HIPAA Compliance for Mental Health Clinicians

Note: This blog post is not a substitute for legal advice. It’s just a blog post.

You’ve decided that you want to start using technology in your practice, whether it’s using an EHR, offering teletherapy, or even emailing with clients. Great! Your clients will thank you for it! But first, you need to be familiar with HIPAA, the Federal Law which establishes national standards for electronic health care transactions and identifiers for providers, health insurance plans, and employers.

FREQUENTLY ASKED QUESTIONS ABOUT HIPAA ANSWERED IN PLAIN ENGLISH

What is a Business Associate Agreement (BAA)?

The BAA is an assurance from a service provider (business associate) that they will safeguard your clients’ data in the same ways you as a clinician (covered entity) are required to. It also clarifies and limits how service providers use and disclose protected health information (PHI). Finally, it highlights the appropriate safeguards necessary to prevent unauthorized use or disclosure of PHI. If a company will not sign a BAA with your organization or practice, then you should not trust them with your clients’ PHI.

Why do I need a BAA?

Because HIPAA says so. Every covered entity must have a written agreement with each of its business associates, or else it is not compliant with HIPAA regulations. Your “business associates” are all the various service providers who interact (“create, receive, maintain, or transmit”) with your clients’ data: email, video, records, texts, etc.

Yeah but what will really happen if I’m not compliant? I’m just a small practice.

It’s not worth the risk, and your organization’s size doesn’t matter. The federal government has the latitude to impose both civil monetary fines and criminal punishments upon individuals and organizations that violate HIPAA. Under the current omnibus HIPAA rules, each violation can incur a penalty of up to $50,000, with repeat violations of the same provision costing as much as $1.5 million per year. In the first seven months of 2016 alone, HHS recorded close to $15 million in HIPAA violation settlement payments.

I don’t have a BAA with Google and use Gmail. Is it enough to simply ask my clients to not email me sensitive information?

Probably not. Even a simple emailed appointment reminder can be considered ePHI. In order to be in compliance, you’ll want to use a provider with whom you can sign a BAA, such as by using G Suite (Google). It’s important to note that in the case of G Suite, your data will be encrypted on Google’s servers, but may not be fully encrypted while in transit. Given that, it’s advisable to document that your clients have provided informed consent to communicate via email.

There are services that are designed to provide fully-encrypted email solutions to providers. Some examples are Hushmail, or Protonmail. Remember you NEED A BAA between yourself and the company to be compliant! Simply signing up for a service from a provider who claims to be HIPAA compliant is not enough.

Can’t I just use FaceTime or Skype for teletherapy? My client says they’re OK with it.

No. Your service provider must sign a BAA with you to be compliant. To the best of my knowledge, Apple currently does not sign BAAs with FaceTime users. Microsoft (who owns Skype) will enter BAAs, but not for Skype. What about Google Hangouts? No. Google will sign BAAs for email (see above re: G Suite), but not for Hangouts. It’s not enough for your client to be OK with using one of these services, and therapists would be well-advised to remember that just because a client says they’re not worried about the privacy of their data today doesn’t mean they won’t sue you in the future.

Can I use something like SurveyMonkey or Google Forms to administer assessments?

Yes, if you sign a BAA with either SurveyMonkey or G Suite (Google) to do this. 

So do I have to sign a whole bunch of BAAs to be HIPAA compliant?!?

Yes, if you are using multiple different types of services. Alternatively you could opt for the simplicity of having a provider that offers a number of services in one platform. Pacifica offers HIPAA-compliant teletherapy, assessments, and access to a large library of CBT- and mindfulness- based therapeutic content. Learn more here.

7 Tips for Incorporating Technology Tools into Conventional Therapy Practice

Individuals seeking health care are increasingly interested in using technology to help manage their symptoms and obtain treatment. A poll by The Pew Research Center reported that in 2012, 72 percent of Internet users reported seeking health information online (PRC, 2013) and of the 64 percent of people who own a smartphone (PRC, 2015), 62 percent reported having used it to acquire some type of health-related information (PRC, 2015).  These trends in general health present a great opportunity for improvements to existing care-delivery models in mental health too.

