Measure Progress, Not Perfection Applying Measurement-Based Care to Addiction Treatment A Tridiuum White Paper, in collaboration with Vertava Health

Emil Chiauzzi, Ph.D., Head of Research, TridiuumDaniel Coyne, BSN, RN, CARN, Director of Utilization Review, Vertava HealthTina Harralson, Ph.D., Vice President, Clinical Science, TridiuumMelissa Stöcker, BSN, RN, CHPN, Director, Quality, Vertava Health

tridiuum.com

© 2021 Tridiuum. All rights reserved.

vertavahealth.com

Measure Progress, Not Perfection: Applying Measurement-Based Care to Addiction Treatment 2

Contents

Introduction ...................................................................3

Background ...................................................................4

Why Measurement-Based Care for SUD ................5

Outcome Measures Are Insufficient................5

Measurement-Based Care Improves Outcomes .............................................................6

Developing an MBC Platform for SUD Patients ................................................................7

Starting Point: Tridiuum ONE for Behavioral Health Patients ................................7

Selecting the Right Tools for SUD Progress Measurement .....................................7

The Solution - Tridiuum ONE SUD Care .........8

Goals / Opportunities ................................................11

For the Patient: Better Outcomes .................. 11

For the Clinician: Enhanced Clinical Management .......................................................11

For the Company/Facility: Improved Patient Placement and Compliance.............. 13

Next Steps ................................................................... 16

References .................................................................. 17

Measure Progress, Not Perfection: Applying Measurement-Based Care to Addiction Treatment 3

Introduction

Measurement-Based Care (MBC) is the practice of

using patient feedback throughout the behavioral

health continuum of care to improve treatment and

enhance outcomes. While MBC’s efficacy is well-

established in mental health treatment, addiction

treatment providers face unique challenges in

the design and implementation of MBC tools

and principles. This is due to fewer standardized

assessment tools, inconsistent or disjointed use, and

a lack of MBC research and aggregate data specific

to Substance Use Disorder (SUD) treatment.

Vertava Health, a leading provider of addiction and

behavioral health treatment, and Tridiuum, a digital

behavioral health company dedicated to advancing

the treatment of behavioral health conditions,

have partnered to create, launch, and scale a

Measurement-Based Care platform and process for

SUD treatment across all levels of care.

Our goals are to:

• Incorporate validated SUD assessment tools

into a comprehensive behavioral health MBC

platform;

• Understand the influence and confluence

of addiction, mental health issues, and early

recovery on physical, emotional, and relational

measures;

• Leverage the MBC feedback loop throughout

treatment to modify and improve treatment

plans and interventions; and

• Realize benefits across a range of disciplines.

By combining mental health and SUD-specific

assessments into an MBC format, we hope to

achieve a more patient-centered and outcome-driven

approach to measuring recovery.

While Measurement-Based Care’s (MBC) efficacy is well-established in mental health treatment, addiction treatment providers face unique challenges in the design and implementation of MBC tools and principles.

Measure Progress, Not Perfection: Applying Measurement-Based Care to Addiction Treatment 4

Background

About Tridiuum

Tridiuum is dedicated to advancing the treatment of behavioral health conditions through the application of

digital technology to measurement-based care (MBC). Tridiuum capabilities are designed to identify members

in need of behavioral health treatment and support, accelerate access to the most appropriate care, facilitate

behavioral-medical integration, and deliver a measurable impact on outcomes.

Tridiuum’s cloud-based platform, Tridiuum ONE®, automates MBC by combining digital behavioral health

assessments with an advanced analytics engine to rapidly identify patient behavioral health issues, assign

risk scores, and generate alerts which are delivered in real-time at the point of care. Tridiuum ONE has been

administered more than six million times and is used by 1.5 million patients.

About Vertava Health

Vertava Health is a leading national behavioral health care system for substance use and mental health

conditions. With residential treatment and outpatient wellness centers across the country as well as virtual

behavioral health care options, Vertava Health provides a full continuum of services based on the individual’s

varying needs throughout their health and recovery journey.

Evidence-based treatment and innovative digital health tools are utilized at each level of care and across a

wide range of services including detox, individual counseling, support groups, and medication management.

Vertava Health’s mission is to pioneer care that empowers people so that they can live out their best future.

