Over the counter service versus training and treatment efficacy: What will behavioral health rehabilitation (wrap-around) programs strive to be?

Abstract

This article is a part of the on-going series of operational, management and consulting issues that appear in developing and running a behavioral health rehabilitation (wrap-around) program. It is recommended that readers begin this series with reading the first article in the first issue of the behavior analyst today (e.g., Cautilli & Clarke, 2000) and work through all of the articles. These articles draw on an organizational behavior management perspective to structure what many have come to see as unstructured at best. Services rendered in the child's home, school and community. Since the first article, we have set out to cover three major objectives: keeping costs low , scheduling in an efficient manner (Cautilli, Rosenwasser, & Clarke, 2000), and enhancing performance of the key players (Cautilli & Santilli-Connor, 2000; Hancock, Cautilli, Clarke, & Rosenwasser, 2000; Thomas & Cautilli, 2000). These objectives often lead to trade-offs between components. For example, the cost of a new supervisor is often a trade-off against the increased performance to the teams under the supervisor's care. It becomes important to recognize that tradeoffs in training, education of key personnel, and a process of developing a continuum of care through expertise and specialization instead of simply developing new programs to provide a continuum of care will ultimately prove more efficacious. Additionally forms compliance should never replace sound clinical decision-making. Also, the way that BHRP programs build partnerships is important to the smooth functioning of such programs. This paper discusses these issues while examining the direction that BHRP's should not but unfortunately seem to have taken. THE COSTS VERSES BENEFIT OF COMPETENCY IN PROVIDING A TRUE CONTINUUM OF CARE The goal of Behavioral Health Rehabilitation Programs (BHRPs) that wish to survive in the current health care environment is to create an agency that fosters a continuous learning environment. Such an environment will increase employee dedication and loyalty, through the use of training to build skills of employees and take an active role in professional development. Thomas & Cautilli, (2000) suggest that such agencies will foster development and promote Behavior Specialist Consultants (BSC), Mobile Therapists (MT) and Therapeutic Staff Support (TSS) who become expert in the treatment of specific issues facing children in their care. This allows the agency to expand their continuum, while increasing the efficacy of their treatment. Pre-service training that focuses on clinical issues likely to be encountered in the field will greatly improve the quality and effectiveness of the services the clinician will provide (Thomas & Cautilli, 2000). These practices will be especially important during the predicted future worker shortages in the mental health field, where potential workers can be particularly choosey about their employment opportunities. While studies have shown that organizations routinely invest as much as 85% of their income in salaries to compensate adequately trained professionals they invest only as much as 1% of income to maintain or improve the skills of their current professionals. Current data suggests that a 30:1 ratio of increase in job performance can be obtained for each investment in training and education of employees. Yet much of the training offered by BHRPs focuses on paperwork and policy over performance, management, and increasing clinical effectiveness. We suggest that BHRPs should reinvest 3-5% of their gross salaries into professional development for their employees. This money should be targeted for education programs and training in performance enhancement, time management, managerial enhancement, and specific clinical training. In order to ensure that BHRPs are attracting and retaining the best clinicians, training should be linked to employee compensation packages through the use of skill based pay systems. …