Mobile apps are a burgeoning area of health technology which have substantial opportunity to improve treatment, quality of life, and patient self-management and engagement. Numerous professional and non-professional groups have acknowledged the value of these tools, as they are often well-liked by users and have advantages over traditional in-person therapy. For many individuals, therapy is out of reach due to cost, access/provider availability, transportation, or stigma. Though not necessarily a replacement for traditional therapy, apps and other healthcare technologies can help these individuals overcome these barriers and begin to reduce their symptoms and better manage their mental health.

For others, apps can be a helpful adjunctive to regular treatment, allowing them to be more engaged and get more support between sessions. While in-person therapy offers a human relationship that isn’t always possible within an app, mental health clinicians have an opportunity to work WITH these tech tools to enhance their in-person work and take advantage of the benefits that come with the use of technology in their practices.

When beginning to introduce apps into your practice, there are some things to consider in order to be successful and ensure your clients accept and use the new technology.

1. Think about your goals–what will the app help you or your client to do? Don’t introduce technology just because you can. Have an idea of what you think the app or program can be good for, and explain that. Perhaps it’s mood tracking or building a mindfulness meditation practice. Make sure that whatever tool you are suggesting is clinically appropriate and indicated for that client.

2. Be familiar with the tools you’re suggesting. A surefire way to make your client doubtful of the technology is to lack understanding and knowledge of the app and how it works. The more comfortable you are with the app, the more they will be too. Download and use the app yourself. In addition to having more credibility with your clients, you may discover interesting or valuable ways to use the technology that perhaps aren’t immediately obvious otherwise.

3. Put yourself in your client’s shoes. When introducing the client to the app, don’t grab the client’s phone and do it for them. Instead, talk them through the process, allowing them to click through the different tools and describing what to use and when so that they feel a level of familiarity with the app before they leave your office. This is particularly important for apps that have minimal in-app guidance.

4. Problem solve using the app. When might a client want to use a given tool? Provide some suggestions for scenarios and think about any difficulties they might run into ahead of time.

5. Don’t overwhelm yourself or your clients. You might find it helpful to pick just one app at a time to keep it simple. If you start using a wide variety of products, it may be difficult to keep track of how the apps work, what they do, etc.

6. Be familiar with the app’s security and privacy policy. Your clients may have questions about their app usage data and what happens to it. It’s helpful if you have at least some knowledge of the app’s policies so that you can either explain those policies, or know where to direct your clients so that they can read the policies themselves.

7. Have a discussion about the use of the technology much like you would have at the beginning of therapy. What are the limits of confidentiality? Will your client expect that you will be reviewing their app usage? Should they use the app to communicate with you? It’s important for provider and client to have an open and frank conversation about what is and is not appropriate for app usage, and what the client’s expectations should be. Some clients may not fully understand how apps work, and it’s incumbent upon the provider to make sure their clients are informed before beginning to use an app or other tech tools.

Thinking about taking the leap of bringing your practice into the 21st century by starting to work with a mental health app? Consider Pacifica. Pacifica is a mobile application that empowers people to manage their stress, anxiety, and depression using cognitive behavioral therapy (CBT) and mindfulness techniques. The app currently has over 1.4 million registered users and has been highly-rated and well-received in the App Store and Google Play Store, reflecting its appealing design and engaging tools.

In addition to its iOS and Android consumer apps, Pacifica Labs also offers Pacifica for Clinicians, a dashboard tool designed to help mental health care providers leverage the app with their patients and improve treatment effectiveness. The HIPAA-compliant clinician-facing product allows providers to administer and score assessments, conduct teletherapy, and increase between-session engagement and therapeutic efficiency with assignments and education.

 

Our ethical obligation to practice outcome monitoring

Why did you become a therapist?