Vertava Health strives to provide the highest levels of quality care with accreditations and memberships with

the following organizations: The Joint Commission, the National Association of Addiction Treatment Providers

(NAATP), and the National Association for Behavioral Healthcare (NABH).

Measure Progress, Not Perfection: Applying Measurement-Based Care to Addiction Treatment 5

Outcome Measures Are Insufficient

Reliable outcome data for SUD treatment is both

highly sought after and notably elusive. Post-

intervention outcome measurement has been

encouraged by the National Institute of Drug Abuse

(NIDA), the National Institute on Alcohol Abuse

and Alcoholism (NIAAA), as well as treatment

organizations such as NAATP. Unfortunately,

substance use disorders present a unique

constellation of challenges to effective outcome

measurement.

Because addiction is a chronic, progressive, and

often cyclical disease that requires treatment over

the lifespan, there is no single appropriate post-

intervention moment to gauge the effectiveness

of treatment. Long-term recovery often requires

episodic involvement in treatment and support over

many years. Relapses are common, and single or

sporadic assessments may misrepresent a bigger

journey of recovery. Inconsistent administration of

measures limits the potential impact of findings on

ongoing treatment.

Additionally, there is a lack of consensus about what

outcome data to measure. There are advantages

and shortcomings to measuring: abstinence from a

patient’s drug of choice; abstinence from all non-

prescribed mood-altering substances; reduction in

amount or frequency of substances used; adherence

with prescribed treatment; continued engagement

with health care services or peer support groups;

reduced criminal activity; reduced risk for HIV or

hepatitis; improved independent function; and/or

improved relationships or quality of life.

Barriers to collecting follow-up outcome data from patients include relapse, shame, isolation, changes in housing, and lack of access to technology.

Finally, SUD patients are difficult to maintain

communication with for long-term follow-up.

Barriers to collecting follow-up outcome data from

patients include relapse, shame, isolation, changes

in housing, and lack of access to technology.

Longstanding traditions of anonymity represent

another challenge to identifying and reaching people

in recovery.

Why Measurement-Based Care for SUD?

Measure Progress, Not Perfection: Applying Measurement-Based Care to Addiction Treatment 6

MBC has been gaining traction in mental health

treatment, and a growing body of rigorous

research supports MBC as positively affecting

patient involvement, therapeutic alliance and

communication, and treatment planning across

various treatment modalities, populations, and

settings (Lewis et al., 2019).

• The feedback process has intervention

properties that trigger treatment change in 40%

of the patient encounters (Lewis et al., 2019).

• MBC produces these effects through symptom

monitoring, improving communication

between patient and clinician, and effecting

patient changes in role functioning and quality

of life (Aboraya et al., 2018).

• Providing clinicians with real-time feedback

enhances patient engagement in treatment, e.g.,

retention over longer periods (Miller et al., 2006).

• Measurement-based care can work particularly

well for patients who are “not on track” for

positive outcomes (Delgadillo et al., 2018).

Based on these results, two key takeaways emerge:

(1) screening-based approaches alone (i.e., screening

patients once by using a symptom rating scale and

alerting clinicians to symptomatic patients) are

inadequate; and (2) measurement works best when

it is fed back to patients and used to drive treatment

planning (Fortney et al., 2017).

Measurement-Based Care Improves Outcomes

MBC offers a distinct advantage over simple measurement, as it introduces a patient feedback loop into the

assessment process. As utilized in behavioral health treatment, MBC includes four components:

Source: Lewis et al., 2019

Measure Progress, Not Perfection: Applying Measurement-Based Care to Addiction Treatment 7

Starting Point: Tridiuum ONE for Behavioral Health Patients

Tridiuum ONE already offers an advanced MBC

platform for behavioral health treatment. Patients

can complete brief, online assessments from any

device. Smart logic branching integrates elements

of the Personal Health Questionnaire-2 and -9

(PHQ), General Anxiety Disorders-2 and -9 (GAD),

therapeutic alliance (TA), Columbia Suicide Severity

Rating Scale (C-SSRS), and PTSD-5.

While these measures include several questions

about substance use, they were insufficient to

capture the progress and challenges for patients

whose primary diagnosis is SUD. Additionally,

questions about current use are inappropriate for

patients in inpatient levels of care, where continued

use is (hopefully) not possible.

Selecting the Right Tools for SUD Progress Measurement

Most assessment tools for addiction focus on the

detection of a potential substance use disorder.

