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Special Report: Annotated Bibliography for
Managed Behavioral Health Care 1989-1999
Training and Education
369. Austad, C. S., & Berman, W. H. (Eds.). (1991). Psychotherapy in
managed health care: The optimal use of time and resources (1st ed.).
Washington, DC: American Psychological Association.
This edited text brings together many prominent contributors who attempt to outline specific
models for the provision of mental health services in a managed care setting. Both practitioners
and administrators should find this book useful. Part I reviews the evolution of psychotherapy
in managed health care and gives the reader a broad overview of the historical and economic
context of managed mental health. Part II presents several theoretical models for the practice
of mental health in the managed care setting. Part III provides guidelines for working with
specific populations and disorders, with an emphasis on how a managed care approach can
enhance care for many patients. The final section addresses future trends in practice, training,
and research in managed mental health.
Keywords: models, psychotherapy, training, trends
370. Austad, C. S., & Hoyt, M. F. (1992). The managed care movement and
the future of psychotherapy. Psychotherapy, 29, 109-118.
This article describes the ways that the practice of psychotherapy is being changed by the eco-nomic
climate of managed health care. The authors describe several models of psychotherapy
that have emerged from a managed care approach that require providers to be clinically effec-tive
as well as cost-effective. These include a goal-directed, problem-solving orientation, with
a focus on efficient use of time, and crisis-oriented intermittent psychotherapy through the life
cycle and single-session approaches. The authors argue that while the trend toward requiring
accountability in the provision of mental health care is understandably controversial, placing
the burden of proof on providers will potentially lead to higher quality mental health care.
Keyword: models, psychotherapy
371. Blackwell, B., & Schmidt, G. L. (1992). The educational implications of
managed mental health care. Hospital and Community Psychiatry, 43,
962-964.
This article discusses the clinical, professional, ethical, and organizational aspects of training
mental health practitioners in an HMO setting. The authors also describe the educational
opportunities unique to such a setting. They argue that mental health trainees should develop
skills such as providing short-term treatment, collaborating with other professionals, and
ensuring that treatment is "medically necessary" and ethical. To support such learning, HMOs
are urged to develop curricula and provide financial support for educational activities for
faculty and trainees. Such support can result in increased recruitment and retention of qualified
mental health staff.
Keywords: HMOs, training
372. Browning, C. H., & Browning, B. J. (1993). How to partner with
managed care: A "do-it-yourself-kit" for building working relationships and
getting steady referrals. (1st ed.). Los Alamitos: Duncliff’s International.
This book is directed toward clinicians who need assistance in overcoming the frustration and
confusion commonly associated with managed care systems. Writing from the perspective that
many mental health practitioners perceive managed care as a "nightmare," the authors offer
detailed, practical advice on how to use managed care to build practices and provide solution-oriented, cost-effective services. The book covers four basic areas: (1) a comprehensive defini-tion of managed care, including managed care trends and current perspectives; (2) how to
market one’s practice in a competitive, managed care environment; (3) how to increase refer-rals
through managed care systems, particularly preferred provider networks and case man-agers;
and (4) how to provide effective brief therapy within a managed care context. The
book’s detailed table of contents reflects the user-friendly approach employed by the authors.
The final chapter covers questions commonly asked by therapists as they consider the impact
of managed care on their practices. Additionally, the appendix includes advice for clinicians
from managed care insiders, assistance for office support staff in managing administrative
details, and a list of definitions of key terms.
Keywords: providers, technical assistance
373. Budman, S. H. (1992). Models of brief individual and group
psychotherapy. In J. Feldman & R. J. Fitzpatrick (Eds.), Managed mental
health care: Administrative and clinical issues (pp. 231-248). Washington,
DC: American Psychiatric Press.
The author of this chapter discusses definitional confusion over what constitutes brief therapy
and distinguishes between the therapeutic assumptions, perspectives, and expectations of the
long- and short-term therapists. He discusses several basic principles of brief individual and
group therapy and describes models of brief individual and group psychotherapy that take into
account the realities of working in a prepaid health care environment. He concludes that in
order for brief therapy in managed settings to be provided in a high-quality, competent man-ner,
therapists need special training programs in HMOs.
Keywords: models, psychotherapy
374. Budman, S. H., & Armstrong, E. (1994). Brief therapy for
managed mental health companies: Becoming a learning organization.
Managed Care Quarterly, 2, 31-35.
