Behavioral Health Care Organizations Research Articles

The Impact of an Alternative to Detention Program on Developmental Assets for Adolescents Involved in the Juvenile Justice or Legal System

Positive youth development (PYD) models can play a critical role in programming for at-risk youth involved with the Juvenile Justice System (JJS) or legal system. This article reports on the outcomes of a study that examined the impact of the Reinvesting in Youth (RIY) program on increasing developmental assets for youth who are at-risk for detention or higher level of care placements. RIY is a three to six month preventive and ATD program within a large non-profit behavioral healthcare organization that provides case management, community asset navigation, and academic support through an asset-building framework. Fifty-nine youth discharged from RIY were included in the study. The impact of the program was measured using the Developmental Assets Profile (DAP). Using a dependent samples t-test, results indicate that the RIY program has a significant and positive impact on increasing assets from admission to discharge on total asset scores, internal and external assets, and seven of the eight asset categories.

Five States Pass Laws to Improve Compliance With MH Parity Laws

Five States Pass Laws to Improve Compliance With MH Parity Laws

Psychiatric Inpatient Discharge Planning Practices and Attendance at Aftercare Appointments.

This study examined discharge planning practices by hospital providers for 17,053 psychiatric discharges in New York's statewide Medicaid program. Claims data were linked to information reported to New York State by managed behavioral health care organizations (MBHOs) conducting inpatient utilization reviews. MBHOs documented hospital providers' reports of the presence of three discharge planning practices for each discharge: communicating with an outpatient provider prior to discharge, scheduling an aftercare appointment, and forwarding a discharge summary. Hospital providers reported completing at least one of the three discharge planning practices for 85% of discharges. Individuals who received all three discharge planning practices had a higher likelihood of follow-up and kept their first outpatient follow-up visit at almost twice the speed compared with individuals who received none of the practices (hazard ratio=1.96, p<.001). This study provided baseline information concerning routine discharge planning practices and their relationship to timeliness of care transitions.

Organizational resilience: Nonprofit organizations' response to change.

Organizational resilience refers to the ability to respond productively to significant disruptive change and transform challenges into opportunities. There is a gap in the literature about resilient nonprofit organizations and its application for identifying organizational conditions for successful adaption to external variables that threaten their existence. The aim of this study was to identify organizational characteristics that point to the resilience of nonprofit behavioral healthcare organizations as they successfully adapt to funding changes. A multiple case study of two behavioral health nonprofit organizations was conducted. Data was collected through interviews and focus groups, and analyzed through a qualitative content analysis. Using the framework of resilience, six themes that equipped these organizations to successfully adapt to funding changes were identified. They included: commitment to the mission, improvisation, community reciprocity, servant and transformational leadership, hope and optimism, and fiscal transparency. The findings suggest that incorporating these qualities into an organizational system equips it to systematically adapt to funding changes and other disruptive challenges. Using resilience as a process and not simply an outcome after recovery, nonprofit organizations can have the capacity to continuously respond to challenges and provide uninterrupted and valuable services to society.

Private Health Plans' Contracts with Managed Behavioral Healthcare Organizations.

Contracts between health plans and managed behavioral health care organizations (MBHOs) influence access and quality of behavioral health care. This report presents information on performance requirements, information sharing, and financial risk from a nationally representative survey of private health plans. Most contracts include geographic access to providers (93.3%) and NCQA’s performance standards (84.2%). Health plans and MBHOs share data (99.0%), generally by the MBHO sending information to the health plan (96.3%). About a quarter of contracts impose financial penalties (23.0%), but few include incentives related to performance standards (<1.0%). Contract terms can shape the provision of behavioral health services in response to changes such as parity legislation or health reform. If current trends continue towards increases in value-based purchasing in the privately financed behavioral health sector, the focus on quality in contracts between health plans and MBHOs will be critical to understand.

Adoption of strategies to improve decision support in community mental health centers

Method Training and implementation on a Decision Support Toolkit (Pat Deegan & Associates) was provided and supported by a managed behavioral health care organization to interested providers. Individuals in service and staff at four community mental health centers completed a skills and practices survey where they rated how often 18 activities occurred during their clinical sessions on a Likert scale. To examine subscales, an exploratory factor analysis was conducted using the Principal Axis Factoring method for non-normally distributed data with Promax rotation to account for correlations among subscales.