Far fewer are designed for engaging patients and

actively tracking their progress in SUD treatment.

After reviewing a number of addiction assessment

measures, we selected the Brief Addiction

Monitor (BAM; Cacciola et al., 2013) and Severity

of Dependence Scale (SDS; Gossop et al., 1995).

The BAM is a recognized screening and outcome

tool and has been selected for the Veteran’s

Administration MBC initiative (Gaddy et al., 2018).

In addition, it has been included as a recommended

outcome measure by the Joint Commission (2021a)

and the Kennedy Forum (Wrenn & Fortney, 2015).

Developing an MBC Platform for SUD Patients

Vertava Health and Tridiuum selected the BAM for

the following reasons:

• SUD-specificity, focusing on detoxification need,

medical need, psychiatric symptoms, treatment

readiness, relapse risk, and recovery support

• Designed for use with SUD measurement-based

care

• Brief to administer with only 17 questions

• Demonstrated validity and reliability

(Cacciola et al., 2103)

• Designed for both screening and outcomes

monitoring

• Captures both risk and protective factors

• Easily adapted across levels of care

• Can be used for program evaluation

and supervision

The SDS is a widely used, five-item questionnaire

for measuring psychological dependence across

different classes of substances. The clinical

and psychometric value of the SDS has been

demonstrated in populations using a variety of

substances (including amphetamines, cocaine,

benzodiazepines, alcohol, opioids, and cannabis), as

well as across a variety of age groups (Deady, 2009).

Measuring psychological dependence provides

important clinical information that can address

relapse risk and needed recovery supports.

In combination with the Tridiuum ONE mental

health assessment, the additional assessments

offer reporting that addresses not only SUD-

specific risk and protective factors but also the

possible presence of co-occurring disorders. This

comprehensive approach helps to address the

important domains in patient placement systems

such as the ASAM Criteria (2021) – withdrawal

potential, physical and psychiatric comorbidities,

relapse potential, psychosocial support factors, and

readiness to change.

Measure Progress, Not Perfection: Applying Measurement-Based Care to Addiction Treatment 8

The Solution – Tridiuum ONE SUD

The Tridiuum ONE SUD assessment is scored in real

time. Immediately, individual questionnaire scores

are available to the clinician (i.e., PHQ, GAD, BAM,

etc.) along with Tridiuum’s Behavioral Health Index

(BHI). Additionally, critical alerts and comprehensive

assessment reports appear on the platform. This

information can be shared and discussed with the

patient immediately.

Behavioral Health Index (BHI)

The BHI is a weighted composite score that includes

questions from four domains: subjective well-being,

functioning, depression, and anxiety. The BHI is

collected at each assessment and used to track

patient progress visit to visit, providing valuable

insights from Tridiuum ONE to adjust treatment

when needed.

Patient Profile Page

The patient profile page (Figure 1) provides important

data at a glance. This page includes critical alerts

for suicide ideation (SUI), harm to others (HARM),

hallucinations (HAL), therapeutic alliance (TA),

relapse risk (RISK), substance use (SUB), and

interpersonal violence (IPV). This page tracks PHQ,

GAD and BAM dimensions over time, as well as

TA, C-SSRS and PC-PTSD-5. Scores for the six

BAM dimensions are shown on the patient profile

page, including detoxification need, medical need,

psychiatric symptoms, treatment readiness, relapse

risk, and recovery support. This page also indicates

whether the patient is prescribed medication-

assisted treatment (MAT) and/or psychiatric

medication and if they are using as prescribed. This

figure shows some of the available alerts triggered by

the above assessments.

Figure 1. Clinician View of Patient’s Profile

Measure Progress, Not Perfection: Applying Measurement-Based Care to Addiction Treatment 9

Patient Reports

A report is generated each time that a patient

completes an assessment. The first page of the

Intake Report (Figure 2) is a summary of the

assessment and includes critical alerts, initial BHI

score, BAM dimension scores, SDS item scoring,

and mental health symptoms. Subsequent pages

of the Intake Report contain more detail on each

of these sections.

The Monitoring Reports (Figure 3) provide current

scores as well as results from the previous

assessment and results from the Intake Report. This

allows clinicians to easily track patient progress.