The authors argue that neither contracted mental health providers nor case managers at
managed mental health companies are sufficiently trained in time-efficient therapy. A success-ful
provider is often defined by managed care companies by the brevity of treatment and the
lack of recidivism of clients. The authors put forward a model that focuses not so much on
the brevity of treatment as on the time-effectiveness of treatment. This article describes some
of the ways that providers can learn to use this mode of treatment effectively, but focuses on
the challenges to managed care companies to provide training programs for their network
providers. The authors contend that the survivors in this competitive industry will be those
companies that are able to learn about the services they are offering, which in essence become
"learning organizations."
Keyword: training
375. Goldman, W., & Feldman, S. (Eds.). (1993). New Directions for Mental
Health Services, 59.
In this special volume of New Directions for Mental Health Services on managed mental
health care, the editors bring together a wide range of expertise on the subject. Authors present
alternative models of managed mental health care. Among the nine chapters are ones describ-ing
models of managed mental health care from various perspectives, including providers and
employers. Other chapters discuss how managed care can focus on special client groups such
as children and adolescents or persons with substance abuse problems. Two model programs
for managed services in the public sector are described; other chapters explore the impact of
managed care, and historical and policy links with the community mental health movement.
Keywords: children, models, substance abuse
376. Haas, L. J., & Cummings, N. A. (1991). Managed outpatient mental
health plans: Clinical, ethical, and practical guidelines for participation.
Professional Psychology: Research and Practice, 22, 45-51.
This article addresses the ways psychologists can make informed decisions about whether to
participate in managed mental health care plans. It describes some of the options and relevant
ethical concerns and common features of plans that psychologists should be aware of before
signing up with a particular plan. The article also addresses the question of whether there are
certain prospective patients for whom time-limited treatment would be contraindicated and
certain clinicians who are not capable of conducting such therapy. The authors note that
time-limited treatment is not simply the abbreviated form of long-term therapy and argue
that this type of therapy requires its own set of skills. They advocate that only by carefully
selecting their training, the plans they associate with, and the interventions they attempt will
psychologists be prepared for a satisfactory professional life under managed care.
Keywords: ethics, psychotherapy
377. Haas, L. J., & Cummings, N. A. (1994). Managed outpatient mental
health plans: Clinical, ethical, and practical guidelines for participation.
In R. L. Lowman & R. J. Resnick (Eds.), The mental health professional’s
guide to managed care (pp. 137-150). Washington, DC: American
Psychological Association.
See Haas and Cummings, 1991 (reference number 376) for annotation.
378. Lowman, R. L., & Resnick, R. J. (Eds.). (1994). The mental health
professional’s guide to managed care. Washington, DC: American
Psychological Association.
This book is directed toward mental health practitioners and researchers who are looking
for a general overview of what managed care is and how to operate effectively within it. For
example, chapter 1 reviews the economic shifts that underpin the rise of managed health care.
Chapter 3 outlines the basic issues in managed mental health services, especially how mental
health professionals must adapt to a changing environment. Chapter 4 summarizes some of
the legal and ethical issues inherent in practicing in a managed care setting, and chapter 6
reviews mental health benefit claims analysis and its implications. The final chapter discusses
future directions in managed mental health care.
Keywords: ethics, overviews
379. Meyer, R. E., & Sotsky, S. M. (1995). Managed care and the role and
training of psychiatrists. Health Affairs, 14(3), 65-77.
This article discusses the future challenges that psychiatry faces as a result of the changing
economic environment produced by managed care. The new managed care environment must
define the psychiatrist’s role and determine new training strategies. The authors discuss the
challenges and opportunities psychiatrists will encounter in managed care, such as a surplus of
psychiatrists; academic training to fit the needs of a managed care system; structural problems
created by the new roles of academic psychiatry departments; getting funding for clinical train-ing
in hospitals; and adapting clinical training to fit the changing environment. The authors
conclude with a discussion on funding challenges faced by academic psychiatry departments.
Keywords: providers, training
380. Moffic, H. S., Krieg, K., & Prosen, H. (1993). Managed care and
academic psychiatry. Journal of Mental Health Administration, 20, 172-177.
This article discusses the impact of managed care on the training of psychiatric residents.
Surveys of chairs of psychiatry in 125 medical schools were conducted in 1989-1990 and
again in 1991-1992. In 1989, only about one-third of respondents reported that their depart-ments
were involved in some aspect of managed care. By 1991, more than half were involved.
