AMBHA's report card

This journal is beginning a quarterly column to provide "best practices." Good job of explaining the term "best practices.'

Employment of lowest possible effective dose is important in medication of children with psychological disorders when considering side effect and stress reactions.

Managed mental health care can successfully yield high-quality treatments with reduced hospitalization and costs while increasing accessibility.

Abuse, parental substance abuse, suicidal ideation, and destructive behavior lead to hospital and residential .

The child's developmental process should not be harmed by the use of medication during therapy.

Posttreatment support essential for the success of adolescents leaving substance rehabilitation services.

A history of substance abuse, leads to similar rise in symptom severity and treatment length as seen with current abusers.

The epidemiology and clinical characteristics of alcohol and drug addiction are presented and distinguished.

Intensive community placement programs offer promise for discharged homeless patients by maintaining access to psychiatric care and shelters.

A central data set was established by cataloging 1300 patients at admission by 32 demographic and clinical variables.

Structured Clinical Interview, Addiction Severity Index

Problem conducting research that appreciates importance of cultural, gender, and agedness of subpopulations are hampered by internal variability, mutual exclusion and definitions of subpopulations.

Costs of the Daily Living are less than usual standard costs for inpatient treatment.

Problems regarding cultural factors that lead to differentiation of presentation of symptoms and access to care are discussed.

The changing demographics of mental health care staff and the resulting implications for targeting care to specific subpopulations is addressed.

Standardized diagnostic criteria are useful to clinicians by providing efficient assessment, and sensitivity in research and comparisons.

Some violent patients respond to long-term psychotherapy and medication: carbamazepine, propranolol hydrochloride, and lithium carbonate.

Multiple levels of care are necessary to treat alcoholism with considerations for other medical / psychological problems and costs.

Client - Tx Matching

Discharges for homeless schizophrenic men were inadequate in areas of planning for living , aftercare and finances.

Patients with multiple previous admissions, low global functioning, violent behavior, and psychopathology are at increased risk of readmission.

Psychotherapy is effective as substance abuse treatment in a univeristy-affiliated, research-oriented context.

Cognitive-behavioral approach to substance abuse therapy are established forms of cost-efficient clinically effective treatment.

The clinician's therapeutic strategy yields greater benefits when considering the patient's frame of reference and need for structure.

Subjects treated in elderly peer group remained in treatment longer and completed treatment more often than those in age-mixed peer groups.

Use of peer-support and psychoeducational programs are presented for use in care of borderline personality disorder patients.

Disulfiram therapy was nearly 100% effective in cohabitating subjects but not with single subjects. The combined therapy was nearly 100% effective in all subjects.

Hospital records

Integration and coordination of services must overcome obstacle of opposing philosophies of care: psychosocial and psychiatric medical.

hing; and clinical issues in matching.

Reviews basic concepts underlying practice pattern profiling; describes roles that profiling can play in QI, assessment of provider performance, & utilization review; roles of profiling in achieving the goals of health care reform.

Client - Tx Matching

Delineates considerations for developing and implementing a Patient Placement Criteria (PPC) and the role of PPCs in research and Healthcare Reform. Provide good references, glossary and resource list.

Involuntary commitment shows limited success in reducing readmissions and length of stay.

Outlines six key conceptual and methodological issues that underlie attempts to match patients with optimal forms of tx and to conduct research on pt-tx matching.

A review of controlled studies that employed alternative treatments for successfully.

Advances in alcoholism treatment are presented. Assessing matched treatments often depends on the outcomes of interest.

Client - Tx Matching

Theories of evaluation of matching by pattern and by outcome are discussed.

Computer-assisted treatments are useful since it provides singular documentation, focuses attention given to symptoms and creates a large data base.

A two-fold effort exists to outreach to the elderly: to educate the elderly of psychological problems and treatment and to educate mental health professionals about the elderly society.

PGP enrollees achieved care twice as frequent as IPP, but IPP enrollees received care more often once care initiated.

