Symposia
Improved Use of Research Evidence
James F. Boswell, Ph.D.
Associate Professor
University at Albany, SUNY
Albany, New York
Michael Constantino, Ph.D.
Professor
University of Massachusetts, Amherst
Amherst, Massachusetts
Alice Coyne, Ph.D.
Postdoctoral Researcher
Case Wester Reserve University
Cleveland, Ohio
David Kraus, Ph.D.
Chief Scientific Officer
Outcome Referrals, Inc.
Framingham, Massachusetts
Background. Evidence suggests that the effectiveness of cognitive-behavioral therapy can be enhanced with the addition of measurement-based care tools (e.g., Delgadillo et al., 2018). Once implemented, MBC-derived data can be used for a variety of internal and external purposes. A recent double-blind, randomized controlled trial (Constantino et al., 2021) tested the effectiveness of a personalized Match System in which patients are assigned to therapists with a practice-based evidence “track record” of effectively treating a given patient’s primary concern(s) (e.g., anxiety, depression indicators derived from ongoing MBC). Within a community mental health network, matched p</span>atients demonstrated significantly better outcomes than those assigned to a therapist through usual pragmatic means. The present study examined patient-level moderators of this match effect. Namely, we hypothesized that the match benefits would be especially pronounced for patients who presented with (a) greater overall problem severity, and (b) greater problem complexity (i.e., number of distinct elevated problem domains). We also explored whether patient racial/ethnic minority status would moderate the condition effect. Method. Patients were 218 adults randomized to the Match or as-usual assignment condition, and then treated naturalistically by 48 largely cognitive-behavioral identifying therapists who were crossed over the conditions. The primary outcome was the Treatment Outcome Package, a multidimensional measurement-based care assessment tool that also primed the Match algorithm (based on historical, therapist-level effectiveness data), and assessed trial patients’ symptoms/functioning and demographic information at baseline. Moderator effects were tested as patient-level interactions in three-level hierarchical linear models. Results. As expected, the beneficial match effect was significantly more pronounced for patients with higher initial severity (-0.03, 95% CI -0.05, -0.01) and problem complexity (-0.01, 95% CI -0.02, -0.004). Moreover, it was more pronounced for racial/ethnic minority patients (i.e., non-white; -0.05, 95% CI -0.09, -0.01). Conclusion: Measurement-based matching based on therapists’ own practice-based evidence is especially effective for patients with certain characteristics, which further informs treatment personalization in mental health care and has potential to augment routinely delivered cognitive-behavioral therapy.