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STRUCTURE
Pages 122-167

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From page 122...
... Workplace service systems (e.g., employee assistance programs [EAPs] ~ and managed behavioral health care strategies, which have had a stronger influence in the private sector, are also reviewed.
From page 123...
... However, the committee is not aware of any evidence from outcomes research that any one category of behavioral health practitioner is more or less eEective than any other type of practitioner. Moreover, treatment philosophies and strategies vary sub' stantially within professions, as well as across practitioner types, so research would need to take these differences into account.
From page 124...
... issues such as health, marital EAPs (EAPA, 1996) and emotional stress, and More than 4,000 have become drug abuse, which can certified employee assistance adversely affect job professionals performance Marriage and Family Therapists (AAMFT, 1996)
From page 125...
... board certification in addiction medicine to its members; encourages other ABMS boards and the American Medical Association to consider offering certification in addiction medicine American Academy of Family Physicians offers training in substance abuse treatment and prevention Additional Information EAPs have no prescription writing privileges 20,000 EAP training programs Hospital, private (solo or group) No prescription-writing practice, public clinic, and privileges granted academia AAMFT has 76 accredited training centers Hospital, private (solo or group)
From page 126...
... Responsibilities Provide diagnostic, treatment, and prevention services to patients with mental illnesses and disorders, including substance abuse, through counseling and medical interventions Provide assessment, treatment, and prevention services to patients with mental illnesses and disorders and other individuals seeking counseling for a variety of problems, including substance abuse Counsel people with marital and family issues and behavioral health problems and promote access to social and community-based services Workforce Population Approximately 30,000 certified psychiatrists An estimated 1,067 are certified in addiction psychiatry An estimated 1,579 are certified in child and adolescent psychiatry Approximately 69,800 licensed and clinically trained psychologists An estimated 950 are certified in substance abuse psychology Approximately 300,000 social workers Provide diagnoses, guidance, andApproximately 40,000~50,000 treatment for people addictedsubstance abuse counselors to drugs, with an emphasis on treatment of specific addictions L
From page 127...
... · · 1 certlrlcatlon in several areas, including substance abuse American Association of State Social Worker Boards licenses social workers through state licensing boards National Association of Social Workers offers national certification in various areas of social work Only six states and the District of Columbia license alcohol and drug abuse counselors National Association of Alcohol and Drug Abuse Counselors offers certification for those with no undergraduate- and graduate-level education; beginning in 1997, all counselors must have at least a baccalaureate degree to be certified Practice Settings Additional Information Hospital, private (solo or group) Prescription-writing privileges practice, public clinic, granted to all physicians managed care, military, VA, (MDs and DOs)
From page 128...
... of the total Medicaid recipients in 1995, an increase of 80 percent since 1985. As of June 1995,32.1 percent of the 36.2 million Medicaid recipients were enrolled in managed care plans (HCFA, 1996a)
From page 129...
... In 1991, 2.7 million (9.5 percent) of the 28.3 million Medicaid recipients were enrolled in managed care plans.
From page 130...
... Medicaid HEDIS was incorporated into the draft version of HEDIS 3.0, which was released for public comment in October 1996, and which integrates measures that are relevant to both publicly and privately insured populations. MEDICARE The Medicare program was created by the 1965 Social Security Act as a form of universal health care coverage for all individuals who are age 65 and over and who are eligible for Social Security.
From page 131...
... Beginning in 1997, managed care plans serving Medicare beneficiaries will be required by HCFA to submit data on the HEDIS measures that are relevant to Medicare. SUBSTANCE ABUSE SERVICE SYSTEMS Services for the treatment of alcoholism and drug abuse are provided in multiple settings: primary care and acute care facilities, mental health clinics, oEicebased practices by individual practitioners, and specialty substance abuse treatment programs (see Table 4.3~.
From page 132...
... This type of service is used most frequently with publicly funded clients. Detoxification services provided in a day (rather than 24hour, supervised)
From page 133...
... intolerance to drug abuse in the workplace. NDATUS and estimate that 944,880 men, women, and adolescents were in care in 11,316 treatment programs on September 30, 1992 (SAMHSA, 1995a)
From page 134...
