Mental health providers confronting organizational change: process, problems, and strategies

Under the influence of managed care and diminished funding, the mental health field is undergoing a major transformation. Existing mental health programs, departments, and agencies are downsizing and restructuring to develop new types of service delivery systems. Organizations must change to survive; yet necessary and adaptive change may be resisted in numerous ways by providers whose reactions and behaviors may reduce the viability of their own programs and agencies. This paper explores various characteristics and reactions of mental health care professionals as they face great stress, professional devaluation, and necessary organizational change and restructuring. Adaptive and maladaptive patterns in response to potential organizational change are explored. The role of the leader in guiding and implementing programmatic changes and in dealing with denial and resistance is highlighted. Strategies to enhance the prospects for adaptive organizational change are offered.     

Organizational wellness programs: A meta-analysis.

Organizational wellness programs are on or off-site services sponsored by organizations which attempt to promote good health or to identify and correct potential health related problems (Wolfe, Parker, & Napier, 1994). The authors conducted a meta-analysis on studies that examined the effects of participation in an organizational wellness program (fitness or comprehensive) on absenteeism and job satisfaction. The results revealed that participation in an organizational wellness program was associated with decreased absenteeism and increased job satisfaction. The type of wellness program (fitness only or comprehensive) and the methodological rigor of the primary studies were examined as moderators; however, no moderating effects were found. These results provide some empirical support for the effectiveness of organizational wellness programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Endometrial cytology in postmenopausal hormone replacement therapy

INTRODUCTION: The purpose was to examine whether health-promotion programs offered by California health plans are a serious attempt to improve health status or a marketing device used in an increasingly competitive marketplace. The research examined differences in the coverage, availability, utilization, and evaluation of health-promotion programs in California health plans. METHODS: A mail survey was done of the 35 HMOs (86% response) and 18 health insurance carriers (83% response) licensed to sell comprehensive health insurance in California in 1996 (some plans sell both HMO and PPO/indemnity products). The final sample included 30 commercial HMOs and 20 PPO and indemnity plans. The 1996 California Behavioral Risk Factor Survey (BRFS) of 4,000 adults was used to estimate population participation rates in health-promotion programs. RESULTS: California's HMOs in 1996 offered more comprehensive preventive benefits and health-promotion programs compared to PPO and indemnity plans. HMOs relied on a more comprehensive set of health-education methods to communicate health information to members and were more likely to open their programs to the public. HMOs are also more likely to have developed relationships with community-based and public health providers. Participation in health-promotion programs is low (2%-3%), regardless of plan type, and most health plans limit evaluations to assessment of member satisfaction and utilization. Only 35%-45% of HMOs, and no PPO/indemnity plans, assess the impact of health-promotion programs on health risks and behaviors, health status, or health care costs. CONCLUSION: For the majority of California's PPO and indemnity plans, health promotion is not an integral part of their business. For the majority of HMOs, health-promotion programs are offered primarily as a marketing vehicle. However, a substantial minority of HMOs offer health-promotion programs to achieve other organizational goals of health improvement and cost control.     

Health care reform and psychological practice in schools.

National policy calls for the placement of comprehensive, customer-oriented, and accessible health and social services programs for America's children and youth. Schools have been targeted as the ideal location for such services. Numerous models of school-based and school-linked programs have been initiated. The role of psychology in these emerging models and programs is highly variable; however, it is an essential service that increasingly is being recognized as necessary in order for schools to address complex and diverse student and staff health needs. In this article, models for the delivery of school health services are profiled. Implications for practitioners who currently work in schools and for psychologists who are not currently working in schools but who are interested in maximizing psychology's contribution to school health services are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The stability of preferences for life-sustaining care among persons with AIDS in the Boston Health Study

