adjustments when needed, helping avoid inappropriate or ineffective treatment.
The questionnaires also empower clients to take an active role in their treatment. They begin to understand that it’s up to them to act and make changes between sessions, not simply rely on their therapist to “fix” them. People who participate in their own care are more likely to keep appointments, stick with therapy, and fare better overall.
Improving the Experience of Care for Providers and Clients
FIC is endorsed by the Joint Commission and the Group for the Advancement of Psychiatry, among others. It’s been adopted by Kaiser and the Department of Veterans Affairs (VA), the nation’s two largest healthcare systems. It’s often cited as a way to eliminate provider bias and improve communication between therapists and clients from traditionally under-represented groups. Above all, it boosts the effectiveness of therapy and strengthens the therapeutic alliance for all clients, no matter who they are or what the therapeutic approach is.
Despite this, only a small fraction of psychiatrists and psychologists use FIC. Some argue they already ask for feedback. But evidence suggests they don’t do it nearly as often or as systematically as they should. Others might resist the thought of still more paperwork, but FIC may actually lighten provider workloads in the long run. At SonderMind, the process is quick and seamless with our integrated digital delivery. Our digital approach makes the process easy by delivering clinical questionnaires to each client based on their diagnosis and providing a secure dashboard for providers to review completed questionnaires. We also have provider coaches who can provide guidance and answer questions related to FIC.
After a few sessions, most therapists are amazed how transformative a simple questionnaire can be, how it can lead to deeper insights, better outcomes, and more rewarding and caring relationships with clients.
Feedback-Informed Care: A Data-Driven Approach to Improving Mental Health Care at Kaiser Permanente.”
Journal of Clinical Psychology: “Providing feedback to psychotherapists on their patients' progress: Clinical results and practice suggestions.”
Focus.psychiatryonline.org: “A Tipping Point for Measurement-Based Care.”
Acorncollaboration.org: Clinician Engagement in Feedback Informed Treatment (FIT) and Patient Outcomes.”
Scott Miller.com: "Using Formal Client Feedback to Improve Retention and Outcomes: Making Ongoing Real-Time Assessment Feasible."
Kaiser Permanente: "A New Course for Depression Treatment."
HealthIT.gov: "Shared Decision Making"
Jason Seidel, PsyD, founder and director of The Colorado Center for Clinical Excellence, Denver.
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