Implementing Patient-Centered Measurement-based Care for LGBTQ+ Patients

Summary

Many people in therapy do not get better with evidence-based treatments, and these treatments work even less well for people who face stigma and discrimination, including LGBTQ+ patients.^1-4 Clinicians say they need more support to provide good care to LGBTQ+ patients, who often deal with stress from bias, discrimination, and barriers to care.⁵ New state and federal policies that limit LGBTQ+ rights and access to healthcare are adding to this stress. Our earlier work shows that these policies are linked to serious emotional distress among LGBTQ+ people.^6,7 Clinicians in the community need training and tools to fully address LGBTQ+ patients’ needs in this challenging policy environment.⁸

Measurement-based care uses brief surveys or check-ins throughout treatment to track symptoms, goals, and progress. Patients and clinicians then work together using the information to guide care decisions. Research suggests this approach can make therapy more effective and more focused on what patients care about. This may be especially helpful for LGBTQ+ patients when the measures are individualized—written in the patient’s own words, based on their specific goals, stressors, and experiences with stigma or policy-related stress. Both clinicians and patients prefer these individualized tools because they better reflect what patients are actually struggling with and hoping to change.^9-11 These measures can also give LGBTQ+ patients more control over defining their goals and how progress is measured.

In this study, we will partner with community clinicians and LGBTQ+ patients to design practical strategies that help clinicians use this kind of patient-centered, measurement-based care. Our team includes experts in implementation science at Stony Brook University and experts in LGBTQ+ mental health and implementation science at Yale University, working with LGBTQ+-focused clinicians across the country.

Significance

Our main aim is to help clinicians better serve their LGBTQ+ patients.

We will work with clinicians and patients to design a strategy that supports clinicians in using measurement-based care, with an emphasis on individualized measures. The strategy will include training and ongoing resources. These measures will prompt clinicians and patients to regularly set, review, and adjust treatment goals together, giving LGBTQ+ patients more say and control in their care.

This is a pilot project. If the approach proves practical, acceptable, and easy for clinicians and patients to use, we will test it in a larger study and introduce it to more clinics across the country. This project promotes health equity by moving away from “one-size-fits-all” care. Standard treatments help fewer than half of patients and tend to be less effective for people who face stigma, discrimination, and financial hardship.^1-4 By supporting clinicians to routinely check in about each patient’s specific goals and needs, we aim to make care more personalized, effective, and affirming for LGBTQ+ patients.

Benefits

Demonstrated benefits are those that have been observed and are verifiable.

Potential benefits are those logically expected with moderate to high confidence.

Clinical & medical benefits

Empower LGBTQ+ patients to have agency in their psychotherapy treatment. potential.

Shared decision-making

Primary beneficiary:

Patients

Inform how to better design measurement-based care to make it contextually sensitive and patient-centered. potential.

Guidelines

Primary beneficiary:

Clinicians

Community & public health benefits

Engage LGBTQ+ patients and their clinicians to improve the effectiveness and patient-centeredness of treatment. potential.

Community power & partnerships

Primary beneficiary:

Patients

Improve the effectiveness of treatment for LGBTQ+ patients. potential.

Health care quality

Primary beneficiary:

Patients

This research has clinical and community implications. The framework for these implications was derived from the Translational Science Benefits Model created by the Institute of Clinical & Translational Sciences at Washington University in St. Louis.¹² 

Clinical

This pilot project will test whether using individualized measures within measurement-based care is more effective and patient-centered for LGBTQ+ patients in real-world settings. The findings will inform a future, larger randomized clinical trial in community clinics. Our early work focuses on making sure that the approach is feasible, acceptable, easy to use, and aligned with the needs of both clinicians and LGBTQ+ patients.

Community

Our work will help identify effective, evidence-based ways for clinicians to create more individualized care plans with LGBTQ+ patients who face unique stigma-related stressors. There is a clear need for care that is both effective and tailored to each patient’s specific treatment needs. Current treatment models often use a one-size-fits-all approach. Measurement-based care can advance health equity by ensuring LGBTQ+ patients’ concerns, goals, and stressors are actively included in treatment.

Lessons Learned

If the project is successful, it will show that clinicians and LGBTQ+ patients are willing to use measurement-based care when it feels relevant and supportive. We expect that both groups will find it valuable when clinicians receive enough support and when the measures are flexible and personalized. We also expect that LGBTQ+ patients will appreciate having more power to shape their own treatment around their needs, goals, and life circumstances.