Review of Breaking free of managed care: A step-by-step guide to regaining control of your practice.

Reviews the book, Breaking free of managed care: A step-by-step guide to regaining control of your practice by Dana C. Ackley (see record 1997-97500-000). This book provides a practitioner's blueprint for moving from dependent (on managed care) to independent practice. It is organized around three major themes: 1) dealing with managed care; 2) the business of managed care-free therapy; and 3) the array of psychotherapists' services. The reviewer points out that the author tends to overlook some problem areas in psychotherapy. In addition, he takes some of his own skills as a doctoral-level clinical psychologist for granted and fails to appeal to practitioners with minimal training or expertise. However, overall, the reviewer believes that this is a highly enjoyable and practically useful book which provides some guidance to practitioners wanting to "break free from managed care." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Youth psychotherapy change trajectories and outcomes in usual care: Community mental health versus managed care settings.

Objective: The authors compared symptom change trajectories and treatment outcome categories in children and adolescents receiving routine outpatient mental health services in a public community mental health system and a private managed care organization. Method: Archival longitudinal outcome data from parents completing the Youth Outcome Questionnaire (Y-OQ) were retrieved for children and adolescents (4–17 years old) served in a community mental health system (n = 936, mean age = 12 years, 40% girls or young women, 28% from families of color) and a managed care organization (n = 3,075, mean age = 13 years, 45% girls or young women, race and ethnicity not reported). The authors analyzed Y-OQ data using multilevel modeling and partial proportional odds modeling to test for differences in change trajectories and final outcomes across the 2 service settings. Results: Although initial symptom level was comparable across the 2 settings, the rate of change was significantly steeper for cases in the managed care setting. In addition, 24% of cases in the community mental health setting demonstrated a significant increase in symptoms over the course of treatment, compared with 14% of cases in the managed care setting. Conclusions: These results emphasize the need for increased attention to negative outcomes in routine mental health services and provide a stronger foundation for identifying youth cases at risk for treatment failure. In addition, given the overall differences observed across treatment settings for average rate of change and deterioration rates, results suggest that setting-specific model heuristics should be used for identifying cases at risk for negative outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Benchmarking the effectiveness of psychotherapy treatment for adult depression in a managed care environment: A preliminary study.

This preliminary study evaluated the effectiveness of psychotherapy treatment for adult clinical depression provided in a natural setting by benchmarking the clinical outcomes in a managed care environment against effect size estimates observed in published clinical trials. Overall results suggest that effect size estimates of effectiveness in a managed care context were comparable to effect size estimates of efficacy observed in clinical trials. Relative to the 1-tailed 95th-percentile critical effect size estimates, effectiveness of treatment provided in this setting was observed to be between 80% (patients with comorbidity and without antidepressants) and 112% (patients without comorbidity concurrently on antidepressants) as compared to the benchmarks. Because the nature of the treatments delivered in the managed care environment were unknown, it was not possible to make conclusions about treatments. However, while replications are warranted, concerns that psychotherapy delivered in a naturalistic setting is inferior to treatments delivered in clinical trials appear unjustified. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Constructing managed care, constructing brief therapy.

Comments on the article by P. Cushman and P. Gilford (see record 2000-05933-002). The author appreciates the questioning of managed care's use of positivism and objective scientism as well as a recognition of its focus on instrumentality, efficiency, and conformity, but argues that brief therapy and managed care are not synonymous. The author sees many problems with managed care, but also sees the need for fiscally viable and clinically sound ways to provide broad services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Innovative brief pithy psychotherapy: A contribution from corporate managed mental health care.

The managed health care movement has reached a stage of maturity that has allowed it to begin to invest in the development of new clinical intervention approaches. Modern managed mental health care therapy, also known as pithy therapy, is expected to replace more traditional, lengthier forms of therapy by the year 2000. This article presents sections of the new treatment manual for purposes of illustrating the newly developed techniques. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology's response to managed care.

Managed care has had a significant impact on the field of psychology. In this article, a former president of the American Psychological Association and an early career psychologist discuss how managed care has affected the practice of psychology, the training of psychologists, and the perception of psychotherapy. They also review how organized psychology has responded to managed care and provide some insights on the future of psychology as it relates to managed care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managed mental health care: The client's perspective.

Changes in psychotherapy services have been the focus of controversy between psychologists and the managed-care industry, yet too seldom have client preferences been directly heard in that debate. This study investigated consumer attitudes about the central elements of psychotherapy service delivery by 3 participant groups: self-pay clients, managed-care clients, and adults without therapy experience. Important differences of opinion were found among participant groups, yet results revealed that all 5 elements investigated were considered essential. Autonomy in treatment decision-making was ranked most important, followed by choice of therapist, copayment amount, limits to confidentiality, and ease of access to care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The importance of professional psychology: A view from managed care.

