Mental Health Blog

From the Founder: Why Measurement-Based Care May Be Our Most Important Skill

• July 8, 2026
• The REACH Institute
• Autism, Child mental health, Pediatric primary care

One of the questions I am often asked is, “What is the single most important clinical skill taught in REACH training?”  Many people expect the answer to be learning medications or mastering diagnostic criteria. Those are certainly important. But if I had to choose one skill that consistently improves clinical care, it would be measurement-based care.

For our purposes in child mental health, measurement-based care (MBC) simply means routinely using standardized rating scales to assess symptoms and functioning, reviewing those results with children and families, and using the information to guide treatment decisions over time. It sounds straightforward – and it is – but it represents a major shift from relying solely on clinical impressions.

Of course, experienced clinicians already “measure” patients in some important ways. During an interview, we estimate symptom severity, compare today’s presentation with prior visits, and judge whether a child is improving. But research over several decades has shown that clinical judgment becomes substantially more accurate when it is combined with standardized measurement.

A thoughtful clinical interview is the foundation of every evaluation. We need to understand the child’s presenting concerns, development, medical and family history, strengths, school performance, friendships, family relationships, and functioning across settings. This narrative account tells us who the child is. Standardized rating scales tell us how much. Together, they create a more complete picture than either alone.

This lesson has emerged repeatedly from many of the landmark child mental health studies, including the MTA (ADHD), TADS (adolescent depression), CAMS (childhood anxiety), and TOSCA (severe aggression). These and other clinical trials depended on careful, repeated measurement of symptoms throughout treatment. Without their use of standardized assessment tools, we would know far less about which treatments work best and for whom.

Similarly, in real-world practice settings, systematic and routine use of symptom rating scales improves diagnostic practices and treatment outcomes, compared to relying on clinical impressions alone. In overly busy clinical practices, rating scales frequently detect residual symptoms that otherwise appear to have resolved, and help clinicians to optimize treatment rather than stopping too soon. 

Equally important are other practical benefits that measurement-based care brings to everyday practice: For example, using these and other standardized rating scales improves communication. Instead of conversations based on vague impressions (“I think things are a little better”), discussions become anchored in concrete information. Families can see exactly which symptoms have improved and which continue to interfere with daily life. In addition, rating scales can serve to educate families. Every item on a Vanderbilt, SCARED, or PHQ-9 teaches parents and adolescents what the disorder actually looks like. Families begin to recognize patterns they previously overlooked and develop a shared language for discussing symptoms and treatment targets.

Not surprisingly, measurement-based care can also strengthen the therapeutic alliance. One of the most interesting findings from recent studies is that families appreciate participating in the interpretation of results. Differences between parent and child ratings are not problems to eliminate – they are opportunities for discussion. Those discrepancies often reveal important information about differences in functioning at home, school, or with peers.

And finally, in my view, measurement-based care makes us better clinicians. Just as a smoke detector alerts us before a fire becomes overwhelming, regular measurement often identifies children who are not improving before our clinical impressions alone might recognize the problem. Instead of continuing an ineffective treatment, we can make timely adjustments based on objective information.

Some clinical colleagues might worry that rating scales could replace clinical judgment.  In my and REACH colleagues’ experience, they do not — they sharpen it. But like every clinical tool, rating scales have limitations. They do not capture the richness of a child’s story, the nuances of family dynamics, or the complexity of development. They should never become a substitute for careful listening or thoughtful clinical formulation. But when standardized measures are combined with a careful interview and a strong therapeutic relationship, they provide something extraordinarily valuable: a shared picture of progress.

So in the service of helping children even more effectively, let me pose a few questions. How are we doing with measurement-based care? Do we routinely use standardized rating scales when evaluating children with ADHD, anxiety, or depression? If not, what is getting in the way? Are we collecting information from more than one informant when appropriate – for example, both parents and teachers for ADHD, or both parents and adolescents for anxiety and depression?

Once we’ve collected the scales, what happens next? Do we review the results with the family, looking together at what has improved and what remains difficult? Do we invite them to notice where their ratings agree — and perhaps more importantly, where they differ? Those differences are often among the richest clinical information we receive. Or do we use rating scales more like a doctor-only laboratory test — filed in the chart but not shared or discussed?   If so, we’re missing one of measurement-based care’s greatest strengths.

The scales are not simply diagnostic aids – they are communication tools. Every item can become the beginning of a conversation: “Tell me more about this.” “Why do you think your daughter answered this differently?” “What has changed since last month?” “What should we work on next?” Those conversations deepen trust, improve shared decision-making, and help families become active partners in treatment rather than passive recipients of advice.

So here’s my challenge: Choose just one standardized measure that you don’t currently use consistently. Perhaps it’s the Vanderbilt Rating Scale for ADHD, the SCARED for anxiety, or the PHQ-9 for adolescent depression. Commit to incorporating it into your routine practice over the next month.

Then don’t stop at scoring it. Pull the form out, place it between you and the family, and talk about it together. You may discover that one of the most powerful clinical tools in your office isn’t a medication or a therapy technique. It’s a conversation built around a few thoughtfully answered questions.

At REACH, we believe measurement-based care should become as routine in pediatric mental health as measuring blood pressure is in primary care. The goal is not to generate more paperwork. The goal is to make better decisions, sooner, and to help children recover more quickly. Sometimes the simplest innovations have the greatest impact. Measurement-based care is one of them.

Thanks for listening…and sharing in this work together!

Peter S. Jensen, MD

Board Chair & Founder; Chief Scientist

The REACH Institute