In most studies heavy users consist of 10 to 30 % of clients and use 50 - 80 % of the services; this group often is characterized as psychotic with comorbid personality disorder and substance abuse history.

IPT is a proven / adjunct to medical care (acute, continuation, treatment.)

Alcohol expectancies correlate to posttreatment functioning; these expectancies should be addressed during treatment and relapse prevention endeavors.

The (adjusting the criterion threshold of a continuous variable) is proposed for application in evaluation of mental health and mental health care.

Hospital records

Long-term utilization should be discouraged when allowing recovery; although care is expensive, its use is often ; assessment should consider cost, treatment, and the client's ability to succeed under determined care.

Bellvue Hospital received the Gold Award for integrating a comprehensive clinical service program, including: dually dx inpatient, cocaine day treatment, MMT, a halfway house.

Research has neglected the ethnic hypothesis of addictive behavior.

Definitive treatment not minimal emergency care should become goal of emergency psychiatric care.

MMT is the basis for cocaine rehabilitation, but should be supplemented by various supportive protocols (day centers, residential environs, inpatient.)

Despite its benefits, MMT therapy alone does not effectively eliminate addictive problems, requiring supplemental therapies.

New medications are transforming emergency psychiatric care; follow-up care based in psychiatric facility reduces hospitalization length and improves integration into society.

drug patterns remain unlearned; low utilization of services will continue until consider the life.

Compliance improves drug-free outcome. Low methadone may lack efficacy.

The research of clinical services should concern itself with accuracy (and improvement) of dx, design of service, coordination of rehab with service, and effectiveness with regard to severely mentally ill.

Gender, compliance, homelessness, and history were related to recidivism.

Better documentation of program implementation will improve research and monitoring.

Adults receive mental health care twice as often as children; The educated receive care more often than non-educated in fee-for-service.

Readmission was less likely for men and women with follow-up visits; follow-up was associated with adjustment and affective disorder diagnoses.

Readmittants often exhibit high BPRS though disorder and self-neglect scores and high number of previous admissions.

Heavy users often are comorbid with personality disorder of longer treatments with poorer outcomes.

The interpretation of prognostic research should consider methodological and theoretical weaknesses.

The cognitive-social approach to relapse prevention demonstrates efficacy.

Large variation in hospital use and community services delivered occurred among regions of Washington state.

Client - Tx Matching

The integration of personality data with idiographic-based behavioral assessments is suggested.

The broadened concept of alcoholic problems has support of the scientific and professional communities.

ERR

The cognitive-behavioral theory of addiction has improved empirically-based treatment.

The marked effects of drug on psychological problems requires mental health and substance abuse centers to accurately identify drug use as clients enter their programs.

Discusses 3 specific Tx Models: "Serial, Parallel, & Integrated, and matches specific disorders with each. Also discusses methods of improving each Tx Model.

eir conceptualization as a mediator or moderator variable in Project MATCH.

Articles provided an overview of potential benefits of matching, methodological factors that increase the complexity of research in this area, & some clinical barriers that make implementation more difficult.

eir conceptualization as a mediator or moderator variable in Project MATCH.

, intrapersonal characteristics, and interpersonal functioning) and by nature of treatment option (cognitively-based approaches, interpersonal or relationally-oriented modalities, & treatments characterized by higher levels of intensity.)

Client - Tx Matching / Homeless Mentally Ill

an adequate trial of outpatient tx.

ratings and outpatient data is described.

Delineates "Best Practices" for adult major depression. Discussion includes Dx & Tx (psychotherapy, pharmacotherapy, electroconvulsive therapy & others). Provides many good references.

Several standardized assessment tools for cocaine/methadone users covering substance abuse & other areas or concern, eg., TB, HIV testing

Client Assessment (sub. abuse/ adolescent)

Several standardized assessment tools for adolescents covering substance use/abuse; physical and mental health; social support/relations; illegal behavior problems, etc.

Focus group discussion reveals the patients impression of new services and offer information of a new aspect of the measurement of quality of care.

Choices which must be made in conducting consumer satisfaction survey (very good).