Over the past 15 years, the development of managed health care has led to changes in the way that psychology is practiced and in the ways that quality is measured in the health care system. In this article, the current status of population-based Health Plan Employer Data and Information Set quality metrics are reviewed. Many medical measures of quality have improved in the past 5 years, whereas behavioral health measures have shown only modest improvement. Reasons for this finding are discussed, and it is suggested that quality of care for individuals and populations could improve as psychology adopts evidenced-based practice and clinical practice guidelines. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Graduate training for managed care: A national survey of psychology and social work programs.

Although there is much discussion within the professional literature about the training needs of graduate students in response to managed care, little empirical research exists that assesses the extent to which graduate programs provide training opportunities in this field. The present study surveyed graduate program training directors in clinical psychology, counseling psychology, and social work about the training opportunities available for their graduate students. Almost 60% of the respondents indicated that they provide some type of training related to managed care. Implications and applications of these results are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist multicultural competency: A study of therapy dyads.

[Correction Notice: An erratum for this article was reported in Vol 44(1) of Psychotherapy: Theory, Research, Practice, Training (see record 2007-04278-014). The fifth author's name should be spelled as follows: Alexa Mislowack.] This study examined the role of therapist multicultural competence (TMC). Fifty-one therapy dyads completed measures of therapist multicultural competency, working alliance, and their satisfaction with therapy. Clients also completed measures of therapist attractiveness, expertness, trustworthiness, and empathy. Results showed strong associations between clients' ratings of TMC and ratings of the working alliance, therapist empathy, and satisfaction. Clients' combined rating of therapist expertness, attractiveness, and trustworthiness were not associated with their TMC ratings but were significantly associated with therapists' self-appraised TMC ratings. Therapists' ratings of their TMC were associated with their ratings of the working alliance and satisfaction with their work. Results are discussed in the context of the relevant literature, as are implications for training and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Practicing psychology in the era of managed care: Implications for practice and training.

Beginning with the HMO Act of 1973, managed care, a system for controlling health care costs, rapidly expanded and gained influence as the main vehicle for health care delivery in the United States. Implementation of managed care principles in the mental health arena has generated much debate, particularly with respect to issues of quality of care. The authors briefly trace the development of managed care and evaluate its impact on the practice of psychology. The extant literature is reviewed with specific attention to issues of quality of care, confidentiality of patient information, and shifting practice patterns of clinicians. Finally, the future of professional psychology within the context of managed care is examined, and the implications of newly created mental health roles for practitioners, training programs, and organized psychology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of cognitive-behavioral treatment for panic disorder versus treatment as usual in a managed care setting: 2-year follow-up.

Eighty clients meeting criteria for panic disorder and receiving either panic control therapy (PCT; M. G. Craske, E. Meadows, & D. H. Barlow, 1994) or treatment as usual (TAU) in a managed care setting were assessed 1 and 2 years following acute treatment. PCT was provided by therapists with little or no previous exposure to cognitive-behavioral therapies. Analyses of the full intent-to-treat sample revealed no significant differences between the treatments across the follow-up period. However, when treatment completer status was added as a moderator, those receiving PCT showed lower levels of panic severity and phobic avoidance and a greater likelihood of achieving and maintaining clinically significant change. Benzodiazepine use during follow-up was associated with greater panic severity for those clients who received PCT, but no such relationship was found for TAU clients. Results are discussed in relation to the dissemination and effectiveness of PCT as well as evidence-based psychotherapies more generally. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Untangling the alliance-outcome correlation: Exploring the relative importance of therapist and patient variability in the alliance.

Although the therapeutic alliance is a consistent predictor of psychotherapy outcomes, research has not distinguished between the roles of patient and therapist variability in the alliance. Multilevel models were used to explore the relative importance of patient and therapist variability in the alliance as they relate to outcome among 331 patients seen by 80 therapists (therapist average caseload was 4.1). Patients rated both the alliance and outcome and all models adjusted for baseline psychological functioning. The results indicated that therapist variability in the alliance predicted outcome, whereas patient variability in the alliance was unrelated to outcome. Reasons why therapist variability as opposed to patient variability predicted outcome are discussed. Clinical implications include therapists monitoring their contribution to the alliance, clinics providing feedback to therapists about their alliances, and therapists receiving training to develop and maintain strong alliances. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Saying good-bye to managed care.