Many people say that they went into therapy in order to help people, yet despite this initial goal, they report that they actually spend most of their “office time” writing notes and completing paperwork. With complicated EHRs, large caseloads, and increasing administrative responsibilities, some of this is inevitable. Fortunately, however, new tools and technologies are emerging to help clinicians to not only fulfill their job duties, but also more effectively treat their patients and ensure that they are providing quality care and utilizing best practices.

One of the best practices that has been demonstrated repeatedly to improve outcomes is using Measurement-Based Care. Measurement-Based Care is a system that utilizes patient-reported symptom rating scales to inform clinical decisions about patient care. Similar to Measurement-Based Care, outcomes monitoring or progress monitoring, is the routine collection of self-report data from clients to evaluate their progress in treatment and perception of the therapeutic alliance. In both Measurement-Based Care and outcomes monitoring, clinicians use the self-report data provided by their clients to objectively assess their progress and make adjustments to their treatment plan or therapeutic approach in accord. Therapists have been slow to adopt routine progress monitoring or Measurement-Based Care, but the time has come to change that. In addition to standard measures of symptoms (e.g. PHQ-9, GAD-7), there are several published measures which can effectively provide feedback to the clinician (e.g. OQ, ROM, PCOMS). With a wide variety of validated measures available to assess one’s clients, there is little reason not to develop a thoughtful plan for evaluating one’s practice.

Improved Communication

Providers’ desire to offer the highest quality of care possible is not the only reason to practice outcomes monitoring or Measurement-Based Care. Monitoring can help patients to stay more engaged in their treatment and more participatory, both in sessions and with between-session assignments. They are less likely to stop treatment if they feel heard by their clinician. Structured measures provide another opportunity for the therapist to listen to the client and get a better understanding of their emotions, experiences, and feelings about therapy itself. Therapists often report having a strong desire to meet their clients where their clients are ready to be met. Providing an additional channel for communication (i.e. other than informal queries in session) will help them move towards this goal. Some clients may feel more comfortable disclosing a symptom or therapeutic rupture on a form than directly to the clinician; the use of objective, validated measures can allow therapists to be aware of these issues without requiring the client to bring them up on their own.

Clients are also less likely to drop out of treatment if they feel that their therapist is responsive to their needs. This means being aware of both the client’s symptoms and the degree to which they are suffering, and being cognizant of the therapeutic relationship and ensuring that it is productive. Studies have repeatedly demonstrated that there is often a disconnect between how the client feels and how the provider thinks the client feels, and therapists who are able to minimize this gap and flexibly respond will find that their clients stay in therapy longer and get well more quickly.

The Time is Now

Advances in technology have led to the development of a number of different methods for administering, scoring, and integrating clients’ responses to both symptoms and outcomes measures into the EHR, to minimize the burden on providers and administrative staff. Clients are increasingly interested in using technology tools to manage their health care, and the use of such devices and programs to monitor treatment progress is an excellent application of such technology.

Many clinicians have been proactive and excited about implementing empirically-supported treatments, and have been outspoken advocates for the use of proven therapies. Why are we so resistant to outcome monitoring and Measurement-Based Care? While behavior change is never easy, as healthcare providers we are obligated to do it when we know there are effective, proven strategies we can implement to improve our care delivery. This means doing progress monitoring and adjusting treatment plans and interventions based on our clients’ feedback. Mental health providers are also health care consumers, and I challenge them to imagine seeing a physician who does not routinely make objective measurements such as blood tests and weights while crafting and managing a treatment plan. Why should mental health be any different when it comes to tracking progress?

Originally published on PsychCentral Pro: https://pro.psychcentral.com/our-ethical-obligation-to-practice-outcome-monitoring/0019316.html

Bringing Mental Health Services to Underserved Populations with Teletherapy

To better reach underserved populations, mental health care providers need to increase accessibility, decrease costs, and eliminate barriers to entry for groups facing difficulties in obtaining mental health services. According to the National Alliance on Mental Illness, one in five American adults experience a mental illness. Unfortunately, these numbers can be even higher for certain groups that also tend to struggle more with getting the help they need for economic, cultural, social, or logistical reasons. These factors, combined with a mental health care provider shortage, can make it prohibitively difficult for some individuals to seek help.

