Issues in casemix funding for acute inpatient psychiatric services and their relevance to mental health nursing

With increased recognition by government, health administrators, and clinicians of the need to simultaneously contain health expenditure, improve the productivity and efficiency of health services and maintain quality of patient care, applications of casemix funding have been advocated as an alternative means of financing acute hospital care. Currently in Australia, the Commonwealth's casemix development program is encouraging the States and Territories to participate in certain casemix initiatives. Acute psychiatric hospital care and treatment have been excluded from the initial stages of the implementation of casemix in recognition of a number of inherent obstacles or challenges affecting the utility and accuracy of casemix in funding the psychiatric sector. Despite anecdotal claims that the reduced length of stay that often occurs under casemix payment systems may negatively impact upon the quality of care and patient outcomes, to date little empirical research has been directed towards measuring the potential impact of psychiatric casemix on the quality of patient care. Psychiatry cannot afford to ignore the casemix debate on account of its current exclusion from the early phases of implementation. To do so is to run the risk of having casemix imposed at some later stage in the absence of consultation. In the meantime it is vital that mental health professionals, including nurses, participate in the development and implementation of casemix, and contribute to research aimed at increasing or maximizing the relevance of casemix to the funding of psychiatric services.     

Capitating mental health services

Many employers are contracting mental or behavioral health services separately from other types of health care. Capitation rates are paid for a defined set of benefits. Mental health services are capitated in two ways; both approaches are discussed.     

Addressing the barriers to mental health services for inner city children and their caretakers

This paper will outline a series of three research studies meant to identify factors related to child mental health service usage and barriers to help seeking for urban minority children and their caretakers. In addition, this paper will describe the systematic development and evaluation of a telephone intervention strategy aimed towards increasing overall attendance at initial intake appointments at an urban child serving agency. The first study explores differences in demographic variables, for two groups of children (n = 450), those that came to an initial intake interview and those that requested child mental health services, but failed to come to any scheduled appointments. The second study evaluates a telephone engagement intervention meant to increase initial attendance (n = 54). Finally, the third study, more rigorously evaluates the impact of an intensive telephone intervention on initial attendance rates by randomly assigning families to the more focused telephone intervention or a "business as usual" telephone screening (n = 108).     

Managed care strategy for mental health services

In the UK, managed care is beginning to be recognized as a cost effective, quality-driven system which can be used to structure patient care. This article examines the potential use of managed care pathways in mental health services, focusing on clients with schizophrenia. The strengths of managed care include the effective coordination of healthcare resources, the clear accountable audit of mental health practice and the re-engineering of mental health practice to improve patient outcomes. Problems in designing representative care pathways and encouraging healthcare providers to implement care pathways are some of the disadvantages of this system.     

Understanding the mental health needs of children and adolescents in residential treatment.

With the penetration of managed care approaches in child welfare, residential treatment services have come under increased scrutiny. In these circumstances it is critical to understand the clinically indicated use of these expensive interventions. As part of a community-reinvestment strategy of reform within a state child welfare agency, a needs-based assessment of children and adolescents was undertaken. A review of cases revealed that although the level of mental health need for many was significant, a substantial proportion of children in residential placement were not at high levels of risk. On the basis of these data, a process of placement review was designed and implemented for more effective use of residential treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Economics and mental health services.

J. A. Buck and R. Hirschman (see record 1980-26240-001) may have applied the tools of supply and demand analysis somewhat casually. The existence of sizable externalities, poor consumer information, and a maldistribution of services across the nation must be incorporated into the economic models that are applied to the mental health services system. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Issues of non-compliance in mental health

Rotating-frame NMR experiments which either emphasize or suppress cross relaxation, and which simultaneously suppress TOCSY, COSY, and zero-quantum peaks in NMR spectra, are presented and analyzed. The new experiments rely on mixing sequences which follow naturally from the transverse-ROESY (Tr-ROESY) sequence of Hwang and Shaka, and which are applicable to larger molecules in solution (spin diffusion limit). In the first variant a modified Tr-ROESY sequence, called multiple-pulse ROESY (MP-ROESY), is used to enhance cross-relaxation peak intensity compared to Tr-ROESY; in the second, called phase-modulated CLEAN chemical exchange (CLEANEX-PM), cross-relaxation peaks are greatly attenuated. The two methods are thus complementary: MP-ROESY is used to observe Overhauser peaks, and CLEANEX-PM is used to eliminate them, permitting clear observation of chemical exchange peaks alone. The new techniques are examined by theory and experiment. Practical guidelines that will result in high-quality spectra are given, including the judicious use of continuous weak static magnetic field gradients.     