Several factors unique to suicidal patients make cost containment difficult without discriminating high risk suicide attempts from low risk attempts.

A strategy used in Louisiana demonstrates that funds can follow a patient from the hospital to the community at an overall saving for the state.

In Texas, funds decreased while expanding services under a prospective payment system.

Guidelines for cost-control in psychiatry do not necessarily limit the care given but ensure that only appropriate care is given.

HMOs needs to integrate all aspects of treatment with responsibility and ethics regarding patients and their care.

Cost analysis shows that in treating depression in primary care setting, the higher cost of paroxetine is justified by lower labor costs than when using impiramine.

Guidelines are presented for the evaluation of surveillance systems focusing on the detriments and benefits of the many different systems.

The seeming ineffectiveness of managed care may be due in part to unstable forces driving supply and demand of services as well as an ever-expanding market of new potential populations to serve.

Instruments are being devised to assess the quality of data generated by different network systems.

Mental health service organizations need to implement risk management strategies to defray the high costs of patients who require absorbitant resources.

Providers, third-party payers and patients need to understand and respect the economic framework with which mental health services are provided.

A mental health benefit model is presented based on research findings regarding demand and supply of services and designed in accord with clinical effectiveness research.

With the demand for increased diversity, HMOs will need to better control costs while maintaining quality of care.

Many factors regarding future use and provision of mental health services under health care reform are discussed.

To improve the management of public mental health, these points need evaluation: accessibility, continuity, comprehensivness, adequacy, outreach, quality incentives, choice and accountability.

The sensitivity of various estimates of "visit" to mental health provider were examined.

This books serves as a useful tool-book about chemical abuse for clinicians, program directors and policy-makers.

This prospective payment plan offers a simple pricing scheme with incentives for economizing behavior.

Appropriate levels of utilization need to be re-evaluated for patients with chronic emotional problems.

The application of the principles of organized systems of care (OSC) to the approach of care management can achieve affordable costs and retain high standard of quality.

Whether managed care can reduce costs without diminishing access to or quality of care is still unknown.

Utilization management systems are useful and informative when speed, reliability and flexibility are primary concerns.

The best managed care of mental health incorporates the best of private practice and the best of rational managed care.

Alcohol abuse treatments should involve early detection, family treatment and occupational treatment.

The development of community support systems as part of managed care reform, cost and quality were controlled as public education increased.

The Oregon Health Plan calls for reform of health to include coverage of mental health care.

This capitation demonstration project exhibits proof that this payment system provides appropriate care at a cost savings.

Capitation is shown to be a very effective method of providing services for seriously mentally ill.

The evaluation of managed health systems isn't fully understood and is complicated by lack of laboratory control.

Quality assurance programs should determine when efficacious and efficient care is delivered and screen for substandard care.

The current structure and limitations of managed care and which services are provided are discussed.

Reasons for the rapid growth of substance abuse treatment and its effect on public health care are explained.

Less intensive treatment associated with prepaid group practice did not result in noticeably worse mental health outcomes.

Reimbursement structures, capitation payment and assertive community treatment provide the organization necessary for insurance to cover public mental health services.

Ways to adapt managed care to community-based settings are described.

Therapeutic communities apply principles of behavioral science to guide self-help strategies.

The implementation of managed mental health care highlights and exacerbates pre-existing ethical delimas.

Total cost of alcoholism care was inversely related to its effectiveness.

Newer methods and statistics need to be developed to generate and assess improvements in health care quality.

Capitation of mental health services promises to alleviate over-extended public programs and relieve cost restraints of funding sources.

Efforts are needed to improve client tracking systems with in mental health service organization.

Under managed competition, the MHCO emphasizes case management with 2 methods of reimbursement.

Methodical universal data collection permits the assessment of outcomes and tx efficacy

Results weakly recommend that cooperation between agencies improves informational exchanges to the benefit of client's health

Paying for Services: Promises & Pitfalls of Capitation, Mechanic & Aiken (eds) New Directions for Mental Health Services, Fall 89

The nursing community offers an appropriate perspective to design and implement a universal data collection service.