One way providers can effectively reach more underserved populations without incurring a high level of extra costs is by offering teletherapy. Studies have shown video therapy sessions to be just as effective as traditional, in-person therapy for treating most mental health conditions. Providing teletherapy can be significantly less expensive for providers by removing overhead costs, and can also improve attendance rates and reduce no-shows and cancellations. It is also more anonymous for clients and removes geographic restrictions, which can make it easier on clients with limited transportation, and gives clients more options when choosing a provider.

In addition to being convenient and effective, teletherapy can also be reimbursable, making it easier for clients to afford mental health services. Medicare’s telehealth benefit now covers certain forms of psychotherapy services. Telehealth is also covered by Medicaid in 48 states and the District of Columbia. Furthermore, 32 states and DC have some sort of private payer policy in place for coverage of telehealth as well.

Teletherapy can solve logistical issues and remove barriers for many different groups that can have limited access to care including:

  • Children and Adolescents: According to the Centers for Disease Control and Prevention, 13-20% of American children experience a mental health disorder in a given year. Of those, only 20% receive treatment. Cost can often play a role in preventing young people from receiving the care they need. Teletherapy can help make mental health care more accessible to children and adolescents, and may be more ideal for teens comfortable with technology that may desire a higher degree of anonymity in care. Additionally, teletherapy can eliminate the need to miss school to attend in-person appointments, providing less disruption to a client’s daily routine.
  • Older Adults: The American Association of Geriatric Psychology estimates that 20% of older adults experience some type of mental health concern. These conditions often co-occur with other physical health issues and can go undiagnosed. Older adults can struggle with the cost of mental health care, and may have difficulty travelling to appointments due to physical health concerns or lack of transportation. Teletherapy can address these struggles by allowing people to see their therapist remotely. Furthermore, Medicare’s telehealth benefit includes psychotherapy codes, making teletherapy more affordable for older adults.
  • Minority Groups: Minority populations have the same level of risk for mental health disorders, but access treatment at much lower rates. Mental health care is often less accessible to minority groups, and people seeking care often anticipate lower quality or experience language or cultural barriers when receiving treatment. By reducing geographic barriers, teletherapy can increase options for people when choosing a provider and help them find someone who is a good fit.
  • Rural Residents: According to the US Department of Health and Human Services, 60% of rural Americans live in a mental health provider shortage area. Combined with lower incomes, high levels of stigma, and a potential lack of anonymity in a smaller community, seeking care can be difficult. Teletherapy allows rural residents to access mental health services more privately with less travel.

We can begin to address the mental health care provider shortage by expanding the utilization and reach of current providers to underserved populations in need of services. Teletherapy is one way to do this, and it can be effective for treating many conditions. To learn more, download our tip sheet:

Download our free tipsheet

How to Improve Therapy Session Attendance, Reduce No-Shows & Cancellations

No-shows and cancellations for therapy appointments are more than just annoying, they can be detrimental to you, your clients, and your practice. If a client cancels a session at the last minute, or if they simply don’t show up, you’re not able to bill for that session, and you’re stuck with a non billable hour in the middle of your day that could have been filled with another appointment. In addition to being frustrating, studies have shown that high rates of cancellations can lead to diminished clinician confidence and affect one’s ability to provide effective care. Poor session attendance rates also impact clients, as they don’t receive the full benefit of therapy and can go on to struggle with persistent symptoms.