Figure 2. Patient Intake Report

Figure 3. Patient Monitoring Report

Measure Progress, Not Perfection: Applying Measurement-Based Care to Addiction Treatment 10

Population Analytics Dashboard

The Tridiuum ONE platform includes a Population Analytics Dashboard (Figure 4). Data can be viewed across

the patient population as a whole or by applying various filters, including individual clinicians and sites within

an organization.

Figure 4. Population Analytics Dashboard

Data can be viewed across the patient population as a whole or by applying various filters, including individual clinicians and sites within an organization.

Measure Progress, Not Perfection: Applying Measurement-Based Care to Addiction Treatment 11

In addition to established MBC benefits related to

patient care, clinician support, and organizational

quality improvement, Vertava Health and Tridiuum

have identified a wider array of potential benefits.

MBC data will be leveraged for:

• compliance and accreditation;

• level of care placement decisions;

• utilization review;

• treatment planning informed by predictive

analytics; and eventually,

• longitudinal analysis that can help establish

or confirm best practices for the treatment of

SUD and co-occurring disorders.

We believe that all stakeholders – patients,

clinicians, and organizations – have much to gain

from MBC data.

For the Patient: Better Outcomes

Strengthening the Therapeutic Alliance

The patient-clinician relationship is often more

important to retention than the treatment being

offered or patient characteristics (Laudet et al.,

2009). MBC may enhance the patient-therapist

alliance by opening communication. In fact, such

discussion can allow patients to expand the

objectives of treatment beyond simple symptom

relief to quality of life issues (Zimmerman et al.,

2006). The treatment alliance should be actively and

consistently assessed, as it may signal potential risks

for disengagement (Goldberg et al., 2020; Connors

et al., 2016). In SUD treatment, more positive ratings

of the treatment alliance have been shown to be

associated with less alcohol usage, particularly in

patients who have not yet begun reducing their use

at intake (Connors et al., 2016). MBC has the potential

for improving the therapeutic alliance, which may

lead to greater patient satisfaction with treatment

(Goodman et al., 2013). In terms of medication-based

opioid therapies, MBC has been shown to increase

engagement, retention, and effectiveness (Marsden

et al., 2019).

Managing Co-Occurring Psychiatric Symptoms

The co-occurrence of substance use and psychiatric

disorders is well established, but is complicated

by withdrawal symptoms, negative life events, and

simple adjustment to a new lifestyle when substance

use is reduced or eliminated. This may be particularly

problematic upon admission, so the clinician’s

challenge is to distinguish a potential co-occurring

disorder from short-term symptoms. Because these

symptom patterns can change daily or weekly,

ongoing assessment is essential. More importantly,

patients need to be apprised of their symptom

picture so that they can accurately gauge their

progress. To make matters even more complicated,

recovery brings its own challenges in the form of

protracted withdrawal (also known as “post-acute

withdrawal”). Symptoms may include depression,

anxiety, sleep difficulties, impaired short-term

memory, difficulties concentrating, poor executive

control, and fatigue (SAMHSA, 2010).

For the Clinician: Enhanced Clinical Management

Treatment and Discharge Planning

Initial treatment planning with SUD patients

requires attention to medical needs, safety

planning, level of care decisions, matching with

clinicians and treatment modalities, and length

of treatment. MBC has been reported by both

patients and clinicians to be helpful in identifying

treatment targets and developing treatment plans

in SUD treatment settings (Johnston et al., 2016).

Goals / Opportunities

Measure Progress, Not Perfection: Applying Measurement-Based Care to Addiction Treatment 12

After treatment begins, ongoing assessment helps

the clinician and patient evaluate symptom patterns

from week to week, understand which symptoms

are persistent, and gauge the interventions that are

most helpful. Objective assessments are important

to validate or dispute a clinician’s intuition, as

clinicians may have an inaccurate view of their own

effectiveness (Werbart et al., 2019). Discharge

planning offers similar opportunities to gauge

progress and readiness, identify risks, and adjust

plans to address new insights.

Unexpected results at any point can prompt

the team to consider a cascade of treatment

modifications to address:

• Safety

• Mental health conditions

• Medication effectiveness

• Medication adherence

• Readiness-to-change and motivational

adjustments

• Potential to discontinue treatment against

medical advice

• Step-down, discharge, and aftercare planning

• Family and relationship issues

Patient Motivational Enhancement

Motivational interviewing (MI), a significant

treatment modality for SUD patients, perfectly

aligns with MBC. Examining self-reported

assessment results help patients accurately

perceive and resolve ambivalence related to their

diagnoses, symptoms, and treatment plan.