The nursing community offers an appropriate perspective to design and implement a universal data collection service.

Presents the responsibilities of the single state agency before & after managed care was implemented.

The use of HMOs for mental health services calls for additional research regarding necessary administrative arrangements and use of alternative delivery systems.

Performance indicators should reflect the intents of the organizations long-term goals.

The rationales for competency assessment for criminals are presented.

Paying for Services: Promises & Pitfalls of Capitation, Mechanic & Aiken (eds) New Directions for Mental Health Services, Fall 89

A survey shows that the number of clients being served by members of the National Community Mental Healthcare Council increased by 33% in 3 years.

How federal government has encouraged the development of strategies for the delivery of health care in the US.

The design of a capitation payment system for mental health within the public sector is highly complicated considering the scarcity of funds.

Paying for Services: Promises & Pitfalls of Capitation, Mechanic & Aiken (eds) New Directions for Mental Health Services, Fall 89

Paying for Services: Promises & Pitfalls of Capitation, Mechanic & Aiken (eds) New Directions for Mental Health Services, Fall 89

Methods of measuring and maintaining high quality of care and delivery are discussed.

CMHC's, when acting as maintenance organizations for clients, may take strong roles in the establishment of alternative benefits and enrollment procedures.

The use of community resources allows for the management of care without the erosion of services of the public sector.

The proper management of mental health care requires the full development of psychiatric services available to all people.

The managed care of drug treatment services is clinically sound in a treatment model system.

Paying for Services: Promises & Pitfalls of Capitation, Mechanic & Aiken (eds) New Directions for Mental Health Services, Fall 89

A managed care clinical setting is described as an appropriate balance of individual and group needs considering scarcity of funding and service resources.

Organized care may be the next generation of HMO's that seeks to make the whole service industry more efficient and thereby reduce costs.

The true economic power of managed care will be to reduce the cost of care for mainly the most expensive cares.

The use of utilization data for evaluating quality improvement studies is proposed.

A table is presented that details the features desired of a HMO by employers.

Prepaid systems shouldn't be unilaterally dismissed of poor performance; the commitment of clinicians to provide quality care timely and efficiently is always present in any reimbursement system.

Increasing the range of services offered allows a system to decrease over utilization and costs and increase efficiency.

How ten trends in managed care will impact the biopsychosocial model of diagnosis is presented.

1995

A literature review of client satisfaction and outcomes is presented.

HMOs must deliver high quality psychiatric services and assess treatment effectiveness through a continuous quality improvement plan.

Research demonstrates that managed care is cost-effective for mental and medical health costs.

Managed care programs of the public sector should establish safeguards against patient dumping.

This article raises questions regarding feasibility, employment, insurance company roles, benefits, cost containment and universality of managed competition in health care reform.

Outcome measures to improve quality of care are: service access, care quality, and service cost.

The difficulties of implementing community mental health offers insights to the difficulties expected with managed care reform.

Those with chronic illnesses must be included as full participants in a future health care system.

The use of managed care and clinical reviews for cases serviced with expensive care is suggested as a cost containment policy that doesn't limit access.

Within a year of reorganization of a private psychiatric unit, length of stay and staffing costs were reduced with no increase in recidivism.

The use of managed care resulted in an increase of for low-intensive treatment that reduced inpatient hospitalization.

To ensure the preservation of care quality and enhance physician - manager relations, a system of checks and balances need to be established.

National standards of care can be devised from surveys of ordinary (non-clinical) users of care.

The results of several ongoing investigations concerning coercion and other legal matters during hospitalizations are presented.

Overall, the greatest fears of managed care have not been realized.

The importance of methodology of research to ensure generalizability, comparability and validity are discussed.

Educating consumers about health care reform will ease the transition of reform.

The purpose of managed care should be to provide a structure for making decisions that satisfy the health needs of patients while maintaining high quality and low costs.

The data collection of managed behavioral health care is detailed.