For many clients suffering from depression or anxiety, trying to improve their session attendance can be something of a catch-22 situation. Attending sessions can be made more difficult due to symptoms of their anxiety or depression, but in order to see improvement in their symptoms, they need to attend therapy. Clients may miss their first appointment due to a perceived stigma, or because they’re having difficulty taking the first step toward seeking help. Therapy can be a difficult experience, and often clients feel worse before they feel better, which can also lead to cancellations or no-shows if the individual does not experience immediate symptom relief. Alternatively, if they start to feel better, they may quit early and still miss out on the full benefit of in-person counseling. Other issues that can lead to cancellations, no-shows, and low session attendance include logistical concerns such as transportation, disability, or difficulty finding childcare or getting time off from work.

There are many ways you can improve session attendance at your practice, a lot of which aren’t expensive or labor intensive:

  • Give clients as much freedom in scheduling as possible. Giving more options for scheduling can result in fewer cancellations or no-shows.
  • Confirm appointment dates and times immediately after making the appointment with a printed card, so misreading handwriting or making a typo in a phone calendar cannot occur.
  • Give adequate appointment reminders in the patient’s method of choice: phone calls, text messages, emails, or postcards in the mail.
  • Offer rewards for attending sessions by giving discounts on bills, or penalties for no-shows or late cancellations. Create a clear no-show policy and work with clients to troubleshoot when they are struggling with repeatedly no-showing. Consider discharging clients who repeatedly no-show or cancel.
  • If a client no-shows for an appointment, follow up to find out why and reschedule promptly. You may notice patterns that can help you improve attendance in the future.
  • Offer video therapy sessions to your clients. Teletherapy can be a great way to lower the barrier to entry for those seeking help, and has been shown to be just as effective as in-person treatment for a variety of conditions.

Of these, teletherapy may be the most major change to make, but it can also be the most impactful. To learn more about how to bring teletherapy to your practice, and why it’s becoming more and more popular, download our free tip sheet.

Download our free tipsheet

Physician, Heal Thyself: The Importance of Self-Care for Mental Health Care Providers

It is well known that therapists (psychologists, psychiatrists, social workers, counselors) need to maintain good mental health in order to be effective. In fact, entire books have been written on the topic of how those in the helping professions can take care of themselves. The phrase “compassion fatigue” has been used to describe the phenomenon of psychological distress or indifference which arises in those who are repeatedly called upon to care for others, extend themselves emotionally, or generally support those who are suffering. The degree of compassion fatigue may relate to the severity of the suffering, or the frequency of these calls, though most seasoned clinicians have had at least a few moments when they felt “burnt out”. These experiences, though, should not go unnoticed or unattended to, as compassion fatigue or burn-out can result in diminished quality of treatment for clients or patients.

So why is it so hard for providers to heed their own advice and practice self-care?

Physicians often have not experienced the ailments they’re treating. However, if it is possible for a provider to walk in the shoes of the client, why wouldn’t they take that opportunity? Understanding what it’s like to call a therapist, navigate payments or insurance, even feeling what it feels like to wait in the waiting room of a mental health provider is worth doing.  Beyond that, actually using the therapy tools can help providers to better understand their work with their clients. Training seminars with experiential or participatory components are often the most effective and compelling because they give the provider a chance to really understand what it’s like to be a client going through the intervention. Having personally examined one’s core beliefs, or spent some time on building one’s own exposure hierarchy can enable therapists to be more effective when using these tools with clients. It opens one up to see the challenges and opportunities that exist.

This is not a novel idea. Indeed, Freud suggested that therapists engage in analysis and a survey study in 1994 examined therapists’ engagement in therapy. As the field has shifted to some degree, so have the types of therapy in which clinicians are encouraged to engage. There have been calls in the literature recently for psychologists to utilize mindfulness-based positive principles and practice and studies have found that MBSR interventions can be effective when taught to therapists-in-training.

