System helps therapists identify patients at risk 

Clues often missed in interviews 

A system to help identify patients who are at risk for suicide, chemical dependency, or premature treatment termination is a great adjunct to traditional psychiatric care, asserts Daryl E. Quick, PhD.

Quick’s organization, Western Psychological and Counseling Services, uses the ALERT Predictive Modeling and Outcomes Management System from PacifiCare Behavioral Health.

The 90 therapists in the group use the ALERT system for patients who are enrolled in PacifiCare Behavioral Health’s mental health and chemical dependency benefit programs, says Quick, president/chief executive officer of the Tigard, OR-based counseling service.

Using the ALERT system, Quick and the other practitioners in his office ask patients to fill out a 30-item questionnaire at regular intervals. The information goes into a PacifiCare Behavioral Health database that compares the patients’ answers with physician-reported data.

During the interview process, therapists look for clues that indicate suicide risks, potential chemical dependency, or that the patient may be considering terminating treatment.

They ask questions such as: Are you gaining weight or losing weight? Are you drinking more than usual? Are you sleeping well? Do you feel stress?

"We look at a cluster of symptoms and use them to make a diagnosis," he says.

The system is helpful because it gives the therapist another way to identify whether patients are at risk and because the reports help them measure whether the patient is making progress, Quick says.

"Just looking at the answers to the questions can make the therapist aware of the overall level of distress right off the bat. We can look at the questionnaire and score it quickly, getting a better idea of the person’s state of mind," Quick says.

Often, the feelings that patients describe in an interview are different from those the questionnaire elicits, he adds.

"People may have trouble saying they have considered suicide and it wouldn’t present in an interview, but they give answers on the questionnaire that indicate they may be suicidal," Quick says.

After submitting the questionnaire to PacifiCare Behavioral Health, the therapist receives a case report showing the patient’s score on the questionnaire, severity range, and critical items.

"This alerts us to a problem if we haven’t already learned of it," he says.

The therapy group gets an outcomes report containing aggregate data as well as individual patient scores over time.

"This data allows us see real movement or lack thereof by patients. It’s a useful tool to let us know when we are making progress with our clients. It’s a great way to create a psychological outcome that has real meaning," he says.

Researchers at PacifiCare Behavioral Health developed the ALERT system following a three-year study involving 43,000 patients and 3,500 mental health providers that showed clinicians miss early warning signs of suicides 57% of the time, compared with information in reports filed by patients themselves.

Outcomes studies by the company show that ALERT was effective in reducing the number of substance abuse cases typically missed by practitioners by 17% and increasing practitioner detection of suicide risk by 35%.