Validated Instruments
Globally validated instruments, applied adaptively.
The science behind the principles.
Four pillars. A peer-reviewed clinical model — built on the standards every credible clinical psychologist trains on.
The Clinical Foundations
Four interlocking pillars. One clinical model.
Refill Health's clinical model is not a single feature. It is a system of four interlocking pillars — each backed by peer-reviewed evidence, each operationalised in clinical practice.
Measurement-Based Care
MBC as a published methodology, applied every session.
Clinical Decision Logic
The hierarchy and engine that route care to the right clinician.
Clinical Governance
Supervision, training, and crisis protocols across the network.
PILLAR 01 · Validated Instruments
Globally validated instruments.
Applied adaptively, never at scale.
Refill Health uses only clinical instruments that have been validated in peer-reviewed research and adopted as standards of care globally — for depression, anxiety, burnout, trauma, addiction, sleep, and crisis. The structure of how they're administered is what matters most.
A short core. An adaptive depth.
Every employee completes a small core of always-administered instruments at onboarding. Beyond the core, additional clinical assessments are administered adaptively — selected by Refill Health's proprietary Issues Screen based on what the employee has actually reported feeling. A typical onboarding takes under 5 minutes. Clinical depth without survey fatigue.
Bibliography note: The full instrument list, including peer-reviewed sources for each, is available to clinical reviewers on request. Write to clinical@refillhealth.com
PILLAR 02 · Measurement-Based Care
Measurement-based care, as the field defines it.
MBC is a published clinical practice — not a Refill Health innovation. We follow the methodology established in clinical research: validated instruments, administered consistently, with thresholds for clinical action.
What MBC is.
In clinical research, MBC is the routine use of validated instruments to track patient outcomes, with the data systematically used to inform treatment decisions. It is endorsed by NICE, the American Psychiatric Association, and the U.K. IAPT programme. Meta-analyses across the literature consistently show MBC outperforms non-MBC care on both clinical outcomes and time to clinical significance.
How MBC works at Refill Health.
Before every session
Validated clinical instruments are administered before the clinician opens the session note.
At each score change
NICE-validated thresholds determine clinical significance.
On worsening
Score deterioration triggers an automatic Care Navigator alert.
Clinical note: MBC is operationalised in our clinician dashboard. Refill Notes records every pre-session score in the structured note — no manual lookup.
PILLAR 03 · PART 1 OF 2 · Clinical Decision Logic
Clinical risk stratification, applied to every care decision.
Every employee's clinical profile is risk-stratified before a care plan is generated. When multiple clinical signals are present — and most employees have more than one — a documented prioritisation logic determines which condition becomes primary, which clinician matches, and which crisis path applies if needed.
Without prioritisation, an employee presenting with both moderate depression and acute crisis signals could be routed to a general therapist while the crisis is missed. Without prioritisation, an employee with bipolar indicators could be matched to a non-specialist. Risk stratification is what prevents both. Every decision is recorded in an auditable reasoning trail — visible to the Care Navigator and to clinical supervision.
Clinical note: This approach is the operationalisation of clinical risk stratification — the same logic used in published collaborative-care models that established modern integrated mental healthcare (Unützer et al., 2002).
PILLAR 03 · PART 2 OF 2
A clinically-validated recommendation engine.
A risk-stratified clinical profile feeds the recommendation engine, which matches the employee to a clinician, a care modality, and a self-care bundle. The engine is data-driven, clinician-supervised, and built on published methodology.
The general approach — personalised treatment matching using validated clinical instruments and machine-learning techniques — is established in clinical research (Chekroud et al., 2016; Cohen & DeRubeis, 2018).
Clinical note: Methodology details are discussed during clinical procurement reviews.
What the engine does
A clinician match (therapist, coach, or both) selected from our network based on clinical fit and member preference.
A modality recommendation (CBT, ACT, DBT, etc.) matched to the clinical presentation.
A self-care bundle tagged to the clinical profile and stated goals.
Every recommendation comes with alternates. The member chooses. The Care Navigator can override.
What the engine does not do
Does not make clinical decisions (every recommendation is reviewed by a Care Navigator).
Does not override clinician judgement (therapists and coaches can escalate or change track at any point).
Does not run unsupervised (outputs are audited monthly for drift, bias, and clinical appropriateness).
PILLAR 04 · PART 1 OF 2 · Clinical Governance
Every clinician supervised. Every outcome tracked.