Many providers describe feeling too busy as a primary problem, and feel that they don’t have the time for self-care. Often clinicians feel pulled in a number of different directions: direct client contacts, administrative tasks, note taking, supervision, etc. New technology tools, though, can help providers streamline some of their processes to increase efficiency and “make” time. Video conferencing software can save travel time to meetings, and EHRs and billing programs can reduce time spent on note-taking and administrative tasks. Additionally, new mental-health and wellness tools such as Pacifica can make engaging in self-managed CBT more engaging and time-efficient. Pacifica has a library of meditation and relaxation tools, customizable reminders for health behaviors, mood tracking, and a suite of thought record tools for reflecting on one’s own challenging moments. Taking a few self-care moments to check-in with yourself is important, regardless of which side of the room you’re sitting on.

Does Your Therapist Track Your Progress?

Due to the recent opioid crisis, the need for expanded mental health and addictions treatment in the United States is finally being broadly recognized by those outside of the medical community. Only the future can tell whether increased access to care will be a reality rather than just a hope. However, in the meantime, there are things that clinicians can do to improve the treatment they give their current clients. One of the most important things is to practice what’s known as Measurement-Based Care.

 Measurement-Based Care can be administered digitally.
What is Measurement-Based Care?

Measurement-Based Care is essentially the use of structured questionnaires to track patient symptoms. For example, someone with depression would regularly take a questionnaire to measure their mood and emotions, to determine whether they are improving or not. This is like your doctor taking your blood pressure or weight, to objectively measure how you are doing.

Why is Measurement-Based Care Important?

Mental and emotional health is, by its nature, more complex and “messy” than some other fields of medicine. Since there isn’t a blood test to determine how you’re doing emotionally, it’s important that your provider uses validated, objective measures to track your progress. While clinicians do their best, they aren’t always able to detect subtle changes in mood, and sometimes may forget to ask certain questions. Structured assessments can help in this area.

Does Measurement-Based Care Actually Help?

In a word, yes. Research on measurement-based care has shown:

  • Greater Improvement:  According to one study of individuals in a behavioral health clinic, patients whose clinicians were receiving patient-reported symptom rating scale data showed 28% greater improvement after 6 weeks compared to those whose clinicians weren’t receiving feedback.
  • Higher Response Rates:  Another study showed patients receiving psychiatric treatment for depression were able to achieve higher response rates and faster remission when treated with measurement-based care methods compared to usual care.
  • Better Outcomes:  In a literature review of 21 studies focused on various specific disorders (e.g. depression or anxiety), 76% showed better outcomes for patients receiving measurement-based care, compared to patients whose therapists did not receive symptom rating data.
So What Do I Do?

If you are currently in treatment with a therapist, you can simply ask your provider how they are tracking your symptoms and progress. Ask how you will know when you are getting “better” and how “better” is defined. If you have not yet started treatment or are considering starting to look for a provider, you can make it part of the questions you ask any prospective therapist. “How will you track my progress? How will we know if therapy is working?”. Often therapists are reluctant to use measures because they worry that clients will find them time-consuming, but if you clarify your preferences at the outset it can make for a more successful therapy relationship later on.

 

Ask your therapist about measurement-based care today.

CBT & ACT: Help your clients give their thoughts a little space

Night sky, CBT and ACT teach us to gain distance from thoughts

One of the major premises of cognitive-behavioral therapy (CBT) is the idea that thoughts affect feelings, and that by changing our interpretations and thoughts about and interpretations of situations or events, we can change our emotional responses. Sometimes this can take the form of challenging the validity or accuracy of thoughts by questioning whether or not they’re true. This process is effective for many people and helps them to recognize that their interpretations, beliefs, and self-talk aren’t accurate or fair to them. By then generating more positive and true statements, they are able to feel differently about their experiences. For example, rather than feeling anxious by focusing on an unlikely worst-case scenario, individuals can acknowledge that the most likely outcome is something they can handle, and their concerns or worries become much more manageable. One of the essential tools for examining and challenging thoughts in cognitive therapy is the thought record. The thought record is used to help individuals see the relationship between their experiences, thoughts, and emotions. It also helps people to identify potential inaccuracies in their thinking, and provide an opportunity to change those thoughts to be more fair.