In 1982, the World Health Organization (WHO) identified inadequate relief from cancer pain as an international health problem. WHO recommended that governments develop and implement national policies and programs for cancer pain relief. This report evaluates national health policy and the systems of health care delivery in relation to cancer pain management in the new South Africa. This field study included multiple methods of data collection: analysis of documents, field trips with participant observation in sites of care delivery, focused interviews, and in-depth interviews of key informants. The purposive sample of key informants (n = 33) represented multiple stakeholders in a variety of settings. Strengths of the developing health policy include specific recommendations related to palliative care; the shift to universal primary care; policies to support drug availability; the inclusion of morphine and codeine as essential drug at the primary health care level; and the development of a national standard related to cancer pain management. Health services are characterized by two parallel systems of care (private and public) with numerous vestiges of the inequities of apartheid. The management of pain varies by provider and setting; major problems with access exist in the rural areas. Health services in South Africa have been plagued by inequity and inadequate resources. New health policies have set a path to ensure universal access to health care including palliative care for cancer. Their successful implementation is the next necessary step toward improving health services and alleviating the suffering of increasing numbers of individuals with cancer.     

Challenges of providing mental health services in Spanish.

The disparity in mental health services to Spanish-speaking clients is well documented. This study examines the service delivery experiences of Spanish-speaking mental health providers by exploring their perceptions and concerns regarding their competence and training to provide services in Spanish. It also identifies practitioner priorities for improving training experiences specific to bilingual mental health service delivery. Implications for graduate psychology programs are discussed in an effort to promote and enhance necessary competencies regarding bilingual training endeavors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

From the community mental health movement to the war on drugs: A study in the definition of social problems.

In the 1980s, the Reagan and Bush administrations reduced funding for community mental health programs and began instead to support substance abuse treatment agencies. One reason for this shift in policy was that the social problem of mental illness had been captured by progressives in the community mental health movement. Conservatives, therefore, needed a new problem to redefine and use to enact new social control policies. The conservatives' claim that substance abuse is primarily the result of a defect in the character or constitution of the abuser has had profound effects on both social policy and the research community. Greater awareness is needed on the part of researchers as to how social problems have been defined and how government research grants affect our thinking about substance abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors influencing survival after gamma knife radiosurgery for patients with single and multiple brain metastases

BACKGROUND: Significant changes are restructurng the U.S. health care delivery system. National health reform is now extending itself into the public sector. Increased health and medical costs by federal and state governments are forcing a reevaluation of major entitlement programs, especially Medicaid. METHODS/RESULTS: Because Medicaid is the single largest item in many state budgets, states are now enrolling Medicaid patients into managed and coordinated care arrangements as a means to control costs and increase access to care. HMOs are not only competing for private patients but also actively seeking the Medicaid population. Nationally, almost one-fourth of all Medicaid patients are now enrolled in managed care plans. Various models and approaches have been developed by individual states. CONCLUSIONS: Because managed care enrollment in the Medicaid program has increased substantially in recent years, selected services including vision care are no longer rendered by any practitioner willing to accept Medicaid fees. Freedom of choice is now restricted to pre-selected and panel practitioners participating with the managed care program. The rules, regulations, billing procedures, fees, and program requisites will differ under managed care programs. Private optometric practitioners must consider entering economic and organizational relationships and linkages that make them attractive to managed care organizations.     

Child Health: A Legitimate Business Concern.

This article reviews evidence substantiating the relationship between child health and business outcomes and evaluates literature regarding organizational interventions that benefit child health and reduce associated costs. The review focuses on 4 family-friendly initiatives, including prenatal programs, lactation programs, sick child care, and flexible working arrangements, and considers 4 business outcomes, specifically health care costs, face time, productive time, and employer attractiveness. Limitations of previous research are discussed, and preventive and reactive models of the relationship between child health and business outcomes are developed as guides for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluations of organizational effectiveness in mental health programs