Managed care research should center on utilization review, precertification, provider selection, case management and clinical consultation.

The advance of cost-containment in managed care requires cost-efficient diagnoses and therapeutic prescriptions.

Seven case histories are presented where a non-psychiatrist case manager followed psychiatric instructions poorly and ultimately lead to fatal or serious outcomes.

A Single-payer health care system would cover all services (inpatient, outpatient, long-term and case-management,) utilization review, and eliminate public / private distinctions.

This book has value to primary and community nurses as an introduction to comprehensive community care.

A comprehensive approach to managing mental health care that includes prescreening admittants yields savings while maintaining consumer and provider satisfaction.

Budgetary difficulties threaten the Agency for Health Care Policy and Research.

The development of managed care in the public sector needs to evaluate the differences from private care inherent with the population served and services delivered through public programs.

Capitation research for specific populations (elderly, chronically ill) will provide necessary information for reform.

California's method of capitation of mental health services is detailed; concerns include the fiscal incentive to underserve a population.

Capitation has been proved to effectively finance health care while tailoring the system to meet the needs of the patients in Rochester.

Positive results for students and the mentally ill generated during project where social work students served as case managers.

State services will become overburdened after reform if the private sector doesn't remain responsible to the chronically ill with few resources.

The Colorado Capitation Outcomes Project Evaluation will assess clinical outcomes, organizational changes and service access when patients will be served under a capitation system.

The use of an HMO data-base identified which populations were not vaccinating children and identified specific barriers to pediatric vaccination.

The Commonwealth Fund is actively working to advocate for patients in the reform of health care.

The effect of the Health Security Act could unexpectedly overburden the mental health care system by enrolling significantly larger numbers of clients than usual.

A clinically driven approach to case management is proposed that provides increased accessibility to psychiatrists.

The success of managed care required active consumer involvement in health care decisions.

Quality improvement is necessary to care for patients efficiently and requires a focus on patient needs and understanding of the proper outcomes to consult.

46% of insured Americans have behavioral health coverage.

The payment system used did not improve the functioning or symptom level for the severely ill, although they were successfully maintained in the community.

Comprehensive cost-analysis of continuous case management reduced hospital costs that were offset by additional community care costs.

The cost efficiency of managed care is questioned when recidivism rates are higher than fhe fee-for-service programs.

The book presents valuable information for those entering managed care programs or contracts although it offers little regarding clinical issues.

Managed care's cost containment policies threaten the survival of expensive and necessary emergency psychiatric care.

Mental health care reform should include affordable, universal coverage without pre-existing condition exclusions, parity of mental health benefits with other benefits, voluntary service coverage, and long-term care incentives.

Position Paper: At various times, SMIs resemble other MH recipients, chronic medical clients & medical disability clients. Managed care should insure parity with these other clients.

The value and different approaches to measuring social functioning are discussed.

A vague definition of quality leads to in its measurement: cost analysis, patient satisfaction and quality of care.

The conceptual basis of treatment outcome and continuous quality improvement are detailed regarding methods to integrate the two aspects of program evaluation.

A successful method of client outcomes of community services for the severely mentally ill is delineated.

Cultural themes are discussed as they apply to treating African-Americans, Latinos, Asian-American, Native Americans and clients of different genders.

Violence intervention for the mentally ill is effective at reducing the dangerousness of the clients to the community when case managers have small case loads, are available 24 hours a day and strong exist substance abuse, social and justice services.

The disparity between clinical practice 100 years ago and now are due to differing philosophies regarding treatment, admission policies and alternative care to hospitalization.

Needs for research that investigates the effects of nontreatment factors (pretreatment demographics) upon outcome.

Research issues the investigation of crisis intervention are discussed: stressor criteria and classification, behavioral , and appropriate points of intervention.

Outcomes

Researchers discuss the definition of "public welfare domain" and seek to develop an outcome measuring device to assess it.

Different aspects of establishing a customized outcomes program are discussed.

