Cindy Lopez: Welcome. My name is Cindy Lopez, the host of this CHC podcast, Voices of Compassion. We hope you find a little courage, feel connected and experience compassion every time you listen.

How do you know if your child is making progress in therapy? What if therapy came with a GPS that showed you exactly where your child is on their mental health journey and the best route to reach their goals? In this episode, we explore measurement based care with CHC experts, Dr. Pardis Khosravi and Dr. Emily Hsu about this approach that’s transforming mental health treatment by making progress visible and treatment more effective. Join us as we break down this game-changing practice that combines regular progress tracking with personalized care. We’ll discover why measurement based care matters for everyone, not just clinicians, and how simple questionnaires and check-ins can dramatically improve the therapy experience.

So, Dr. Khosravi and Dr. Hsu, thank you so much for joining us today, and I’m really interested in this topic of measurement based care. It’s been a learning journey for me, understanding this whole process and why it’s important for our listeners. Before we jump into that conversation, it would be great if you could tell our listeners just a little bit more about yourselves.

Pardis Khosravi, PsyD: Thank you for having us, Cindy. So, my name is Dr. Pardis Khosravi. I’m a clinical psychologist, and I’m also the clinical director here at CHC. So, clinically I specialize in working with teenagers and young adults through therapy and assessment. And as the clinical director, I have the privilege of getting to lead an incredible team of clinicians to do their best work. And as part of that, over the last year has been us implementing measurement based care at CHC. So, this is a topic near and dear to my heart, and I’m super excited to be here. 

Cindy Lopez: Thank you, Dr. Khosravi. Dr. Hsu?

Emily Hsu, PhD: Hello, and thank you so much for having me here. My name is Dr. Emily Hsu. I am a bilingual psychologist. I specialize in adult psychology, and I’m really excited about this topic because measurement-based care is something that was regularly practiced at practicum, internship and postdoc, and one of my first research questions was on comparing whether or not my adult patients would be more likely to disclose suicide on a questionnaire or when directly asked by their clinician. So, I think this is a great way to gather data and also to see how treatment is moving along and if there are any barriers. So, this is also something that is near and dear to my heart as well.

Cindy Lopez: So, let’s talk about this idea of measurement based care and why it matters to all of us, and I’m saying all of us, me, as a nonclinical person, why it matters to me and others like me?

Pardis Khosravi, PsyD: Simply put, measurement based care is the process of having a client fill out short questionnaires regularly throughout therapy to measure progress. So for example, if a client is seeking treatment for depression, then measurement based care might look like them filling out a really short depression scale every week at the start of session to help track the severity of their symptoms and if treatment is going well, we would expect to see that score go down over time as those treatment interventions start to take effect. And I think one of the beautiful things about measurement based care is that you can actually see if it’s not working and you need to shift course. 

So, I think about measurement based care like having a GPS for your mental health journey. A GPS shows you where you are, how far you’ve come, what route might work best to get to your destination, but it’s not GPS of the old days, like for people who remember MapQuest and printing out directions and you get on the road and if you take a wrong turn, like good luck to you. It’s not that, it’s more like WAZE. It’s not a set it and forget it. It’s if you make a wrong turn, it adjusts with you. It adjusts your route to make sure that you get to your destination. And so I think about measurement based care in that way of it’s bringing the voice of the client into the room. It’s increasing collaboration with the therapist. It’s really empowering the client to have different ways of sharing how things are going for them and helps them have a really active role in their healing process. And to be able to see that journey and make sure that for the client and the therapist alike, to make sure that they’re on track to get to their destination.

Cindy Lopez: Yeah, I like that analogy. I’m wondering, you mentioned questionnaires. So, I assume that’s a component of measurement based care. What are the components? Are there additional components?