... in collaboration with the state authorities for substance abuse collects and maintains a database (TEDS) on the admissions characteristics of individuals admitted to publicly funded substance abuse treatment services.
From page 135...
... Public treatment programs therefore need to have much sensitivity to racial and cultural patterns of abuse and must be respon' sive to different cultural needs. Funding for publicly supported substance abuse treatment services comes from state, local, and federal appropriations.
From page 136...
... Over the years, state mental health agencies have begun to contract with an array of practitioners, including community mental health centers and non-profit community based service agencies (Essock and Goldman, 1995~. As discussed in Chapter 3, the public system delivers care for individuals who are uninsured and underinsured and serves a safety net function.
From page 137...
... Outpatient psychiatry Ambulatory care provided by psychiatrists, social workers, Specialty Care Private psychiatric hospital State psychiatric hospital Community mental health center Day hospital Private practice Nursing homes Community Based, Nonmedical Crisis center Family/social services agencies 137 psychologists, and psychiatric nurses. Long- and shortterm care paid for by private and public insurance.
From page 138...
... These services were identified as "enabling" services in the health plan proposed by Presi' dent Bill Clinton (White House Domestic Policy Council, 1993~. A portion of the state~managed substance abuse treatment services is funded through the Substance Abuse Prevention and Treatment Block Grant adminis' tered by SAMHSA.
From page 139...
... Rita Vandivort National Association of Social Workers Public Workshop, April 18, 1996, Washington, DC If the goal of treatment is long~term recovery from alcohol and other drug abuse, as well as from severe mental illness, wraparound services are often needed to sustain the progress made through medical and psychosocial treatment. Table 4.6 displays many of the wraparound and enabling services used to help individu' als with substance abuse and mental health problems.
From page 141...
... A 1995 survey found that 21.7 million people were enrolled in capitated programs in which behavioral health companies were paid an average of $60 per individual per year (Oss, 1995~. Although managed behavioral health care companies have demonstrated cost savings in the area of behavioral health (Iglehart, 1996)
From page 142...
... . In 1995, AMBHA released its first report card, Performance-Based Measures for Managed Behavioral Healthcare Programs (PERMS 1.0~.
From page 143...
... Attention to workplace performance can be one of the best means of identifying behavioral problems. Then intervention can occur and the individual can be provided with the help and assistance he or she needs to resolve behavioral health problems.
From page 144...
... mixed: utilizes a combination of both internal and external models. EAPs have a multitiered relationship with the managed behavioral health care system.
From page 145...
... Disability management involves a variety of service components that focus on getting an employee the most appropriate care necessary to enable the employee to return to the workplace in a timely fashion. A behavioral health disability management service is composed of a plan design, specially trained disability case managers, assessment instruments, a specialized practitioner network, and return-to-work protocols.
From page 146...
... These expectations may increase the integration of behavioral health, primary care, and EAP services. Health Promotion, Weliness, and Prevention Worksite health promotion is an organized effort supported by an employer to improve employee health, fitness, and well-being.
From page 147...
... Behavioral health care specialists conduct training programs so that employees not only gain information but also, many times, use this information as a motivator for accessing the health care delivery system. Summary of Workplace Issues The workplace provides one of the best means of accessing health care in the United States.
From page 148...
... DEPARTMENT OF DEFENSE AND U.S. DEPARTMENT OF VETERANS AFFAIRS Background The federal government has long provided acute and rehabilitative medical services, including mental health care services, for its military personnel.
From page 149...
... A small number of social workers, especially in the Army and Air Force, provide a core of therapeutic services, especially in remote settings. Children with special psychiatric and developmental needs are referred to U.S.
From page 150...
... Older Adults Depending on service availability, preferences, and financial abilities, retired military personnel may receive treatment in a military, VA or civilian program, both before and after age 65. Their family members, who are not eligible for care in the VA, may receive some limited care in a military facility, but they generally must count on CHAMPUS, private insurance, or, when eligible, Medicare to support their treatment needs.
From page 151...
... This program migrated to commercial insurers and eventually promoted the development of a number of private managed behavioral health care companies during the mid-to-late 1980s. During this same period, DOD established contracts for a targeted mental health demonstration project in the Tidewater area and for a comprehensive managed care program in California and Hawaii, the CHAMPUS Reform Initiative.
From page 152...