Social Validity Assessment of Job Satisfaction, Resources, and Support Among Educational Service Practitioners for Students with Intellectual and Developmental Disabilities

We conducted social validity assessment with educational service practitioners (N = 46) to document their satisfaction and acceptance of resources, supports, roles, and responsibilities at a specialized school for children and youth with intellectual and developmental disabilities. The findings revealed several positive ratings as well as other endorsements of programmatic needs. These assessment results informed recommendations for performance improvement and positive staff perceptions. The study illustrates application of social validity assessment to systems issues affecting practitioner training, attitudes, and professional development within human services and behavioral healthcare organizations.

Characteristics of practitioners in a private managed behavioral health plan.

BackgroundLittle is known about the practitioners in managed behavioral healthcare organization (MBHO) networks who are treating mental and substance use disorders among privately insured patients in the United States. It is likely that the role of the private sector in treating behavioral health will increase due to the recent implementation of federal parity legislation and the inclusion of behavioral health as a required service in the insurance exchange plans created under healthcare reform. Further, the healthcare reform legislation has highlighted the need to ensure a qualified workforce in order to improve access to quality healthcare, and provides an additional focus on the behavioral health workforce. To expand understanding of treatment of mental and substance use disorders among privately insured patients, this study examines practitioner types, experience, specialized expertise, and demographics of in-network practitioners providing outpatient care in one large national MBHO.MethodsDescriptive analyses used 2004 practitioner credentialing and other administrative data for one MBHO. The sample included 28,897 practitioners who submitted at least one outpatient claim in 2004. Chi-square and t-tests were used to compare findings across types of practitioners.ResultsAbout half of practitioners were female, 12% were bilingual, and mean age was 53, with significant variation by practitioner type. On average, practitioners report 15.3 years of experience (SD = 9.4), also with significant variation by practitioner type. Many practitioners reported specialized expertise, with about 40% reporting expertise for treating children and about 60% for treating adolescents.ConclusionsOverall, these results based on self-report indicate that the practitioner network in this large MBHO is experienced and has specialized training, but echo concerns about the aging of this workforce. These data should provide us with a baseline of practitioner characteristics as we enter an era that anticipates great change in the behavioral health workforce.

Substance abuse treatment client experience in an employed population: results of a client survey.

BackgroundUnderstanding client perspectives on treatment is increasingly recognized as key to improving care. Yet information on the perceptions and experiences of workers with private insurance coverage who receive help for substance use conditions is relatively sparse, particularly in managed behavioral health care organization (MBHO) populations. Furthermore, the role of several factors including prior service use has not been fully explored.MethodsEmployees covered by a large MBHO who had received substance abuse services in the past year were surveyed (146 respondents completed the telephone survey and self-reported service use).ResultsThe most common reasons for entering treatment were problems with health; home, family or friends; or work. Prior treatment users reported more reasons for entering treatment and more substance use-related work impairment. The majority of all respondents felt treatment helped a lot or some. One quarter reported getting less treatment than they felt they needed.Discussion and conclusionsStudy findings point to the need to tailor treatment for prior service users and to recognize the role of work in treatment entry and outcomes. Perceived access issues may be present even among insured clients already in treatment.

EAP Service Use in a Managed Behavioral Health Care Organization: From the Employee Perspective

Contemporary Employee Assistance Program (EAP) services are typically provided in broad-brush programs delivered by large external vendors in a network model. Yet research has not kept pace with EAP evolution, including in terms of how EAP clients themselves view services. The authors surveyed a random sample of EAP service users from a national provider (361 respondents). About one third of respondents reported getting help for workplace issues. Most learned about the EAP through employer communications such as the company Web site. The large majority reported that the EAP helped them “a lot” or “some,” suggesting they valued this benefit.

Integrated employee assistance program/managed behavioral health plan utilization by persons with substance use disorders

New federal parity and health reform legislation, promising increased behavioral health care access and a focus on prevention, has heightened interest in employee assistance programs (EAPs). This study investigated service utilization by persons with a primary substance use disorder (SUD) diagnosis in a managed behavioral health care (MBHC) organization's integrated EAP/MBHC product ( N = 1,158). In 2004, 25.0% of clients used the EAP first for new treatment episodes. After initial EAP utilization, 44.4% received no additional formal services through the plan, and 40.4% received regular outpatient services. Overall, outpatient care, intensive outpatient/day treatment, and inpatient/residential detoxification were most common. About half of the clients had co-occurring psychiatric diagnoses. Mental health service utilization was extensive. Findings suggest that for service users with primary SUD diagnoses in an integrated EAP/MBHC product, the EAP benefit plays a key role at the front end of treatment and is often only one component of treatment episodes.