MBC is not simply information retrieval, but an

active patient process (Greenhalgh et al., 2018).

Findings show that patient-reported outcome

measures (PROMs) can change patient perceptions

of their conditions (Greenhalgh et al., 2018).

Answering clinical questions can prompt reflection

about topics not previously considered, giving

patients “permission” to raise new issues with the

therapist.

All of these features of MBC are highly consistent

with MI, as regular completion of outcome measures

increases the likelihood that patients will become

more knowledgeable and aware of their disorders

and pay more attention to symptom fluctuations

that act as warning signs of relapse or recurrence

(Valenstein et al., 2009). As stated by the influential

Kennedy Forum issue brief, Fixing Behavioral Health

Care in America: National Call for Measurement-

Based Care in Behavioral Health and Primary Care

(Fortney & Sladek, 2015):

… behavioral health providers are

empowered to fine-tune treatment plans

when patients are not improving, and patients

who participate in rating their symptoms are

likely to become more knowledgeable about

their disorders, attuned to their symptoms,

and cognizant of the warning signs of relapse

or reoccurrence, enabling them to better

self-manage their illness and seek treatment

without delay.

Vertava Health has found that MBC results can

reveal incongruence between patients’ presentation

and their self-reported results. This has proven to be

a fertile area for MI exploration in therapy sessions.

Goals / Opportunities continued

Measure Progress, Not Perfection: Applying Measurement-Based Care to Addiction Treatment 13

Treatment Retention

Clinicians working with SUD patients are well aware

that treatment dropouts are an ongoing challenge.

In fact, residential programs report only a 65%

completion rate, while this number dips to 52% in

outpatient programs (Stahler et al., 2016). Patient

feedback about their outcomes has been shown to

be effective in helping off-track patients to get back

“on track”, i.e., improving attendance and reducing

substance use. Counseling sessions that include

direct patient assessment feedback increased the

number of outpatient treatment sessions attended

(Raes et al., 2011). MBC has been shown to increase

the attendance and efficacy of group sessions as

well. Group participants who receive assessment

feedback attend more group sessions and show

higher rates of reliable and clinically significant

change (Schuman et al., 2015).

Clinicians at Vertava Health have found that patients

eager to return home typically overestimate their

progress and readiness. A review of their current

vulnerabilities based on their own responses is an

effective way to bolster motivation to complete

treatment. Conversely, a patient who is anxious

about leaving treatment can gain confidence from a

review of their progress.

For the Company/Facility: Improved Patient Placement and Compliance

The tendency to isolate MBC as a clinical technique

rather than understand it as an organizational quality

improvement tool is misguided. As stated by Connors

et al. (2021),

To promote better MBC implementation,

the ideal situation is a synergistic one, in

which clinicians gather data that are useful

to their clinical decision-making and provide

useful information for agency-wide quality

improvement purposes. The field has been

primarily focused on the former, without clear

linkages to the latter.

Our initiative seeks to leverage MBC not only as a

routine outcome monitoring tool, but as a means of

enhancing service delivery and clinical strategy.

Implications for Utilization Review

Payers value feedback from patients as a credible

indicator of treatment progress. Treatment facilities have

a financial incentive to extend treatment, while insurance

companies benefit (in the short-term) from denying

it. Data from validated assessments, electronically

administered in regular intervals, offers a non-biased

view of a patient’s current condition and progress during

treatment. Tridiuum’s reports graph various indices,

giving payers a clear visual representation — both of

current state and change over time.

While level of care decisions are ultimately the

judgment of qualified clinicians or medical providers,

Tridiuum reports can help identify the presence of

symptoms, risks, behaviors, thought processes etc.

that are consistent with ASAM level-of-care criteria.

Goals / Opportunities continued

Measure Progress, Not Perfection: Applying Measurement-Based Care to Addiction Treatment 14

Over time, aggregate data may provide insight that

can help justify the course of treatment for certain

types of patients. For example, if patients with

opioid use disorder consistently report a significant

spike in cravings three to five days after finishing a

buprenorphine taper, insurance companies may be

persuaded to authorize additional treatment to cover

patients approaching that vulnerable time period.