... . Copayments are comparable for primary care and behavioral health care.
From page 153...
... Child and Adolescent Service Systems Nature and Extent of the Problem An estimated 12 million children 20 percent of all children experience some mental health or substance abuse problems while they are growing up, in' eluding attention deficit hyperactivity disorder, severe conduct disorder, depress sign, and alcohol and other drug abuse and dependence problems (CMHS, 1996; DHHS, 1991; IOM, 1989; OTA, 1986~. An estimated 3.5 million children have serious emotional disturbances (CMHS, 1996~.
From page 154...
... Managed behavioral health care plans serving children and their families face the added challenge of providing familycentered services that need to interface with the multitude of systems that serve children. Michael Faenza National Mental Health Association Public Workshop, April 18, 1996, Washington, DC National policy for children's mental health services promotes "systems of care," based on principles and values of the Child and Adolescent Service System Program (CASSP)
From page 155...
... And we finally got him into a group home situation. The health plan paid for it and then they did a cost-benefit analysis.
From page 156...
... These programs build on a team approach with primary care physicians, nurse practitioners, social workers, nutritionists, and others who participate in the joint planning and delivery of care. With the increasing movement of Medicare populations into managed care plans, the Health Care Financing Administration has undertaken a project with the United Seniors Health Cooperative to help seniors become more informed consumers.
From page 157...
... . Many of the concerns of Medicare~covered individuals entering managed care plans are unique to the concerns of the elderly.
From page 158...
... L 102-573, of the Indian clinics' right to provide health care first and foremost to American Indians and Alaska Natives; · recognition of the need of Indian clinics to provide culturally sensitive health care; and; · acknowledgment of the Indian clinics' federally qualified health center status and, therefore, agreement to reasonable-cost reimbursement to the clinics and acceptance of the automatic enrollment of Indian patients into Indian health clinics (IHS, 1995~.
From page 159...
... The literature, the science, and the body of knowledge about the effect of culture in providing mental health services or in being able to diagnose mental health problems is very important. Raphael Metzger National Coalition of Hispanic Health and Human Services Organizations Public Workshop, April 18, 1996, Washington, DC Cultural competence is a term that refers to the sensitivity, cultural knowl' edge, skills, and actions of practitioners that meet the needs of patients from di' verse backgrounds (AMA, 1994~.
From page 160...
... Grace Wang Association of Asian Pacific Community Health Organizations Presentation to the Committee, June 29, 1996 Washington, DC Several models and guides have been developed to promote cultural competence in service delivery to particular racial and ethnic groups. For example, the Association of Asian Pacific Community Health Organizations developed a manual on culturally competent managed care for Asians and Pacific Islanders, with support from the Bureau of Primary Health Care (AAPCHO, 1994~.
From page 161...
... Julia Puebla Fortier Resources for Cross-Cultural Health Care Presentation to the Committee, June 29, 1996 Washington, DC A culturally-competent system of care values diversity, has the capacity for cultural self-assessment, is conscious of the dynamics inherent when cultures interact, has institutionalized cultural knowledge, and has developed adaptations to diversity. Grace Wang Association of Asian Pacific Community Health Organizations Presentation to the Committee, June 29, 1996 Washington, DC California's MediCal managed care system moved from determining thresh' olds on a percentage basis to using absolute numbers (AAPCHO, 1994~.
From page 162...
... Managed care plans in rural areas are hoping to help improve health care availability and affordability. Managed care plans in rural areas appear to be more successful when they are built around physicians instead of hospitals, since practitioners usually control both the hospital and specialist referrals in such an area.
From page 163...
... . Managed health care plans in rural areas provide communities with opportu' nities to reduce health care costs, enhance the financial viability of practitioners, and overcome distances and isolation that can reduce the quality of health care in these areas.
From page 164...
... AMBHA (American Managed Behavioral Healthcare Association)
From page 165...
... Washington, DC American Managed Behavioral Healthcare Association. Frank RG, McGuire TO.
From page 166...
... 1995. Speaking With a Common Language: The Past, Present, and Future of Data Standards for Managed Behavioral Healthcare.
From page 167...
... 1995. Successful Integration of System of Care Development with Managed Behavioral Healthcare Technologies in Public Children's Mental Health.


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