Economic grand rounds: types of practitioners and outpatient visits in a private managed behavioral health plan.

Types of privately insured outpatient treatment provided by in-network practitioners were examined in a national managed behavioral health care organization to consider how practitioner type and expertise are related to diagnoses of mental disorders, substance use disorders, or both. Using 2004 practitioner credentialing, patient enrollment, and claims data, the investigators found that two-thirds of claims for psychiatrists involved medication management and two-thirds also involved psychotherapy (an overlap of about 30%). Most patients with substance use disorders saw practitioners who had specialized alcohol or drug disorder training. Claims for patients with more complex co-occurring mental and substance use disorders indicate utilization of appropriately qualified practitioners with substantial experience on average.

Economic Grand Rounds: Types of Practitioners and Outpatient Visits in a Private Managed Behavioral Health Plan

Economic Grand Rounds: Types of Practitioners and Outpatient Visits in a Private Managed Behavioral Health Plan

A collaborative approach to identifying effective incentives for mental health clinicians to improve depression care in a large managed behavioral healthcare organization.

This descriptive study used stakeholder input to prioritize evidence-based strategies for improving depression care and to select incentives for mental health clinicians to adopt those strategies, and to conduct a feasibility test of an incentive-based program in a managed behavioral healthcare organization (MBHO). In two rounds of interviews and a stakeholder meeting, MBHO administrators and clinicians selected increasing combination treatment (antidepressant plus psychotherapy) rates as the program goal; and paying a bonus for case reviews, clinician feedback, and clinician education as incentives. We assessed program feasibility with case review and clinician surveys from a large independent practice association that contracts with the MBHO. Findings suggest that providing incentives for mental health clinicians is feasible and the incentive program did increase awareness. However, adoption may be challenging because of administrative barriers and limited clinical data available to MBHOs.

Teaching Applied Behavior Analysis Knowledge Competencies to Direct-Care Service Providers: Outcome Assessment and Social Validation of a Training Program

Staff training is a critical performance improvement objective within behavioral health care organizations. This study evaluated a systematic training program for teaching applied behavior analysis knowledge competencies to newly hired direct-care employees at a day and residential habilitation services agency for adults with intellectual and developmental disabilities. Three content areas--measurement, behavior support, and skill acquisition--were trained in a group format using Powerpoint® presentations that featured didactic instruction, practice exercises, and video demonstrations. The employees completed an assessment of knowledge test before and after training in each content area. Across five training groups, the average correct posttraining test scores were consistently higher than pretraining test scores. A social validity assessment revealed that the employees judged the training program favorably along several dimensions. Issues pertaining to staff training and performance improvement initiatives are discussed.

Trends in the Duration of Emergency Department Visits, 2001-2006

Trends in the Duration of Emergency Department Visits, 2001-2006

Employer Choices in Employee Assistance Program Design and Worksite Services

In today's complex private health care market, employers have varied preferences for particular features of behavioral health products such as Employee Assistance Programs (EAPs). Factors that may influence these preferences include establishment size, type of organization, industry, workplace substance abuse regulations, and structure of health insurance benefits. This study of 103 large employer purchasers from a single managed behavioral health care organization investigated the impact of such variables on the EAP features that employers select to provide to workers and their families. Findings indicate that for this group of employers, preferences for the type, and delivery mode of EAP counseling services are fairly universal, whereas number of sessions provided and choices for EAP-provided worksite activities are much more varied and may be more reflective of the diverse characteristics, organizational missions, and workplace culture found among larger employers in the United States.

Managed Care Firms Sue to Stop Federal Parity Law

Managed Care Firms Sue to Stop Federal Parity Law

Assessment of evidence-based psychotherapy practices in usual care: challenges, promising approaches, and future directions.

Assessment of evidence-based psychotherapy practices in usual care: challenges, promising approaches, and future directions.

Development of a Clinician Report Measure to Assess Psychotherapy for Depression in Usual Care Settings

Although mental health policy initiatives have called for quality improvement in depression care, practical tools to describe the quality of psychotherapy for depression are not available. We developed a clinician-report measure of adherence to three types of psychotherapy for depression—cognitive behavioral therapy, interpersonal therapy, and psychodynamic therapy. A total of 727 clinicians from a large, national managed behavioral health care organization responded to a mail survey. The measure demonstrated good psychometric properties, including appropriate item-scale correlations, internal consistency reliability, and a three-factor structure. Our results suggest that this questionnaire may be a promising approach to describing psychotherapy for depression in usual care.