Ask a therapist for their success rate and most will tell you something like 85%. Then look at the research, where somewhere around 45% of psychotherapy patients either don't improve or get worse.
"The math ain't mathing," says Dr. Antoinette Giedzinska.
That gap is the reason measurement-based care exists. It is also why so many treatment centers that believe they are doing it are not. Collecting a PHQ-9 every week is not measurement-based care. It's data collection, and without a plan to use it, Dr. G says, it "might end up in the garbage."
In this episode of Recovery Reach, Dr. G breaks down what measurement-based care actually is, how it differs from the outcomes reporting your website promises, what she would do in the first 90 days at a new organization, and why the C-suite needs to stop treating all of it as a clinical task.
Dr. Antoinette Giedzinska is VP of Quality and Outcomes at Sandstone Care. She is a clinical psychologist and a self-described scientist practitioner, someone trained to deliver therapy and to study whether it works.
She has built outcomes and measurement-based care programs at three well-known treatment organizations: Sierra Tucson, Cumberland Heights, and now Sandstone Care. She is also the co-author, with Aaron R. Wilson, MD, of The Clinician's Handbook on Measurement-Based Care: The How, the What, and the Why Bother (American Psychiatric Association Publishing, 2022).
Her path started in 2008. Reading Sierra Tucson's glowing patient testimonials, she asked the medical director a simple question: could she see the outcomes data that backed them up? He didn't know what she meant. That question became her career.
Dr. G's simplest definition: measurement-based care is a psychological vital sign.
If you have hypertension, your doctor checks your blood pressure and runs labs to see whether the medication is working. A doctor who told you that you were improving without ever measuring anything would lose your trust fast. In behavioral health, that is often how it works. Clinicians take the patient's word for it, observe them, and conclude they're getting better.
Measurement-based care adds the missing layer:
"The goal of measurement-based care is not just to collect data," she says. "It's to collect the data and use it to make sure the patient is getting the most out of care. That's really it, heart and soul."
Every treatment center website says "evidence-based." Dr. G is clear that evidence-based treatment is essential. CBT, DBT, and other modalities have been studied in randomized controlled trials, and clinicians spend years learning to deliver them. That is the map: what to do and how to do it.
But a map can't tell you whether this patient is actually moving in the right direction. That's what measurement-based care does
Measurement-based care is also modality-agnostic. It works alongside a CBT program, a 12-step program, or anything else. And it has a strong evidence base of its own, covered below.
Picture a patient in a 30-day residential program that tracks anxiety and substance cravings. They sit down for their weekly session, and the therapist has their dashboard on screen.
"Hey, you're doing great. Look at this. Your anxiety dropped by five points from last week." A simple line graph shows it. Then the therapist points out a pattern: when anxiety goes up, cravings follow. That becomes the conversation.
It doesn't take over the hour. It gives the hour a starting point. And Dr. G says patients get more engaged because they can see that something is changing. "There's a magic to when you see your own progress change."
This is where measurement-based care earns its keep. A patient might present as fine in group while their anxiety and cravings climb. They may not think to mention it, and the therapist may not think to ask. The scale catches it anyway.
In Dr. G's example, that conversation surfaces a trigger tied to childhood trauma. The therapist adds a trauma survivors group to the plan that week, not three weeks later. "It catches you before you fall through the cracks."
Self-report varies. Some people rate a broken leg a 2. Dr. G's answer is a baseline. Patients complete the same measures during admission, before treatment starts. If someone in a substance use program reports almost no anxiety and zero cravings, that's a prompt to talk, recalibrate how they understand the scale, and sometimes retake it. From there, a patient's scores are compared against their own starting point, not anyone else's.
The modern case for measurement-based care traces back to psychologist Michael Lambert at Brigham Young University in the 1990s. As Dr. G describes it, his work found that up to 25% of psychotherapy patients get worse and around 20% don't change at all. Meanwhile, therapists consistently overestimated their own success.
Lambert and his students compared treatment as usual with the same treatment plus regular progress scales that clinician and patient reviewed together. Patients in the measurement-based groups were more likely to complete treatment successfully and sustain recovery longer.
Dr. G points to therapeutic alliance as the secret ingredient. That's the bond of trust and safety between patient and clinician, and it's one of the strongest predictors of good outcomes. When a therapist spends time on a patient's progress data, the patient feels valued and understood. They engage more. They stay.
The benefits she lists stack up quickly:
"That's money," she says of the drop in early discharges. "So it makes business sense to be doing it."
The burnout point surprises people, since clinicians often see measurement as one more thing to do, or worse, a way to grade them. Dr. G's response is to reframe it. The data are about the patient, not the therapist. A score heading the wrong way means it's time for a conversation and a plan adjustment, not a performance review.
On the workload, her ask is modest: a checkbox in the progress note asking whether the data were discussed this session, and a dashboard that's ready when the patient walks in.