Refill Health is not a marketplace. Every clinician in our network is credentialed, onboarded, supervised, and continuously developed through Refill Health Academy. An employee matched with a Refill Health therapist receives the same standard of supervision, training, and outcome accountability as one matched with any other therapist in our network. Variability is the enemy of clinical outcome — supervision is how we eliminate it.
Clinical note: The supervision system, the Academy curriculum, and the outcome-monitoring framework are owned by Refill Health's clinical leadership team — senior clinical psychologists with deep experience in India's mental health ecosystem.
Credentialing
Every therapist is RCI-registered. Every coach is ICF-certified. Verified at onboarding and re-verified annually.
Supervision
Every clinician is supervised by a senior clinical psychologist on a documented cadence.
Academy
Refill Health Academy delivers ongoing professional development. Mandatory participation.
Outcome monitoring
Every clinician's outcomes are tracked at the cohort level. Sustained underperformance triggers network review.
PILLAR 04 · PART 2 OF 2 · Clinical Governance
Crisis is treated as a clinical condition with a documented lifecycle.
Most platforms respond to crisis as an event — a phone call, a one-time intervention, a closed ticket. Refill Health treats it as a managed clinical condition with a defined lifecycle. The condition is not closed until clinical leadership signs off.
Refill Health uses the Columbia Suicide Severity Rating Scale (C-SSRS) — the gold-standard instrument used by the U.S. FDA, NIMH, and the WHO (Posner et al., 2011). It is administered by a trained clinician when crisis triggers fire. Crisis is the only clinical situation in which individual context flows beyond the clinical care relationship. When the protocol calls for institutional engagement, it follows documented consent gates owned by clinical leadership. Premature closure is the single biggest predictor of poor crisis outcomes — the non-closable safeguard, the lifecycle, and the clinical leadership sign-off all exist to eliminate it.
Clinical note: Crisis protocol training is part of Refill Health Academy and is mandatory for every clinician in the network.
1
Identify
Crisis triggers are detected during onboarding or via measurement-based care alerts. A Care Navigator is alerted in real time.
2
Intervene
The Navigator administers C-SSRS within the documented response window. A first session is scheduled.
3
Monitor
Active monitoring continues. The employee is held in active monitoring — never discharged to a waiting list.
4
Sign-off
Closure requires clinical leadership review. A crisis tag cannot be closed without sign-off. Zero premature closures, ever.
The Evidence Base
Every claim on this page traces back to a published source.
Refill Health does not invent its clinical model. It applies what the field has already established.
99
“Routine outcome monitoring and feedback improves outcomes, especially for those patients who are not progressing as expected.”
— Lambert, M. J. (2015). Maximizing psychotherapy outcome beyond evidence-based medicine. Psychotherapy and Psychosomatics.
Bibliography note: The full bibliography — 20+ peer-reviewed citations across all four pillars — is available on request. Write to clinical@refillhealth.com
Outcomes Methodology
How we measure outcomes — and what we can defensibly claim.
Every outcome statistic on the Refill Health website comes from a single transparent source: a 12-month deployment at SLV Technologies.
| Client | SLV Technologies (Indian IT services company) |
| Cohort size | 362 onboarded employees |
| Duration | 12 months |
| Geography | India |
| Population | Working professionals across roles and seniority |
| Reporting period | Pre-deployment baseline → 12-month follow-up |
The headline outcomes.
The numbers reported across the Refill Health website — PHQ-9 reduction, GAD-7 reduction, BAT-4 reduction, engagement rate, sessions to outcome, ROI multiple — are all measured against NICE-validated thresholds for clinical significance, the international standard for distinguishing real clinical change from measurement noise. These thresholds are not Refill Health's invention. They are the field's published standards.
How outcomes are reported to clients.
Clients receive anonymised aggregate reports quarterly, including clinical and productivity signals at the cohort level. Individual employee data is never included. Department-level data appears only when the cohort is large enough to anonymise.
What this evidence is — and what it isn't
This is a single-cohort outcome study, not a randomised controlled trial. The numbers are real, measured, and defensible — but they reflect one deployment in one organisation in one industry. Outcomes from deployments in other industries — BFSI, manufacturing, healthcare — are being collected and will be published as data matures.
Methodology note: Detailed outcomes methodology — including instrument administration protocols, statistical thresholds, calculation approaches, and the WOS-to-productivity conversion — is reviewed in a clinical procurement demo.
See how this works inside our clinical model.
The principles set the philosophy. The clinical model shows the science behind every outcome we measure.