What is measurement-based care

MBC is an evidence-informed approach that places students at the centre of their own care. It involves the regular collection, review and discussion of data, such as progress measures or student feedback, throughout an intervention.

In schools, MBC helps students and school mental health professionals work together to guide care, track progress and make decisions about next steps. It complements clinical judgment, allowing for responsive, student-directed and identity-affirming mental health support.

What the research tells us

• MBC is recognized as a person-centred practice that is culturally relevant and provides responsive student-centred care.
• Students experience better and faster goal attainment and symptom reduction with MBC as compared to usual care.
• Studies show that young people feel more engaged in their care when regular progress monitoring is used and shared with them to support joint decision-making about their care.
• Using clinical judgement alone, mental health providers detect deterioration for only 21% of their patients. MBC helps to track progress systematically so that clinicians notice when patients are no longer benefiting from a therapeutic approach.
• Whereas providers often fear that using MBC will disrupt the therapeutic relationship, studies show that MBC can actually enhance the therapeutic relationship.
• Despite some negative views of MBC by care providers, patient interviews indicate an almost universally positive view about MBC.
• Research shows that students receiving MBC experience faster goal attainment and greater symptom reduction than those in traditional care.
• MBC is a scalable, evidence-based clinical practice that can be added to nearly any school-based mental health treatment approach.

Why this is important

MBC is one of the essential practices for Tier Two and Tier Three school mental health services, supporting early identification, intervention and continuous improvement.

By routinely monitoring progress and outcomes, MBC helps:

• enhance student engagement and agency in their own care
• improve communication and trust between students and clinicians
• guide timely adjustments to interventions based on real data
• strengthen system-level accountability and transparency
• advance equity by examining outcomes across diverse student groups

What measurement-based care looks like in practice

In a school setting, MBC is a collaborative, session-by-session process:

1. Collect: students complete a brief, meaningful measure before or at the start of a session.
2. Reflect: the clinician and student review results together, noting progress and concerns.
3. Act: they decide together whether to continue the current approach or adjust focus or strategies.

This ongoing dialogue helps students see their growth, builds trust and ensures that interventions remain relevant and responsive.

Benefits of measurement-based care

For students

• understand their strengths and challenges
• feel empowered and involved in their care
• visualize progress and celebrate successes
• experience greater confidence and engagement

For school mental health professionals

• provide responsive, identity-affirming care
• strengthen therapeutic alliance and shared decision-making
• assess effectiveness of interventions in real time
• access structured tools to inform and adjust practice

For school boards and systems

• promote accountability and service transparency
• identify areas for professional learning or improvement
• use local data to inform equitable service planning
• strengthen collaboration across the continuum of care

Core components of measurement-based care in schools

• use of meaningful, evidence-informed measures to identify concerns, set goals and monitor progress
• routine data collection and discussion during sessions to guide decisions
• application of evidence-based interventions that align with student goals
• collaborative reflection and adaptation, ensuring care remains culturally and developmentally appropriate

MBC can also aggregate data (in de-identified form) across schools or systems, supporting quality improvement and equitable planning at the board level.

An identity-affirming approach to measurement-based care

An identity-affirming approach to measurement-based care ensures that every student’s experiences, identities and cultural contexts are respected.

School Mental Health Ontario encourages teams to:

• Engage Black, Indigenous and marginalized students in adapting tools and processes.
• Choose measures that are culturally responsive, accessible and meaningful.
• Use disaggregated data to identify and address inequities in access, engagement and outcome

Implementing measurement-based care in schools

Schools are a unique setting for mental health treatment services, so implementation strategies defined for other behavioural healthcare delivery settings are unlikely to fit perfectly for schools. Practicing MBC in a school setting is different than practicing MBC in a community or hospital setting. It’s doable, but different.

School boards can prepare for successful MBC adoption by:

• building champions within the school mental health team
• developing an implementation plan aligned with board priorities and capacity
• providing access to validated, brief and free measures in collaboration with clinicians
• offering training, coaching and supervision to ensure fidelity and sustainability
• streamlining documentation and technological support for ease of use

MBC works best when integrated into the broader school mental health strategy and supported through leadership, supervision and professional learning.

Building confidence in measurement-based care

For school mental health professionals and leaders:

• Familiarize yourself with your board’s MBC framework and service delivery model.
• Access professional learning through School Mental Health Ontario’s Leadership Portal and Knowledge & Implementation Series.
• Engage with communities of practice to share learning and refine implementation.
• Reflect on how MBC aligns with your local mental health and addictions strategy.
• Prioritize identity-affirming student-centred practice at every step.