Pardis Khosravi, PsyD: So, the components of measurement based care, it’s really a three part process. So, first part is to collect the data. So, that’s having the client regularly complete measures to report on their symptoms and how they’re doing. The second part is to share, so that’s why the therapist actually shares the results and the data trends with the client. So, you might come in a session having filled out your measure, and the therapist brings up that data and says, “Oh, I see, this last week, you’ve had a hard time sleeping, or you’ve experienced more anxiety,” and they get curious about the data and you have a conversation about that data or you might talk about trends over time – like, “I see that your score has actually gone down over the last few weeks, you know, let’s talk about that.” And so there’s this component of measurement based care that is really about that, that rich discussion that happens when you bring that data into the room and get to have a conversation about it because a lot of times what comes out in that conversation is helping you and the client get to the heart of the matter faster, to getting to the meat of what is going on, and how can we intervene and how can we help. But it also helps the client self-reflect, increase their awareness of maybe they experienced some stressors that week and that actually correlated with an increase in their depression and anxiety symptoms. And so helping to make those connections to understand themselves better is a really big component of this. And then the third piece is to act. So based on this data, what is the shared decision making that the therapist and client can do around the treatment course. So, are things going well and we just want to keep on this same route and keep doing what we’re doing? Is it not going well? Are we not seeing the anticipated results we would expect? And so, do we want to shift course? Do we want to try a different intervention? Do we want to add on something new? So, I kind of think about it like a GPS or if you think about, like when you go to a doctor or a pediatrician, they start by taking vitals and then the doctor comes in and they ask you how you’re doing and why you’re there that day. And so, the vital signs are one data point. The conversation they have with you is another data point. And so measurement based care is that, but for mental health. So, you’re collecting the data, you’re talking about it, and then you’re using that data to make a decision together with your therapist.

Cindy Lopez: I love that. And it makes total sense. As you were talking, I was thinking so a lot of your clients are youth, are young people. So, what does that look like when you’re using measurement based care with youth because it includes the parents because they’re parts of that process?

Emily Hsu, PhD: So, I use measurement based care with youth and also with parents. And I found it to be really helpful, especially if a teen is coming and they’re reporting that things are going well. What I will do is, especially if they haven’t been able to do the questionnaire before a session, is we will do it in session. And I do recognize that I do have to be cognizant of the fact that how they respond might be different because I am doing it with them, but I do think it starts bringing up a conversation about how they’re responding and if anything surprised them. And also what I like about measurement based care with some of my teens is that we talk about symptoms like depression and anxiety, but for every person that’s different. And depending on the questionnaires we assign, what I really like is that it goes into all the different parts of, for example, anxiety, how it affects them mentally, emotionally, and physically, and in ways that they didn’t expect and then also over the course of two weeks, you know, and things like that. And so, I’ve really liked measurement based care as a conversation starter, as an ongoing conversation starter to really see, well, if you’re saying you’re doing “okay,” and sometimes with teens that’s all they really want to say. I can then look at their measurement questionnaire that I administered or they administered the week before, and I’d be like, “Oh, well I’m noticing from last week you were saying this. Is that still the case?” And then we can start engaging in more of a conversation. Whereas I think of with, “okay,” sometimes it’s really hard to know where else to go because you just have, “okay,” and if they don’t want to respond to what that means, then I think it’s a little bit harder.

With parents, what I’ve noticed is, I’ve just administered a bunch of questionnaires for parents because I want to track… for one of my moms who tends to get very depressed, which negatively impacts her ability to take care of her child, work on his treatment goals, help him with coping skills. Tracking her depression has been very helpful for her to know when she’s having her triggers for depression. And I’ve also been using the parenting stress scale as well to see is there anything about when she has to parent that is adding to stress not only for this child but her other child, and then also affecting her depression levels and then looking at the trajectory. And she’s really enjoyed the graphs that we also have as part of our blueprint measures to see, wow, your depression was really high at this point. Can you remember what happened? Which also helps her to have a conversation and awareness of, you’re right at these certain points in my life, I started having some challenges, but now it’s better because of X, Y, and Z. So, that’s why I’ve noticed that measurement based care has been helpful for youth and for my parents.

Cindy Lopez: From what you both are describing, it sounds like measurement based care, it makes you feel like at least if I were the client like a little bit more in control. I mean, it feels like what you just said, Dr. Hsu, is this parent now sees this graph and like, oh my gosh, okay, I can see and then I can look back and say, “Perhaps I was more depressed at this point because of these things that were going on.” And that helps me as the client think, oh, this is not out of my control. This is not all happening to me. I can have some agency here. So, that’s kind of cool.