Reviews the book, Saying good-bye to managed care by Sandra Haber, Elaine Rodino, and Iris Lipner (see record 2001-16521-000). This is a very challenging, well-written text that is likely to be of greatest interest to three readily identifiable groups of psychologists, as well as other therapists and mental health professionals. First, students and younger professionals new to the field are likely to be looking for hot tips and substantive ideas of a more lasting variety that can help them build a new clinical practice. Second, more mature psychotherapists who wish to insulate their practices against the financial impact of managed-care encroachment on their professional decision-making and on their incomes may be looking for ways to diversify their professional activities, so they can be less dependent upon any single entity-whether it is a referral source, a particular type of client, a special clinical population, or another problem. Third, many therapists, regardless of practice duration or commitment in terms of hours per week, are looking to develop practice niches that reflect their own interests, abilities, and developing competencies. As Haber et al. remind us, questions of effectiveness go hand in hand with other questions of information quality; that in fact is a secret of sustained, effective marketing strategies-no matter what the field. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child and adolescent psychological assessment: Current clinical practices and the impact of managed care.

Which psychological testing measures are clinical child and adolescent psychologists most commonly using? How has managed care influenced the practice of assessment for these professionals? This study provides survey data from 162 child practitioners employed in independent practice and in hospital, outpatient, and school-based settings throughout the United States. The results demonstrate marked consistency with recent surveys of clinicians working with adults, and a list of the 30 most frequently utilized measures is provided. Over 40% of the sample reported significant limitations in psychological testing due to managed-care policies. Strategies for maintaining an assessment practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapist immediacy in brief psychotherapy: Case study I.

The authors examined immediacy (i.e., discussions about the here-and-now therapeutic relationship) in a 12-session case of individual interpersonal psychotherapy. Therapist immediacy during immediacy events most often focused on parallels between external relationships and the therapy relationship, encouraging expression of immediate feelings, processing termination, therapist expressing disappointment/sadness/hurt and inquiring about the client's reactions. Client involvement was slightly higher before and after than during immediacy events. On the positive side, therapist immediacy seemed to help the client express her immediate feelings about the therapist more openly, feel closer to the therapist, and become less defended. On the negative side, the client felt somewhat awkward and pressured when the therapist used immediacy. Limitations and implications for practice and research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Practical and ethical assessment issues in rural, impoverished, and managed care settings.

The rising costs of new psychological tests, increased frequency of test revisions, and difficulty receiving authorization and reimbursement from managed care companies make it increasingly difficult for practitioners to provide the best standard of care to clients when conducting psychological and neuropsychological assessments. Practitioners, especially those in low-income and rural areas, may struggle with handling these practical realities while maintaining ethical standards in conducting psychological assessment. Suggestions for how to manage practical challenges faced by practitioners who provide psychological assessments, such as selecting tests when authorization or reimbursement by a third-party payer is restricted or denied, purchasing psychological tests on a budget, and providing assessments with a limited number of qualified staff are discussed. The authors also provide recommendations for the future prevention of these challenges through work with test developers, test publishing corporations, third-party payers, political action groups, and the psychology profession itself. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Racial/ethnic matching of clients and therapists in mental health services: A meta-analytic review of preferences, perceptions, and outcomes.

Across several decades the effects of matching clients with therapists of the same race/ethnicity have been explored using a variety of approaches. We conducted a meta-analysis of 3 variables frequently used in research on racial/ethnic matching: individuals' preferences for a therapist of their own race/ethnicity, clients' perceptions of therapists across racial/ethnic match, and therapeutic outcomes across racial/ethnic match. Across 52 studies of preferences, the average effect size (Cohen's d) was 0.63, indicating a moderately strong preference for a therapist of one's own race/ethnicity. Across 81 studies of individuals' perceptions of therapists, the average effect size was 0.32, indicating a tendency to perceive therapists of one's own race/ethnicity somewhat more positively than other therapists. Across 53 studies of client outcomes in mental health treatment, the average effect size was 0.09, indicating almost no benefit to treatment outcomes from racial/ethnic matching of clients with therapists. These 3 averaged effect sizes were characterized by substantial heterogeneity: The effects of racial/ethnic matching are highly variable. Studies involving African American participants demonstrated the highest effect sizes across all 3 types of evaluations: preferences, perceptions, and outcomes. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychotherapy length of stay and outcome: A meta-analysis of the effect of therapist sex.

This meta-analysis combined results from 64 published and unpublished studies that sought to determine the effect of therapist sex on the outcome of psychotherapy. The articles were obtained using PsychLit and PsychInfo and spanned the years 1930–2000. Results show that therapist sex was found to be a poor predictor of outcome for both male and female clients. Level of therapist training, theoretical orientation of treatment, quality of study, age of clients, and number of treatment sessions did not moderate the minimal effect of therapist sex on the outcome of psychotherapy. The authors conclude that the sex of the therapist has little overall effect on the outcome of psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)