Compliance and Accreditation

The Joint Commission has developed a set of MBC

standards that define the use of standardized,

evidence-based, and multidimensional assessments

(Joint Commission, 2018). The Tridiuum ONE

assessments used by Vertava Health fulfill these

criteria, e.g., the Personal Health Questionnaire-2

and 9 (PHQ), Generalized Anxiety Disorder-2 and 7

(GAD), and Columbia-Suicide Severity Rating Scale

(C-SSRS).

Joint Commission standard CTS.03.01.09

(3/4/21): Measurement-Based Care –

Standardized Tools and Instruments - The

Joint Commission standard CTS.03.01.09

requires that outcomes of care, treatment,

or services be monitored over the course of

service using a standardized instrument – a

practice generally known as measurement-

based care. (Joint Commission, 2021b)

Standard CTS.02.03.13: For organizations

providing care, treatment, or services to

individuals with addictions: The individual

served is placed in the appropriate level

of care. Requires use of evidence-based,

multidimensional admission assessment

tools. (Joint Commission. 2019)

The Joint Commission has added another key

assessment target to SUD accreditation: readiness

to change, which is also assessed in Tridiuum ONE.

Standard CTS.02.03.07: For organizations

providing care, treatment, or services to

individuals with addictions: The assessment

includes the individual’s history of

addictive behaviors. It is important for

the organization to gather information

on readiness to change and factor this

into the individual’s treatment plan. (Joint

Commission. 2019)

Most importantly, this information needs to be

gathered continuously because readiness to change

at admission does not predict abstinence from

substance use at follow-up (Opsal et al., 2019).

Motivation is not static, and many patients improve

their readiness during the course of treatment.

Goals / Opportunities continued

Motivation is not static, and many patients improve their readiness during the course of treatment.

Measure Progress, Not Perfection: Applying Measurement-Based Care to Addiction Treatment 15

Enhanced Population-Level Planning

Digital assessment allows the collection of data

from thousands of patients across the entire

United States. Using Tridiuum ONE, Vertava Health

expects to collect longitudinal data that can reveal

not only the characteristics and clinical status of

patients (BHI, assessment results), but also:

• information about the sites where they have

been treated (types of programs, level of care,

location);

• the modalities of treatment offered;

• treatment delivery (length of treatment, number

of sessions, referrals),

• treatment outcomes (effect sizes, remission,

response); and

• clinician characteristics (degree, discipline, etc.).

Tridiuum ONE offers a population analytics dashboard

that allows administrators to view performance

metrics at a population level and by site. Utilizing

this database for predictive analytics can improve

treatment interventions, inform service refinements,

address clinician training needs, and define patient

treatment utilization in a more proactive manner.

Using MBC data, we can begin to ask questions

such as:

• What treatment plan modifications might be

triggered by various patient responses and

scores?

• Which assessment findings best predict SUD

outcomes?

• Does group attendance correlate with BHI

scores?

• Is there a correlation between beginning MAT

and a reduction in anxiety or depression?

• Does a particular drug of choice correlate with

higher suicidality?

• Can we predict appropriate length of stay

at each level of care based on assessment

outcomes?

• What is the expected treatment path for

patients with different characteristics, e.g.,

substances used, co-occurring disorders etc.?

• Are population outcome trends reflected in

local treatment programs?

Goals / Opportunities continued

© 2021 Tridiuum. All rights reserved.

tridiuum.com

Next Steps

Addiction is often a fatal disease, and patients

leaving SUD treatment are at an exceptionally high

risk for unintentional fatal overdose, due to the

potential for relapse and naïve receptors (Ravndal

& Amundsen, 2010). The stakes are too high to

wait until after treatment to assess the outcome.

We need to accelerate the development of tools

to assess SUD treatment progress at regular,

frequent intervals throughout the continuum of

care. In addition, we need to establish feedback

and response processes to ensure that the data is

immediately available to help clinicians, patients,

administrators, and other stakeholders to course-

correct for the patient-at-risk, and to evaluate

treatment models for future best practices.

Tridiuum ONE for SUD is the result of a pioneering

partnership with Vertava Health to offer a new

approach to integrating MBC in SUD treatment.

We need to accelerate the development of tools to assess SUD treatment progress at regular, frequent intervals throughout the continuum of care.

vertavahealth.com

Measure Progress, Not Perfection: Applying Measurement-Based Care to Addiction Treatment 17

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