In 1989, 19 percent of psychiatric residency programs had provided training in some aspect of
clinical managed care to their residents; by 1991, the figure had doubled to 38 percent of pro-grams. Despite academic psychiatry’s growing involvement in managed care, academic leaders in the field continue to view managed care with skepticism, and feel that the main beneficiaries
may not be the patients.
Keyword: training
381. Pomerantz, J. M., Liptzin, B., Carter, A. H., & Perlman, M. S. (1994).
The professional affiliation group: A new model for managed mental
health care. Hospital and Community Psychiatry, 45, 308-310.
This article suggests that a professional affiliation group might be an ideal model for the deliv-ery
and financing of mental health services. The 30 Independent Physicians Association psychi-atrists
associated with an HMO in Massachusetts chose to design their own model rather than
use a national managed mental health care company to carve out their mental health benefits.
The model that they selected included a 1-year fee freeze, risk-sharing, and other controls. The
article describes the process, outcomes, limitations, and benefits of developing a professional
affiliation group.
Keywords: models, providers
382. Quaytman, M., & Sharfstein, S. S. (1990). Managed patient care.
Hospital and Community Psychiatry, 41, 1296-1298.
Managed care in a psychiatric setting may intensify conflicts between members of the treat-ment
team as to how to best address patients’ defenses to treatment. This dynamic is explored
in three case examples, which illustrate how managed care can arouse patients’ ambivalence
about treatment. The authors argue that inadequate treatment can result unless clinicians work
collaboratively. They base their assessments on reliable outcome data as well as on the views of
the patients and their families.
Keyword: providers
383. Shueman, S. A., Troy, W G., & Mayhugh, S. L. (1994). The way ahead:
The promise and challenges of managed behavioral health care. In S. A.
Shueman, W. G. Troy, & S. L. Mayhugh (Eds.), Managed behavioral health
care: An industry perspective (pp. 243-256). Springfield, IL: Charles C.
Thomas.
In this final chapter of the book, the authors discuss their vision of the promises and challenges
that lie ahead for managed behavioral health care. The two major types of challenges are (1)
"developmental" ones, such as quality of care issues, that arise from rapidly developing pro-grams;
and (2) structural ones, like those between two or more agencies, such as managed care
companies and governments or providers. They describe some specific promises and chal-lenges.
They conclude with a discussion of the ways in which financing and service delivery
systems are substantially changing the evolution and identity of mental health professionals.
Keyword: trends
Special Report 150
384. Staton, D. (1991). Psychiatry’s future: Facing reality. Psychiatric
Quarterly, 62, 165-176.
Public and private mental health care costs have risen markedly in recent years. To address this
problem, public programs such as Medicaid will soon severely limit or cut psychiatric cover-age.
Proposals to contain mental health care costs in Oregon and California have established
reimbursement priority. In several States, priority is given to seriously psychiatrically ill children and employable individuals with substance abuse disorders. The author argues that psychiatric treatment must now be short-term, be crisis-oriented, and permit transfer of patients
to alternative settings such as in-home crisis management. Further, psychiatrists must develop
cost-effective, high-quality performance indicators and an ethic in which they see themselves as
responsible for meeting society’s mental health priorities. The author believes that psychiatrists
should be trained to make rapid assessments and to provide short-term treatment in non-hospital
settings.
Keyword: providers
385. Troy, W. G. (1994). Developing and improving professional
competencies. In S. A. Shueman, W. G. Troy, & S. L. Mayhugh (Eds.),
Managed behavioral health care: An industry perspective (pp. 168-188).
Springfield, IL: Charles C. Thomas.
A major thesis of this chapter is that most training programs do not have among their faculties
the expertise needed to treat the critical issues of managed care. Moreover, the author argues
that their allegiance to a core set of knowledge and skills curtails their interest in expanding
the curriculum to include issues of managed care. He asserts that managed care companies
need to take a proactive, leadership role with regard to post-graduate training and describes
some approaches to curricular reform.
Keyword: training
386. Winegar, N. (1992). The clinician’s guide to managed mental health
care (1st ed.). New York: Haworth Press.
This book provides mental health clinicians with a thorough overview of the essential compo-nents
of the emerging managed care system. Chapters cover topics such as the role of preferred
provider organizations and employee assistance programs, and how to manage the utilization
review process. Several chapters offer concrete suggestions for clinicians on how to survive in
the era of managed care, including lengthy appendices with sample contracts, and examples of
how to maintain treatment records. Overall, this book gives clinicians the basic knowledge
they need to respond effectively to the rise of managed mental health care.
Keywords: overviews, technical assistance
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