We present a conceptual framework derived from organizational theory for understanding the evaluation of the effectiveness of mental health services. We postulate that organizations are deemed "successful" by their constituents when they conform to institutional demands and expectations that are both internally and externally generated. We empirically assess institutional conformity by examining evaluations of effectiveness by 269 mental health providers in 29 different mental health programs. Specialist programs responded to institutional demands by targeting services to those considered most in need: clients with severe mental illnesses. The formal structure and program philosophy of these programs clearly reflected this emphasis; consequently, levels of goal incongruence were low and evaluations of effectiveness were high. Generalist programs continued to provide care to diverse client groups, had more professionals, offered traditional services (such as psychotherapy), and exhibited higher levels of goal incongruence; these factors resulted in lower evaluations of effectiveness. This research is important because it demonstrates that organizational processes of institutional conformity (program objectives meet the demands of external constituents) and goal congruence (program objectives meet with expectations of internal constituents) are critical to positive evaluations of effectiveness. With the current institutional demand for effective, efficient services, it is critical that researchers have a conceptual framework for analyzing those factors which influence evaluations of effectiveness.     

Customer driven mental healthcare and the role of the mental healthcare consultant.

Health care, including mental health care (MHC), is in the midst of revolutionary change. The simultaneous demands for increasing quality and constraining costs have necessitated the search for a new service delivery paradigm. The Total Quality Management model has been introduced into health care under the term Continuous Quality Improvement. In order to meet the demands being placed on it, MHC is beginning to introduce the "patient-customer" into its quality improvement programs. The transition to a customer driven framework will be a difficult one for many MHC practitioners. MHC consultants (i.e., consultants with knowledge of organizational processes and MHC issues) can facilitate this transition by helping MHC administrators and practitioners align around the goal of improved quality of care, defined in terms of both patient outcome and patient satisfaction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Innovative service redesign and resource reallocation: responding to political realities, mental health reform and community mental health needs

General hospital mental health programs in large inner city communities face challenges in developing responsive services for populations facing high rates of serious mental illness, substance abuse, homelessness, and poverty. In addition provincial political pressures such as Mental Health Reform and hospital restructuring have caused general hospital mental health programs to reevaluate how services are delivered and resources are allocated. This paper describes how one inner city mental health service in a university teaching setting developed successful strategies to respond to these pressures. Strategies included: (a) merging two general hospital mental health services to pool resources; (b) allocating resources to innovative care delivery models consistent with provincial reforms and community needs; (c) fostering staff role changes, job transitions, and the development of new professional competencies to complement the innovative care delivery models; and (d) developing processes to evaluate the effects of these changes on client.     

Industrial and organizational psychology in Iran.

Presents a preliminary attempt to provide a framework for further studies, from an Iranian view, of events in the area of industrial and organizational psychology. Psychology as a subject was introduced in Iran following World War I. However, it was only after World War II that industrial psychology germinated into an independent discipline and a new profession. Still, industrial psychology was forced to remain largely outside academia, thus limiting the opportunity to educate sufficient numbers of industrial and organizational psychologists, who are now badly needed due to rapid economic development. The better developed parts of this new discipline are personnel evaluation techniques and management training programs. Academic programs in industrial psychology have greatly increased in the 1970s. As the result of research and studies in this field, some substantive problems have been identified that are basic and vital and that have to be treated scientifically in order to rally industrial psychology services in support of national development programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Development of a Framework for a Comprehensive Approach to Stress Management Interventions at Work.

This overview shows that organizations adopt a variety of programs to prevent and manage stress at various levels of the organization. Programs vary widely in their objectives, structure, and target groups, and there is some skepticism regarding the practicality of using off-the-peg programs that have been developed without considering specific organizational requirements. Organizational policies to sustain and develop employee health and well-being must involve the development of strategies that comprehensively address health and safety issues. These strategies should comprise plans to prevent and manage stress, support individual and organizational needs, and be continually evaluated and reviewed. A framework is presented for developing a comprehensive approach to stress prevention and management in the workplace, encompassing the identification, implementation, and evaluation of bespoke intervention programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Organizational culture and climate and mental health provider attitudes toward evidence-based practice.

