Information on patient history varies considerably from plan to plan. Three plans do not ask for any information on the patient’s history or previous treatment. Several plans ask whether the patient has received treatment for mental health and/or substance abuse; some plans provide the clinician with a checklist of treatment types (i.e. outpatient, partial hospitalization or inpatient), asking the clinician to indicate which ones the patient had received. Three plans ask whether the patient has other family members also receiving treatment; two simply require a yes/no response, while the third asks the provider to provide descriptive information about personal and family history relating to mental health and substance abuse disorders.
Information collected on a patient’s current status and presenting problems also varies greatly by plan. Three of the outpatient treatment forms we examined asked the provider to explain the patient’s current problems and to describe the plan for addressing each one. Other plans provide a checklist of symptoms and ask the provider to indicate which ones the patient has experienced, and in some cases, to also indicate the severity and duration of the symptoms. Some plans also include a separate checklist for level of functioning in such areas as family and social relationships, work/school performance, physical health, sexual functioning, legal problems, financial situation, and activities of daily living.
There is a great deal of variation among plans in the lists of symptoms they ask providers about. The Magellan Treatment Request Form (Appendix C) is the shortest list used by the plans we studied. Magellan simply lists four symptoms: self-injurious behavior, suicidal ideation, homicidal ideation, and substance use problems; the form also requests information on the severity of each (mild, moderate, severe). The Maryland Uniform Treatment Plan (Appendix B), which requests the most detailed information of the forms we studied, includes a checklist of 56 symptoms. It also asks the provider to rate the patient’s level of functioning (mild, moderate, severe) in six areas: family relations, job/school, finances, physical health, legal, friends/social. The ValueOptions Report lists 24 symptoms and asks for information on their duration. It also includes a checklist for level of functioning in 12 areas and asks the provider to rate the severity level on a scale of one to five and to estimate the severity level of each at discharge. A comprehensive list of the symptoms requested by all plans is included in Appendix D along with the number of plans requesting information on each.
Plans also vary considerably in their questions regarding the level of risk of harm to self or others. Three plans do not ask for any information on this topic. Notably, both of the forms geared specifically towards substance abuse do not ask for information on this topic. However, the majority of the plans request information on the patient’s risk of suicide and homicide, asking the provider to indicate whether the patient has exhibited ideation, a plan, or intent with or without means. Two plans request information on other risk behaviors as well, including items such as self-injury, fire setting, family violence, and psychosis. These two plans also ask the clinician to record any additional risk behaviors.