Despite CBT’s wide acceptance and demonstrated efficacy, for some individuals, the process of challenging their thoughts can feel invalidating. Some people find that they get stuck in what feels like an academic exercise of trying to find evidence for or against their thoughts. More recently, there has been a “third wave” of therapy (such as Acceptance and Commitment Therapy or ACT) which integrates concepts from mindfulness and acceptance to help individuals change their relationship to their thoughts. On first glance, some people (therapists and clients alike) have a difficult time reconciling CBT and acceptance-based approaches, because they appear to be in conflict (one aimed at changing thoughts while the other is focused on accepting them).

CBT & ACT: Integrating Different Approaches

However, both CBT and these newer therapies have the effect of helping people see their thoughts as more like “mental events”, being more objective, and giving their thoughts more space. CBT is more oriented towards challenging the content of the thoughts whereas acceptance- and mindfulness-based therapies are more focused on allowing oneself to co-exist with the thoughts, without necessarily believing or acting on them, or trying to change them. In both cases, the individual is changing their relationship to their thoughts; often this means putting some distance between themselves and their thoughts. One of the difficulties clients often face is taking their thoughts to be the truth and believing them. Often they have the same thoughts over and over, and that repetition makes the thoughts seem all the more true. Whether mindfulness, acceptance, or distancing by challenging validity ring most true for your clients, increasing their awareness of their thoughts and emotions will help them to disconnect and de-fuse from those thoughts.

Pacifica is a digital implementation of an integrated approach, which is to say, it includes elements of cognitive-behavioral therapy and mindfulness-based approaches. Pacifica includes several different types of thought records with different foci, some delving more deeply into cognitive distortions, with another more focused on guiding the user to generate alternative thoughts, etc. Additionally, there are guided meditations focused on awareness and acceptance of thoughts and emotions, and psychoeducational content which guides users through the process of using the various tools. Pacifica users are able to select which approaches and tools are most effective for them and which fit their needs and personality best.

"The most effective solution is the one you are willing to implement", ACT or CBT


 

Pacifica for Clinicians: Bring Measurement-Based Care to Your Practice

As demand increases for healthcare providers to transition from a fee-for-service to a value-based model, the need to implement measurement-based care is greater than ever. Although measurement-based care practices are commonplace in the medical and surgical fields (testing cholesterol levels or A1C level for diabetes, for example), they tend to be less widespread within the behavioral health community. According to a report published by the Kennedy Forum, only 18% of psychiatrists and 11% of psychologists regularly use measurement methods to monitor their patients’ progress.

What is Measurement-Based Care?

A report in the journal Cognitive Behavior and Practice defines measurement-based care as the practice of basing clinical care on client data collected throughout treatment. Aside from working well with a value-based reimbursement model, measurement-based care can be very beneficial to both clinicians and their patients. Studies have shown that patients receiving measurement-based care are more likely to achieve greater response and remission rates than those receiving standard care. Measurement-based care allows providers to create measurable, data-driven treatment plans that can be amended and reassessed if patients are not responding to a course of treatment. Additionally, when patients are involved in providing ratings of their symptoms, they can feel more actively involved in their treatment and more aware of potential symptomatic patterns.

While it may sound appealing to bring measurement-based care methods to your practice, knowing where to start can be difficult. Creating a symptom rating and tracking system on your own can be cumbersome, and potentially become a roadblock to offering more effective care. Though prebuilt solutions exist, many products on the market often don’t equally address the needs of the clinician as well as the needs of the patient.

Introducing Pacifica for Clinicians

Screenshot of Pacifica's Clinician Dashboard, bringing measurement-based care to your practice
A preview of Pacifica’s Clinician Dashboard.

Pacifica for Clinicians is a first-of-its-kind, web-based dashboard tool that mental health care providers can use to easily bring measurement-based care to their own practice. Using Pacifica’s popular consumer-facing mobile app, which has over 1.25 million registered users and counting, Pacifica for Clinicians makes it easy for you to track your patients’ progress, and use data to inform treatment decisions.