Public and private responsibility for mental health services.

Relative to public services, private sector corporate mental health care has significantly increased since the late 1960s. The many tensions encountered in assigning public and private responsibility for mental health services give rise to significant value-laden questions for psychologists. These questions go to the heart of community mental health, deinstitutionalization, mental health policy development and evaluation, and many other areas in which psychologists are playing major roles. The public–private issue should be understood historically, from the twin vantage points of developments in general medicine and in mental health. Among the many public interest and public policy matters psychologists and others concerned with mental health should address are the emergence of corporate chains; the nature, cost, and quality of private sector services; the compatibility of profit motivation and the motivation to provide care; and patient selection issues (e.g., cream-skimming). Public and private cooperation and planning are certainly in order if the public interest is to be served in addressing the nation's mental health problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Delivering health and mental health care services to children in family foster care after welfare and health care reform

As the 20th century draws to a close, fundamental changes in the organization, financing, and delivery of health care and welfare services, principally directed at poor families, are likely to result in an increased number of children entering out-of-home care. These children typically have significant physical, mental health, and developmental problems. Whether the quality of health care services they receive will improve as a result of health care reform efforts and new approaches to service delivery remains to be seen. This article addresses some of the major changes wrought by welfare and health care reform and describes the essential features of a health care system that can meet the special needs of children in care.     

A public mental health approach to the postdisaster treatment of children and adolescents

This article describes the implementation of mental health intervention programs for children, adolescents,and their families exposed to natural disaster and violence. Recommendations are made regarding needed levels of organization, methods of screening and triage, training and supervision of mental health staff, design and implementation of treatment approaches, and longitudinal monitoring of course of recovery and intervention outcome.     

Provision of mental health services in women's health centers

Women's health centers are often associated with a comprehensive model of health care that treats the "whole woman." Using data from a nationwide study of 467 women's health centers, we explored how the ideal of comprehensive care was implemented with respect to mental health services. Specifically, we examined the rates of screening and treatment for a subset of mental health and behavioral and social problems in women's health centers and the structural, staffing, philosophical, and patient factors associated with the provision of services. Across 12 services, the overall rates of provision ranged from 7.7% for screening for dementing disorders to 27.6% for smoking cessation counseling and treatment. In a series of logistic regressions, center type (primary care) and having a mental health staff person were consistently associated with service provision; other important variables were having a high percentage of women using the center as their usual source of care and having a belief in women-centered care. Findings indicate that the majority of women using women's health centers do not receive services in a comprehensive care environment that includes key mental health services.     

Collaboration of a university and state mental health agency: Curriculum for improving services for children.

We describe the collaboration of a state university and a state mental health agency in implementing training to improve skills of community mental health center staff for working with children, adolescents, and their families. The project consisted of three phases: (a) a needs assessment survey was conducted, (b) a series of written instructional modules were developed, and (c) workshops were conducted in six locations across the state. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of indicated preventive intervention (secondary prevention) mental health programs for children and adolescents

Evaluated the outcomes of 130 indicated preventive interventions (secondary prevention) mental health programs for children and adolescents that seek to identify early signs of maladjustment and to intervene before full-blown disorders develop. Results indicate such programs significantly reduce problems and significantly increase competencies. In particular, behavioral and cognitive-behavior programs for children with subclinical disorders (mean ESs in the 0.50s) appear as effective as psychotherapy for children with established problems and more effective than attempts to prevent adolescent smoking alcohol use, and delinquency. In practical terms, the average participant receiving behavioral or cognitive-behavior intervention surpasses the performance of approximately 70% of those in a control group. Of particular interest was the high mean effect (0.72) achieved by programs targeting incipient externalizing problems which are customarily the least amenable to change via traditional psychotherapeutic efforts when they reach clinical levels. Priorities for future research include greater specification of intervention procedures, assessment of treatment implementation, more follow-up studies, and identifying how different participants respond to early intervention.     

