Annotated Bibliography - Training and Education

This special supplementary section of the bibliography provides an independently produced annotated bibliography on managed behavioural healthcare prepared for the US Substance Abuse and Mental Health Services Administration; please see the first page of the supplement for recommended citation information.

Table of Contents

  1. Introduction
  2. Benefit and System Design
  3. Capitation
  4. Community Mental Health Services
  5. Diagnosis-Related Groups (DRGs)
  6. Economics, Forecasting, and Pricing
  7. Employee Assistance Programs (EAPs)
  8. Health Maintenance Organizations (HMOs)
  9. Law and Ethics
  10. Provider Issues
  11. Public Sector
  12. Quality Assurance and Outcomes
  13. Special Populations
    1. Children
    2. Elderly
    3. Ethnic Groups
    4. Women
  14. Substance Abuse
  15. Training and Education
  16. Utilization Management
  17. Author Index
  18. Keyword Index

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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This page was last reviewed by Dr Greg Mulhauser, Thursday, 14 October 2021.