Pardis Khosravi, PsyD: I think the other piece when working with youth that is really powerful is when you have both the kiddo and the parent completing measures about the kiddo, you get a lot of different perspectives and there’s richness in that discrepancy. Often a teen and their parent are not seeing things exactly the same way. There’s not always a hundred percent agreement on how well a teen is doing in terms of their mood, their anxiety, their sleep, all of those things. And so, sometimes that discrepancy is actually fantastic because you can use that data to help teen and parent kind of bring both of those viewpoints together and help them see each other’s perspective, by just getting curious, like, “Hey, I’m noticing that you’re reporting that sleep is great. And you’re reporting that sleep is not, I’m curious about that. Let’s talk about that.” And a lot of really helpful insights come out in those conversations and I think it helps, like Dr. Hsu was mentioning, most people connect the dots, both kind of trends over time. But even I’ve had teens say to me like, I didn’t realize depression can impact sleep. I didn’t realize that this is a symptom of anxiety. And just by filling out the measure and being asked those questions, they’re starting to connect some of the dots and have greater ownership of their mental health journey and understanding themselves. And so that empowerment piece is really great.

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Cindy Lopez: Dr. Khosravi, you just mentioned some of this, but what’s the value for clients and those who are engaged in therapy? You just mentioned clients have greater ownership of that process. Are there other things that would be valuable for clients as well?

Pardis Khosravi, PsyD: Yeah, absolutely. There’s decades of research that support the practice of measurement based care as part of therapy, and we’ve really seen that at work, at CHC as well, but the research really supports patients show greater improvement, faster. And there’s a few reasons for this. One is some of what we’ve already been talking about,  clients, they’re going to see their progress more clearly.  There’s so much power in seeing your scores shift as you use your newly learned skills.  And so, as they put in the effort and the work into therapy – because therapy is hard work as a client – as they’re putting in that effort, and they’re seeing that corresponding change in scores, that’s motivation. Hey, this is working. Let me keep putting in this effort. Let me keep doing this. It’s really helpful to see those patterns. So, those things contribute to being able to see that progress and make progress more quickly.

The other piece is clients report a stronger working relationship with their therapist. They feel like their therapist is listening to them, is understanding their experience. They feel like they have more voice in the process. And we know through decades and decades of research that the quality of the relationship between the therapist and the client is one of the largest factors that predicts change in therapy. So above and beyond what kind of therapy you’re doing and the skill set of your therapist, it’s that relationship. And so, anything that strengthens that relationship is going to improve outcomes. And this is actually especially true for youth. So, the research tells us for so many kids and teens, I mean, they’re there because an adult told them to be, right. I can’t tell you the number of times I sat in front of a teen client and what brings you in today. And “Well, Mom said I had to be here.” And they don’t have a lot of ownership or a sense of agency. They just feel like they’re here to check a box. And when I can engage them in that process of measurement based care and like, “Hey, what are your goals? What do you want to track?” Not what your mom wants, not what your teacher wants, not what anyone else wants. What do you want? And what do you want to track and what do you want to see change? They get so much more invested in the process. And so there’s actually a large body of research that shows that if you compare treatment without measurement based care to treatment with measurement based care, the difference in change is so much greater for youth than for adults, actually. I mean, it’s highly effective in both populations, but particularly for youth because I think it empowers them, it increases that sense of transparency and collaboration and the clinician and the client are going to see if something is off track so much earlier, and so they’re able to pivot and change direction and try a new approach.

Cindy Lopez: So, you’ve mentioned some evidence that measurement based care works, and is there anything additionally you’d like to say about that? How does measurement based care lead to better outcomes?

Emily Hsu, PhD: I think it leads to better outcomes because what I like about questionnaires is, in preparing for a session we have an agenda, as clinicians, the client, their parents have an agenda. And what I like about questionnaires is it asks questions that we might not one, be able to ask or think to ask. And so, going back to my research where early on in my studies I was comparing, would my adults be more likely to disclose suicidal ideation if directly asked by a clinician or if it was through measurement based care? And we saw there were other factors that came to play as well, such as the gender, ethnicity, how many sessions, if this person had utilized therapy before, but we definitely saw there was an increase from when a client was asked because we show them measurement based care is not just a questionnaire you’re filling out. It’s something that we take very seriously, and we’re going to ask you about it. And so the combination of being asked these questions on the questionnaire and having the clinician follow up was really great. 

And I also like how sometimes what can happen is we’re there with the client. They may come in, they may be very upset, and what’s nice about the questionnaire is we can always review it beforehand. We can do it with the client, but it also asks questions that maybe because of what’s going on in the moment, we weren’t able to ask. The client was like, “Oh, that’s what I wanted to tell you, I noticed…” And so I think it’s always for me, in my experience, I’ve noticed it’s a great way to lead the conversation, guide it, and also bring us back to areas that are important in many different ways.