How Does It Work?

The goal of Pacifica for Clinicians is to help facilitate measurement-based care without disrupting your existing practice.

With a subscription to Pacifica for Clinicians, all of your patients will receive a Premium subscription to Pacifica’s mobile application. The app includes a variety of tools based on cognitive-behavioral therapy and mindfulness:

  • Mood and Health Tracking: Users can enter mood ratings and attach feelings or include notes on each rating. The Health tool allows users to select specific habits (such as sleep, exercise, alcohol, caffeine, etc.) and track them each day. Together, these tools can help users identify patterns in their mood based on different health activities.
  • Thoughts and Goals: Using one of Pacifica’s nine psychologist-designed thought recording tools, users can keep track of their thoughts and learn to challenge negative thinking patterns. By setting daily challenges, users can reach their long-term goals one step at a time.
  • Relaxation Techniques: Pacifica offers over 25 audio activities including deep breathing, muscle relaxation, and a variety of  mindfulness exercises.
  • Community and Hope Board: The peer-support community in Pacifica allows users to connect with others for encouragement. Based on the dialectical behavior therapy (DBT) concept of a “Distress Tolerance Box”, the Hope Board is a place for users to save and review inspiring content, including photos, quotes, completed Pacifica activities and community content.
  • Guided Self-Help Paths: Designed by psychologists, Paths include an audio lesson and accompanying activity. Topics include CBT and mindfulness, with more to be added in the future.
  • Progress Data: View daily, weekly and monthly progress reports so users can see improvement over time and notice patterns in their moods.

Using Pacifica for Clinicians, you will get full access to the Clinician Dashboard, which offers you oversight of your patients’ progress all in one place.

  • Review Client Data: Using the Clinician Dashboard, you can see your clients’ mood and health history, goal tracking information, completed thought records and relaxation activities. This can both help your patient feel more involved in treatment decisions and give you more insight between sessions.
  • Assign Assessments: Beyond gathering data from app usage, Pacifica for Clinicians allows you to assign recurring assessments (e.g. GAD-7, PHQ-9) to your clients and review and export their response data from the Clinician Dashboard.

    Screenshot of assigning an assessment, an excellent measurement-based care technique
    Assign assessments to your clients and view their responses through the dashboard.
  • Data-Driven Decision Making: Put measurement-based care in action by using insights from the Clinician Dashboard to assess treatment effectiveness and inform clinical decisions
  • Coming Soon – We’re expanding the features of the Clinician Dashboard rapidly. Some upcoming features include:
    • Teletherapy: Projected for release in April 2017, the Clinician Dashboard will soon include a teletherapy feature that will allow you to perform virtual text or video sessions with your clients.

      Screenshot of teletherapy feature to continue measurement-based care between sessions
      Coming Soon: Text and video teletherapy options to conduct virtual sessions with your clients.
    • Client Assignments and Reminders: Give your clients assignments to complete activities within Pacifica and send push notification reminders to their phones.
    • EHR Integration: Integrate patient data from Pacifica into your electronic health record system.

Security: HIPAA Compliance

Pacifica for Clinicians is fully HIPAA compliant, with all necessary physical, technical and administrative safeguards in place to maintain data security.

The Science Behind Pacifica

All of the tools and activities in the Pacifica app are designed by psychologists based on the scientifically-backed principles of cognitive-behavioral therapy and mindfulness.

Additionally, Pacifica has partnered with the University of Minnesota on an ongoing Randomized Control Trial. The results have yet to be published, but the initial pilot has shown impressive effect sizes across multiple measures, including the NIH PROMIS scale for global mental health, and the DASS-21.

Try Pacifica for Clinicians Free for 30 Days

Ready to put measurement-based care to work for your clients? With your 30 day free trial of Pacifica for Clinicians, you’ll get Premium subscriptions to the Pacifica mobile app for you and your clients and full access to the Clinician Dashboard. You can request a one on one demonstration, or get started right away by clicking the button below.




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