Measuring Client Improvement: Introducing the Functional Assessment

One of our driving goals is to make it easy for SonderMind therapists to deliver high-quality care in the right place at the right time. We’re already beginning to see preliminary data that shows our Feedback-Informed Care (FIC) program is improving clinical outcomes both from an individual perspective and a population health perspective. 

So far, we’ve developed our FIC program based on three clinical questionnaires: 

• PHQ9 
• GAD7
• Therapeutic Alliance
   

This August, we’re rolling out a fourth questionnaire: the functional assessment. This questionnaire examines how a client perceives their day-to-day functioning, and more specifically, how they perceive their improvement — or decline — in treatment. 
 

In this article, we’ll provide more detail about this assessment, how it fits into our FIC program, and how you can use your clients’ responses to help improve their clinical outcomes. 

What is the functional assessment?

The functional assessment, sent to clients every two weeks, looks at how clients perceive their day-to-day functioning, and more specifically, how they perceive their improvement — or decline — in treatment. 
 

Similar to the therapeutic alliance assessment, the functional assessment is both transdiagnostic and transtheoretical, meaning it can be utilized with all clients regardless of diagnosis or therapeutic approach. 
 

Clients are asked to respond to the following questions, which are left intentionally broad to apply to varying ages, life circumstances, and stressors: 

• “Compared to two weeks ago, my ability to deal with daily problems is…”
• “Compared to two weeks ago, my ability to deal with social situations is…”
• “Compared to two weeks ago, my ability to accomplish the things I want to do is…”
• “Compared to two weeks ago, I would rate my problems or symptoms as…”

How does the functional assessment improve clinical outcomes?

Considering a client’s self-efficacy, social engagement and support, resilience, and perception of impairment can alert a therapist to the potential risk for deterioration or dropping out of treatment altogether. 
 

Daily functioning is also helpful for therapy and treatment planning, as it can become a treatment target. For example, clients who struggle to meet the demands of their daily lives may benefit from short-term, goal-focused behavioral planning or motivational interviewing.

The functional assessment rounds out the clinical snapshot of how clients are doing while in treatment. In addition to our standard, well-validated symptom assessments (the PHQ9 and the GAD7), the functional assessment provides other data points to consider in clinical decision-making. 
 

Most importantly, it is feedback coming directly from your client. Openly discussing this feedback with your client, and making it a routine part of your sessions, has been shown to lead to improved clinical outcomes. 

How can I use the functional assessment to build the therapeutic alliance with my clients?

Clients will complete and submit this questionnaire right from their SonderMind portal, just like the other assessments. Once completed, you will be able to view clients' questionnaire responses within your provider portal.
 

The functional assessment will be delivered to clients before a session with you, as long as it has been at least ten days since their last assessment. Before your session, it is best practice to review your client’s responses and be prepared to discuss their responses with them in session. For example, if your client were to endorse difficulty on any of the areas of functioning (ability to deal with daily problems, social settings, or accomplish what needs to be done), but then rates these as only mildly distressing, you may reflect this potential incongruence to your client. 
 

More important than specific scores are your open discussions with your client and involving them in their treatment planning. If your client doesn’t find these areas particularly problematic, what’s helping them get through their day-to-day life? Are there strengths you can highlight and build on?

The functional assessment is key to SonderMind’s mission.

On the individual level, the functional assessment can inform and empower you in your clinical decision-making, case by case. From a population health perspective, this assessment allows us to support new educational opportunities, ensuring our network can continue to provide the best possible care. 
 

How? Along with the other assessments, SonderMind can anonymize and aggregate this data to measure overall improvement for all clients. This is key to our mission to redesign mental and behavioral health through improved access, utilization, and outcomes.
 

If you’re a SonderMind provider and would like to learn more about FIC or clinical questionnaires, talk with your provider coach or check out these resources:

• Sharing the Importance of Clinical Questionnaires with Your Clients ‍
• SonderMind Community FAQ: Feedback-Informed Care