Pardis Khosravi, PsyD: I would add to that, that there’s a newer body of research that’s showing that youth of color or youth from historically underserved communities, who typically have higher rates of treatment dropout and poor overall outcomes in therapy, show a lot more improvement while measurement based care is part of the therapeutic approach.  And the reason for that is and as we’ve been talking about, clients who are engaged in measurement based care are overall just more engaged in their therapy. They’re more likely to stay in treatment and they’re more likely to have better outcomes. And so for populations where all of those things have historically been challenges, they’re more likely to drop out of treatment. They’re more likely to not be engaged. Measurement based care is an incredible way to engage them and to protect against some of that early dropout because it’s promoting mental health literacy, right? You’re learning about yourself, you’re learning about your patterns. It’s enhancing the communication with the therapist. So, whereas a lot of individuals from these historically underserved communities might feel like, oh, my therapist doesn’t get me. They don’t understand what I’m going through. They don’t get how this is impacting my life. These measures and the conversations really that come out of them because it’s bigger than just the measure itself, lead to more communication and more transparency, and so a lot more engagement in care and sticking with the care to get to those positive outcomes.

Cindy Lopez: So, my background is all education, and so much of what you’re talking about really resonates with me as an educator because we’ve used “progress monitoring” for a kabillion years. And so understanding where a student is and what their trajectory is and what interventions can help just reminds me a lot of this conversation we’re having. So, I’m wondering, given all of this measurement based care, all of the strengths of measurement based care, and the value of it for the client especially, do all providers use measurement based care? It seems like they should be. And if they don’t, is that something our listeners should be aware of? How would they find providers?

Pardis Khosravi, PsyD: I wish I could say yes, Cindy, everyone uses it. But, I actually read some pretty concerning research the other day that less than 20% of providers in the community use measurement based care, despite literally decades of evidence that this is best practice, and I think there’s a lot of reasons for that. Historically, it’s hard to do measurement based care without the appropriate technology to support it. So, not to date myself, but when I learned to do this in graduate school, you had to print out the questionnaire, you had to have the client fill it out, then you have to hand score it and it’s a whole process, right. Fortunately technology has really come a long way to help automate a lot of those things. And so I think we’re seeing in the field a greater trend towards using it, but I think we’re a long way from having every therapist out there using measurement based care. And so I really highly encourage parents or any of our listeners who are seeking therapy for themselves, for their kids, for anyone in their life to ask potential therapists, just like we might ask a therapist about their background or their experience, I would ask, how do you track outcomes throughout the treatment journey? How do you track progress? And see what they say and see if they’re engaging in that measurement based care process.

Cindy Lopez: So, let’s bring it back home, CHC. Do all providers at Children’s Health Council use measurement based care?

Pardis Khosravi, PsyD: Yes, I can very proudly say, yes, we do. And speaking to that technology piece, we have a technology platform called Blueprint that makes it really easy. So, for the client or the parent, they’re sent a text or an email, whatever their preference is with the link. They click on the link, there’s no login or anything. They just fill out their questionnaire and the clinician can see it immediately. So, it’s scored for them automatically. It puts it on this nice little graph that the clinician can then share with the client or the parent during those discussions. So, it makes it really easy and seamless, both for the client and for the clinician, which I just think is really key to making it effective.

Cindy Lopez: Do you have any stories from clients? So, I’ve been hearing from you both that it’s a really valuable tool for you, as a provider, as a clinician. And you’ve said all these great things about greater agency, ownership, all of those things for the client. Can you talk about the improved client experience because of measurement based care?

