Future Directions in Measurement-Based Care for Youth: Leveraging Fidelity and Mechanisms Data to Improve Public Health Impact

There is a need to improve the effectiveness of youth mental health services and address health disparities within them. Measurement-based care (MBC), which uses ongoing assessment to support communication and decision-making during psychosocial treatment, holds promise for helping the field reach these goals. However, MBC is not routinely used in youth psychosocial treatment, and research on its effectiveness in youth is limited and mixed, in part due to variation in implementation across studies. In this Future Directions paper, we highlight the need for theory-informed research, grounded in rigorous fidelity measurement, to identify influential MBC practices that engage target mechanisms and predict clinical outcomes. We detail a framework for this research that outlines potential MBC target mechanisms, describes MBC practices, and discusses potential measurement strategies. This framework can guide an experimental therapeutics approach to studying MBC, enabling the reverse-engineering of an MBC protocol based on a clear definition of MBC fidelity. This research can also refine our understanding of what effective MBC entails, which, in turn, can inform the development of implementation strategies to support the successful and sustained implementation of MBC.