This distinction trips up a lot of organizations.
Measurement-based care is a process for one patient at a time. The measures are brief and actionable: if anxiety spikes, the therapist knows what to do. Nobody answers 100 questions a week.
Outcomes are the aggregate. Was treatment effective across all of your patients? That means a fuller set of measures at admission and again at discharge, analyzed by cohort, diagnosis, age, and severity.
Outcomes also come in two flavors:
The second category is where most facilities get lost, and where Dr. G gets excited. "Give it to me," she says. "I love that stuff."
If you want to know which outcomes to measure, start with what your website promises. If you tell prospective patients you'll help them get sober, address trauma and anxiety, and build stress management skills, those are your deliverables. "Well, then, you better be measuring those."
At Cumberland Heights, Dr. G pushed the team to operationally define the Serenity Prayer. Changing what you can and accepting what you can't is stress management, and stress management can be measured. The same goes for recovery capital: resilience, meaning, and the support system around a person.
Do this well, and a treatment center can tell the story of its own effectiveness using patient-reported data before and after care. Skip it, and you end up grabbing whatever measures the clinic down the street uses.
Dr. G sees two root causes. The first is choosing measures without thinking: copying a competitor or a payer instead of starting from your own mission. The second is treating each data point as single-use.
Her fix is to make data multifaceted, so one piece of information serves many people. A set of validated surveys completed at admission can:
The brief weekly measures then power measurement-based care and give UR real-time evidence for continued stay. The same surveys at discharge produce a patient report card, a pre-to-post comparison of program fidelity, and the raw material for aggregate outcomes.
"Without that pre-status baseline, you don't have an outcome," she says. "You just don't have outcomes."
When data serve that many purposes, you can often ask patients fewer questions, not more, and nothing gets stuck in a back room.
Dr. G calls the field mixed. Some organizations have built strong data infrastructure, but she's not sure how many treatment teams actually use the data in sessions. Her book is one playbook. She also points to Collect, Share, Act, a free measurement-based care framework that's available online.
Asked what she'd do with 90 days to stand up a program, Dr. G started smaller: "The first 90 minutes is, let's talk about your mission statement."
Here is the sequence she described:
Dr. G laid out three tiers:
At Sierra Tucson, with no budget for her work, she built a full tracking and analysis system in Excel. "It was done on a dime budget," she says.
Dr. G joins Sandstone's VP of payer relations for quarterly meetings with major commercial payers and brings patient data for each one. The response, she says, is consistently some version of: this is exactly what we're looking for.
What makes it credible is the statistics. Instead of reporting a raw "35% improvement," she reports the reliable change index (RCI), which shows whether a change is large enough to reflect treatment rather than measurement error. When scores drop below a clinical cutoff into the normal range, she reports clinical significance. "Forget statistical significance," she says. "Let's talk about what matters."
Day to day, measurement-based care gives utilization review a stronger case. Imagine a UR specialist telling a payer: this patient's depression is dropping three points a week, but they're still in the elevated range. Look at the trajectory. They need one or two more weeks. That changes the conversation.
She also wants facilities to set the terms. She recently saw a payer request the PCL-5, a trauma measure she notes was developed and validated with military veterans, for an adolescent population. If every payer demands a different set of measures, facilities bounce between them. Her preferred world: facilities choose validated measures that fit their population and philosophy, do the scholarship, and payers accept them.
At discharge, each patient gets a report card showing their scores before and after treatment. When they take it back to the provider who referred them, that provider sees the results in familiar measures and knows where to pick up continuing care. It builds trust, and it builds your reputation as an institution.
Dr. G has outcomes analyses checked by a third-party statistician. "Do not take my word for it," she says. If scores aren't hugely high, report them anyway. Transparency is what makes the numbers trustworthy.
And when the data show a program isn't working for a group of patients? At Sandstone, high administrative discharge rates in one adolescent program led her to a root cause analysis using patient-reported data, and the program changed. "You learn from the data," she says. "It's really that simple."
Looking back across three organizations, Dr. G wouldn't change her approach. She would change two things about the industry.
1. Give scientist practitioners a seat at the table. Building these programs takes clinical judgment (what's evidence-based, how treatment actually works) and scientific training (methods, baselines, and the right statistics to measure change). Dr. G now meets regularly with scientist practitioners at other major facilities, and she says they share the same frustration: high expectations, no seat at the table. She'd like to see research and science officer roles become standard, and she has started speaking with graduate programs about it as a career path for clinical psychology PhDs.
2. Teach measurement-based care in graduate school. Social work, marriage and family therapy, counseling, and psychiatric residency programs should all include a semester on it. Clinicians who learn early that "data are your friends" won't be intimidated when their employer rolls out a program.
Underneath both is the same principle. "At the end of the day, it's always about that patient," she says. "If we keep that as our focus and not the bottom line, we're gonna make the money we need to make."