Issues regarding appropriateness of using social indicators in assessing mental health needs are presented.

terview

Indiana Job Satisfaction Scale, Brayfield and Rothe Job Satisfaction Index, Quality of Employment Scale

Outcomes

Partitioning the variation among mortality rates into patient severity, quality of care and randomness accounts for two-thirds of the variation observed among hospitals.

This report provides information for the development of report card programs evaluating access and quality.

A system of outcome indicators is needed to assess health care input, process and outcomes for all major categories of mental illness.

Consortium Research on Indicators of System Performance (CRISP) has developed indicators to assess product efficiency and consumer satisfaction for health care systems.

Outcomes

A six factor tool has been developed to measure overall treatment outcome and progress.

Even imperfect conditions for performance analysis can yield valuable information to purchasers.

The JCAH method of incorporating patient input to improve quality is detailed.

Profiling is essential to determine with certainty the good health care offers.

Outcomes

Study populations often are not adequately described regarding nature of mental health problems or demographics; treatment programs are described obscurely; research design are unsophisticated; outcomes are unsuitable for cross-comparisons.

Increase of copayment decreased utilization across degrees of diagnostic severity.

Social Adjustment Scale, Role Functioning Scale, Satisfaction with Life Scale, Diagnostic Interview Schedule

Outcomes

Tabular recommendations for outcome assessment in substance abuse studies are presented.

BASIS

The use of quality of care measuring devices may be suited only for distinct areas of health and not readily transposable to all other areas of psychiatric help.

Terrance Gorski interviewed Murray Naditch, CEO of Strategic Advantage Inc., on what outcomes should measure, the importance of client satisfaction (not as an outcome) & choosing internal systems or external contractors.

List the benefits of outcomes. Outcomes should be the cornerstone of health care reform.

Discusses strategies for effectively measuring CMHCs and the difficulties. List 4 priorities: client, family, provider & community.

Conceptions of drinking measurements are reviewed.

A review of Form 90 of MATCH is presented.

Outcomes

Pervasive differences regarding kind of data collected and reporting of results impede comparison across studies.

measures need to be established and tested to be proven reliable.

Profiling should be used as an educational tool (develop financial incentives) not as credentialing device (physician selections.)

Lehman Quality of Life Interview

Identifying which measures to pool is critical for using them successfully.

Conceptions of treatment outcomes are historically and reviewed.

Performance measures will increase the pressure on physicians to offer greater qualities of care.

Details the background of MSHIP and how management can use its performance indicators.

Purchasers will look to value and cost measures when considering quality

The design of data collection systems should lend themselves to the creation of report cards to reduce costs, and improve accuracy and utility.

Outcomes

How use of outcome analysis a home respiratory service / company.

Outcomes

Differences exist among outcomes of management, monitoring and measurement.

A 4-phase, tri-functional model to implement accountability system based on performance relying on research, participation, and orientation is proposed.

Outlines basic approaches and considerations when developing an statewide outcomes monitoring system. Provides good references.

Quality Assurance

Psychiatric nurses are needed to aid the design of managed care plans to insure that care, not just cost, is managed.

The ability to measure quality and interpret its relation to a health care system trying to contain costs while expanding accessibility is discussed.

Obtaining appropriate coverage at a reasonable cost is difficult for employers who must provide mental health insurance for their employees.

The current inflationary and competitive mental health care market favors managed mental health services because they use professional case management resources.

The current difficulties in quality improvement given the suspension of health care reform are considered.

A Total Quality Management system allows providers to market their services based on value in addition to price.

Illustrations of quality improvement in public mental health systems in areas of patient advocacy, hospital admission monitoring and restraint usage monitoring.

Limited resources require that physicians not be allowed to treat a patient with all beneficial interventions; those with the greatest potential for improvement should receive scarce aid first.

Profiling quality of care may be done according to a hierarchical model to analyze data regarding the performance of providers.

A model for proposing psychiatric rehabilitation is made that describes intended and unintended effects of intervention as well as data collection strategies that help discriminate between process and outcome variables.

Measures of which functions rendered by health departments serve the populations in their jurisdiction.