Using self-report to improve substance abuse risk assessment in behavioral health care

Primary care and behavioral health clinicians frequently fail to detect substance-related problems among their patients, thereby leading to increased morbidity and mortality and health care costs. A managed behavioral health care organization(MBHO) conducted a quality improvement initiative in which clients seeking outpatient psychotherapy were screened by self-report for substance-related problems, and clinicians were provided with feedback in cases of discrepant findings.

Client self-report questionnaires, which included items inquiring regarding problems related to substance abuse, were administered at multiple points during treatment episodes. Clinicians were also asked to complete assessments, including indicating the presence of a substance abuse problem.

Clinicians failed to identify substance abuse problems in > 80% of the cases where the patient endorsed items clearly related to substance abuse on the outcome questionnaire. In the quality improvement intervention, the MBHO sent letters alerting clinicians to the clients' self-reported substance abuse problems. The concordance between clinician assessment and client self-reported problems then increased significantly.

Results of the study argue for the utility of using client self-report measures as part of a comprehensive effort to measure and improve the effectiveness of behavioral health care treatment services.