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How Do I Determine What is Quality in Behavioral Health Services? 5 Suggestions for What to Look For

By Steven Schwartz, PhD

It is now generally accepted that the “burden of” mental/behavioral health conditions are on par with or surpasses our most common physical/medical illnesses. The National Committee for Quality Assurance 2021 report Behavioral Health Quality Framework: A Roadmap for Using Measurement to Promote Joint Accountability and Whole-Person Care, summarizes the deep and varied barriers to high-quality behavioral health services. So, what is a would-be client to consider while trying to make sense of the quality choices in behavioral healthcare?

Consumers of behavioral healthcare services or those seeking such services for the first time may be presented with some confusing choices. What type of therapist should I look for? Do I need medication? A Psychiatrist? How will I know if I am getting what I need? What will my insurance cover?

While no individual can address the complexities of healthcare including behavioral health there are some things one might look for in terms of selecting quality behavioral health services. Let’s look at 5 key factors consumers should consider when contemplating behavioral health services and while receiving behavioral health services.

1. Access. If you are just starting in the process of seeking help, almost by definition you may be experiencing significant emotional distress and there is often both hesitancy and urgency in the situation that causes a person to seek help. One thing to look for is how the provider and their organization provide and schedule access to a provider. Access concerns both how quickly and conveniently you can be seen by a qualified clinician and start the process of getting help. Keep in mind that access can be influenced by a variety of factors, not all of which you or the provider can control. Some of these include insurance coverage, the available providers in the practice that are taking on new clients, along with your specific risks and the urgency of need among others, all of which influence who receives care and when. Don’t be afraid to ask how quickly you can be seen and if medication is required ask how quickly most clients can get a psychiatric consultation.

2. Your Needs/Provider Skills Match. Practices providing behavioral health services have a “network” or team of providers that likely includes therapists with a variety of skills and experiences. These skills and experiences may or may not always be a good match for your needs. While you need not be an expert on different evidence-based treatments, the provider with whom you have been matched should be able to explain clearly and understandably how they have been trained and their therapeutic approach to helping. That approach should make sense to you and should be something that you agree with before you proceed too far into treatment. This assures that you and your therapist both have the right expectations of each other in the therapeutic process.

3. Connection. If the match between your needs and the therapist’s skills is good, you should start to feel a sense of comfort and trust with your therapist developing over the sessions. This trust is often referred to by therapists as the “therapeutic” or “working” alliance. A therapeutic alliance should feel like a sense of trust, and confidence that your therapist has your best interests in mind. You should be able to feel this way even when there is tension between you and your therapist or when you disagree with something said. At times therapy may require you to confront issues that are painful or difficult to face but must face in order to move past them. Simply put, you should feel that together you can make a good working team that can address the issues that meet your needs and weather any interpersonal storms. Importantly, if over some time you feel that you are just not connecting with your therapist, you should absolutely feel free to bring this to the attention of your therapists. No therapist worth their training should take offense and all therapists should process the issues and then help facilitate a referral to a potentially better match as appropriate.

4. Monitoring and Measuring. Quality therapy should establish a goal or goals that both you and your therapist agree to and work towards. In therapy, these are often developed over time as some form of SMART goal. SMART in this case stands for Specific, Measurable, Attainable, Relevant, and Time Framed. Forming goals like this allows them to be monitored and even measured to better determine for both you and your therapist just how you are progressing. Just “feeling better” is a good thing but not as informative as “getting more sleep”, “having more energy”, or having fewer angry interactions with others. It is equally important to know concretely if you are not improving or even if things are getting worse. Note that SMART goals can change over time but attain even more power for helping you change when they are tied to Aspirational Goals. These tend to be based on the things you value most, things like independence, family, health, work, etc.

5. Outcomes. In the end, most people seek therapy to ease suffering, solve problems, work through issues, or otherwise get back to a level of functioning better than where they started. The experience of therapy unfolds over time and continues to evolve based on ongoing interactions with your therapist. This means there may be ups and downs in the process of therapy, but ultimately therapy should lead to a resolution of issues and symptoms. In an ideal circumstance, you should come out of the therapy stronger and even more resilient than you did when you started.

The process of therapy is hard work and time-consuming. Those entering psychotherapy need to understand that they will ultimately get out what they put into the process. Hopefully, these 5 factors are helpful in looking for the right fit and the right care as part of your consideration when assessing if any given therapy or therapist is providing you with what you need.

Dr. Schwartz is a fully licensed Clinical (Medical) Psychologist with significant theoretical and practical expertise in (Cognitive) Behavioral Psychology, Medicine, Learning Theory, Positive Psychology, Behavioral Economics, and Clinical Trials. He has authored numerous trade and peer-reviewed papers, book chapters and other pieces on a variety of topics in health, health care delivery and behavior change. Further he has presented research papers, therapy workshops and seminars at both national and international conferences for 20+ years. Dr. Schwartz earned his doctorate degree from Virginia Commonwealth University in 1995 with specialized training in Health Psychology and Behavioral Medicine. He also received a master’s degree in Experimental Psychology from the College of William & Mary in 1985. Past grant activities have included funding by the NIH, Michigan Department of Community Health, and the Ford Foundation.

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