Mental health provider attitudes toward adopting evidence-based practice (EBP) are associated with organizational context and provider individual differences. Organizational culture and climate are contextual factors that can affect staff acceptance of innovation. This study examined the association of organizational culture and climate with attitudes toward adopting EBP. Participants were 301 public sector mental health service providers from 49 programs providing mental health services for youths and families. Correlation analyses and multilevel hierarchical regressions, controlling for effects of provider characteristics, showed that constructive culture was associated with more positive attitudes toward adoption of EBP and poor organizational climates with perceived divergence of usual practice and EBP. Behavioral health organizations may benefit from consideration of how culture and climate affect staff attitudes toward change in practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role orientation in novice home healthcare nurses

The focus of healthcare delivery continues to shift from hospital-based nursing practice to care in the community, which includes home health care. Many basic nursing education programs provide home healthcare clinical experiences for students. However, this may not be enough to assist nurses in achieving home health nursing competency. Most nurses recruited into home health care worked exclusively in hospitals. Many nurses are employed in a practice environment for which they lack the necessary education and skills. As the practice environment for the nurse changes, so does the role of the nurse. Nurses are having difficulty adjusting to changing roles and responsibilities. This cross-sectional research study was conducted to evaluate the extent that new home healthcare nurses understand their role. This study reveals that nurses employed in home health care for 24 months or less continue to have only a moderate degree of understanding of their new role. These data suggest that educators critically evaluate the effectiveness of orientation programs for novice home healthcare nurses.     

Restructuring health services delivery research: a community-based model

As management of acute illness shifts to the community from tertiary care centres, there is a need for community-based research into the delivery of health services. One author is the coordinator of a health services delivery research unit located in a community health centre as well as the director of research in the Department of Family Medicine at McMaster University. The other author is a member of the administration of the sponsoring institution. The research unit, created in 1994, has close links with the sponsoring hospital, a research centre and the faculty of health sciences at a nearby university. Its staff has grown from 2 to 12 members, mainly as a result of grant support. Its aim is to improve the delivery of community-based health services, and to this end it conducts research in collaboration with programs at the health centre, stakeholder groups, communities and institutions. Research projects have been undertaken in clinical guidelines, women's health, mature adults' health, medication use and new technologies for screening. As an example, concern about chlamydial infections in women in the community led to research into burden of illness, diagnosis, screening methods, test technologies, validation of guidelines and provider behaviors. In the future, funding will be a major concern. The authors contend that more funding from such agencies as the Medical Research Council of Canada should flow to community-based research.     

Foundations for Medical Care.

Notes that, in California, what began as the San Joaquin County Medical Society's answer to Kaiser-Permanente (i.e., the San Joaquin Foundation for Medical Care) has spread to a growing movement that is now nationally recognized as a viable, effective, competitive model of health care delivery. Each foundation is a federation of fee-service practitioners into an organizational entity that can contract to provide designated services on a prepaid basis within a geographical area. This gives the foundation for medical care (FMC) many of the attributes of the health maintenance organization, and indeed, they are recognized in the Health Maintenance Organization Act of 1973, PL 93-222, as individual practice associations (D?rken, 1974). Additional details about the foundations are provided, including the participation of practicing psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress management training in health psychology practice: Critical clinical issues.

Stress management training interventions have become one of the most popular treatment programs in health psychology practice. Although numerous clinical approaches are available, limited attention is given to the matching of intervention with the clinical needs of individuals. As a result, stress management programs are more frequently marketed in clinical and community settings as palliative techniques without sufficient exploration of the causes of stress. We review these concerns and highlight critical assessment and treatment variables that moderate the efficacy of specific stress management interventions. Suggestions for further research and guidelines for clinical practice are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preparing psychologists for managed care settings: Enhancing internship training programs.

Do internship programs prepare new professionals for success in today's behavioral health care marketplace? Managed care has quickly affected internship training programs and has dramatically altered the delivery of mental health services. but training programs have been slow to adapt to these changes. For example, instruction in business concepts and training in clinical and professional issues unique to managed care are discernible deficiencies in contemporary internship training programs. This article presents strategies to remedy training deficits in order to produce psychologists who are capable of meeting current market demands. (PsycINFO Database Record (c) 2010 APA, all rights reserved)