Bilingual professionals in community mental health services

OBJECTIVE: This paper presents results from research that explored the roles of bilingual professionals in community mental health services in the Sydney metropolitan area of New South Wales. There were two main objectives to the research: (i) to identify and describe the roles of bilingual professionals that are important in improving the quality of community mental health services for clients from non-English-speaking backgrounds (NESB); and (ii) to identify and describe the factors that facilitate and inhibit the conduct of these roles. METHOD: Data collection involved indepth interviews with bilingual professionals and team leaders in community mental health services and various other community health services; and various staff responsible for policy and service development with regard to cultural diversity. RESULTS: Bilingual mental health workers were found to have at least four critical roles. These were (i) direct clinical service provision to NESB clients; (ii) mental health promotion and community development; (iii) cultural consultancy; and (iv) service development. Respondents reported that the latter three roles were seriously underdeveloped compared to the clinical service provision role. CONCLUSIONS: It is critical that service managers implement strategies to make better use of the linguistic and cultural skills of bilingual professionals. In addition to their role in clinical service provision ways must be found to facilitate the community-focused, cultural consultancy and service development roles of bilingual professionals employed in mental health services.     

Rural models for integrating primary care and mental health services

This paper presents findings from a study designed to identify and describe models for integrating primary care and mental health services in rural communities. Data were obtained from telephone interviews with staff at rural primary care sites around the country. Findings are based on the responses of 53 primary care organizations in 22 states. The authors identify four integration models--diversification, linkage, referral and enhancement--which appear to exist in combination, rather than as pure types. The proposed analytic framework outlines aspects of integration that are readily amenable to study.     

Mental health services to children and adolescents under CHAMPUS: Fiscal year 1975.

CHAMPUS (Civilian Health and Medical Program of the Uniformed Services) serves over 6 million military-related persons in the US. Data on children and adolescents were compared with data on adults. It was found that the younger the age group, the longer the duration of hospital stay and the fewer the professional visits, even for diagnoses that are usually considered functional and less serious. Psychologists provide a relatively higher proportion of their time to children and adolescents than do the other provider groups. Individual psychotherapy is obviously the treatment procedure most often used by practitioners, accounting for 75% of all outpatient visits. Psychological services on other than an outpatient basis are very limited. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Roles for psychologists in emerging models of school-related health and mental health services.

Describes contributions of school, clinical, community, and health psychology to emerging school-based and school-linked health and mental health service delivery models. The author contends that these 4 areas integrate well to inform the development and targets of health service delivery approaches in and linked to the schools and to set the stage for defining the emerging and future roles of psychologists providing health and mental health care in these contexts. Emerging and future roles of psychologists as health care providers through schools include roles in development, implementation, and administration of these models, direct and indirect service provision, interfacing of health and educational outcomes, and applied research and evaluation activities. Implications for the education and training of current and future psychologists are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community-based systems of care for children's mental health services

Community-based mental health systems of care for children, adolescents, and their families involve innovative approaches to improve access, utilization, financing, clinical efficacy, and cost-effectiveness of mental health services provided to children and adolescents within the context of their home communities. This model offers numerous advantages as rising needs for mental health services in an increasingly diverse population of children and families are recognized, while public and private resources are increasingly stressed. This report reviews the history of the development of this model, its basic principles, its emerging research literature, and its application within a managed care context.     

An overview of mental health services for the elderly

Psychiatric distress is substantially prevalent among elderly individuals, particularly in the primary care and institutional settings, where most older persons receive mental health care. Barriers to care from providers include negative attitudes and stigmatization and poor recognition by general health care professionals. When psychiatric disorders are recognized, the intensity and duration of treatment provided is generally below standards for adequacy. Further research can determine the impact of patient, caregiver, and provider factors on treatment provision and on patient adherence to treatment. Assessment of factors influencing the treatment process are needed to ensure that treatments provided in the real world approximate the efficacy established in controlled clinical trials.