Emily Hsu, PhD: I definitely can. I have a Spanish speaking mother that I am working with. She’s a single mom, and she has a son who I’m also working with, with a complicated medical condition, and she wasn’t familiar with measurement based care and check-ins turned into we need more because she was introduced to the concept of mindfulness, coping skills, and she’s somebody who’s willing to do everything that was recommended, but also wasn’t quite sure like what was it? Was it that I did a breathing exercise? Was it that I practiced mindfulness? Was it that I used an affirmation? Was it that I went out? And so, what I thought was really helpful about measurement based care, what she’s noticed because she really likes the graphs, she’s a visual person like myself, was that I was able to track what was it about.. because we also talk about vulnerabilities, like, did you eat? And I would see a shift in her whenever we do the questions together because she’s found that to be also very therapeutic. She likes me asking the questions, and then she sees her graph and she’s found it to be really helpful to be like, “Oh, when he was hospitalized, I was not doing well. But he got hospitalized again three months later, how come I was better,” and I said, “What were the coping skills that we used back in January, 2025 to now? What have you learned about yourself and does what you’ve learned about yourself and what’s worked with you using the coping skills, does that align with your numbers? Because you still are depressed, but you’re not severely depressed. There has been a decrease.” And so, I think that’s been helpful for her to be like, “Yes, when I do this, when I eat. When I use the reminders to eat, you know, on my phone, when I reach out, when I notice my negative cognitions, I’ve actually noticed that there is a sigh of relief that I’m starting to have, like I’m physically feeling that and I think it’s because I’m starting to notice the trends, but I’m also now seeing it being reinforced by what I’m reporting.” And so for her it’s been really comforting to have that extra data that we track every two weeks, and she’s really great about it. So, she’s given me that feedback being like, yeah, I’ve never done this before. And it’s been very exciting for her to see that. Because we track a lot: depression, parenting stress. I’m also using DBT, dialectal behavior therapy techniques with her. And so, it’s been really helpful. She’s told me independently to be like, okay, are we moving along at the pace we need to be? And when she is a little bit more depressed, less depressed, does that track with what she’s reporting on the questionnaires?

Cindy Lopez: As we’ve been talking. I’m becoming more and more sold on measurement based care. And I can see it’s not just like theoretical. There are real world studies and evidence consistently showing that when therapists and clients work together, using this kind of progress tracking and regular progress tracking that they get better results from their mental health care. So, I think that that’s really important and it’s important for our listeners to hear today too. In addition to that, what do you hope that our listeners really take away from our conversation today?

Pardis Khosravi, PsyD: Therapy doesn’t have to feel like a mystery. I think measurement based care really brings together both data and lived experience. So, that you can actually see your progress, have more voice in the process, and work in true partnership with your therapist or your child’s therapist. And so, it’s not about, you know, data replacing the richness of therapy conversations, your clinician’s expertise, it’s just another data point to help make therapy smarter, more collaborative, more personalized to you, and ultimately more effective.

Emily Hsu, PhD: I would agree with Dr. Khosravi. I think of questionnaires, measurement based care as a tool – something else to put in your arsenal, to really understand yourself. I had a mother ask me the other day, like should I be talking about mental health with my children? And I said, Absolutely. In therapy, not in therapy. We really want our children to start having language to what’s going on for them and how you start having language, how you start putting words to things is by facilitating a conversation. We don’t have to be like, “How are you feeling?” We could have a check-in, you know, that’s something that I’m facilitating with one of my families. And I also have noticed with my youth, there’s been some children I’ve been working with where they’ve been like, “I don’t know why I’m feeling sad. I just am.” And I think what is great about questionnaires is like Dr. Khosravi had said, we don’t want mental health to be a mystery. We don’t want people to not have the language to describe what’s going on for them. Because we know that there’s so many words to describe how one’s feeling and you can feel multiple things at once and that changes over time. And I think this is what I like about measurements based care because yes, it is a snapshot in time, but it is also a data point for us to be able to look back upon and be curious about. What was it then that helped me? Or what was it then that didn’t help me? And I think it’s a really great way to also provide feedback to your therapist, to your clinical team about what’s working and what’s not. And it’s also, I think, a better way to also help facilitate insight and put words on, oh, I wasn’t feeling well because I didn’t sleep. I know for me I now need seven to eight hours of sleep. And so I think it can really take the mystery out by talking more authentically about symptoms and raise awareness as this is what depression looks like. This is how it’s different for you, anxiety and other mental health symptoms.

Cindy Lopez: Thank you so much Dr. Hsu and Dr. Khosravi for joining us today, for talking about this important topic. For our listeners, if you’re looking for therapy or assessment for your child, please reach out. Whatever’s going on from a mental health perspective, learning differences perspective, we can help. You can email us at [email protected], or you can call us at 650-688-3625. So thank you all for joining us and especially Dr. Khosravi and Dr. Hsu.

Pardis Khosravi, PsyD: Thank you, Cindy.

Emily Hsu, PhD: Thank you so much, Cindy.

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