Tennessee's failed managed care program for mental health and substance abuse services

In July 1996, Tennessee initiated a managed mental health and substance abuse program called TennCare Partners. This publicly funded "carve-out" experiment started chaotically and soon deteriorated into a crisis. Many patients did not receive care or lost continuity of care, and the traditional "safety net" mental health system nearly disintegrated. This qualitative case study sought to ascertain the impact of the TennCare Partners program. It points out that the program's difficulties stemmed directly from a flawed design that spread funds previously earmarked for severely mentally ill patients across the entire Medicaid population. States contemplating similar reforms should strive to protect vulnerable patients by risk-adjusting capitation payments and by focusing resources on care for severely mentally ill persons. States should also minimize program complexity and ensure the accountability of managed care networks for their patients' behavioral health care needs.     

A meaningful role for graduate students in disaster mental health services.

Describes the role of graduate students in providing disaster mental health services through a program with the American Red Cross (ARC). ARC Disaster Mental Health Services teams focus on the immediate emotional needs and possible posttraumatic stress disorder (PTSD) associated with the shock of a natural disaster, including the needs and reactions of both victims and volunteers, especially the latter. The implementation of volunteer stress teams by the Minnesota School of Professional Psychology, including 25 students and faculty, is also described. The teams were designed to help assess and limit the effects of acute and traumatic stress resulting from disaster flooding. Specific objectives included assisting local mental health and social service agencies, distributing information, providing support, and triaging victims needing professional mental health services and other flood recovery services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Creating a population-based linked health database: a new resource for health services research

Cytologically, the distinction between bronchioalveolar carcinoma and reactive/reparative processes of respiratory epithelium can be difficult. Retrospectively, we have identified 11 consecutive cases of bronchioalveolar carcinoma from the cytology files of University Missouri-Kansas City/Truman Medical Center. On average, a combined 5.71 cytologic/histologic procedures were performed before reaching a definitive diagnosis for this group. An additional seven random cases of reactive/reparative respiratory cases of adult respiratory distress syndrome patients were used as a control. Cytomorphometric analysis was performed. The mean average nuclear diameter for the carcinoma group was 13.76 microns and for the reactive/reparative group was 13.29 microns. There was no statistical difference between the two groups (paired student t test, P > .05). It appears from our data that mean nuclear diameter is not a discriminator for the cytologic distinction between bronchioalveolar carcinoma and reactive/reparative respiratory epithelium and that the accepted cytologic parameters of for bronchioalveolar carcinoma are more valid.     

Integrating mental health services within primary care. A Canadian program

The increasingly prominent role of the family physician in delivering mental health care can be enhanced if productive and collaborative relationships can be established with local mental health services. This paper describes a Canadian program that has achieved this by bringing mental health counselors and psychiatrists into the offices of 87 family physicians in 35 practices in a community in Southern Ontario. The paper describes the program, the activities of counselors and psychiatrists within the practices, and the administrative structures set up to coordinate these activities. Data is presented from the evaluation of the first year of the program's operation (13 practices and 45 family physicians) during which time 3085 referrals were received. The program made mental health care more available and accessible, increased continuity of care, provided additional support for the family physician, offered new opportunities for continuing education, and led to a reduced and more efficient use of other mental health services. The components of the program can be adapted to most communities.     

Student responsiveness to specialized college services: Contribution of personality variables and perceptions of services.

Student responsiveness to an offer of vocational assistance from a college counseling center was studied. Vocationally undecided graduating seniors (130 respondents and 145 nonrespondents) were examined on a set of four variables: state anxiety, locus of control, and perceptions of the relevance (measured with items from Warman's Appropriateness Checklist) and of the helpfulness of the Center (measured with items from Form's Counseling Attitude Scale). After invitational letters were mailed, data were collected within a 2?-week period at selected classrooms or in the counseling center. Multiple discriminant analysis and correlational techniques were used to test the relation among variables. As a set, the four variables contributed significantly to the discrimination between respondents and nonrespondents. Examined separately, only perceptions of relevance and of helpfulness were found to be significantly related to responsiveness. Implications for future research and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implications for health services

Health services for older people in the NHS have developed pragmatically, and reflect the nature of disease in later life and the need to agree objectives of care with patients. Although services are likely to be able to cope with the immediate future, the growth of the elderly population anticipated from 2030 calls for long-term planning and research. The issue of funding requires immediate political thought and action. Scientifically the focus needs to be on maximizing the efficiency of services by health services research and reducing the incidence of disability in later life through research on its biological and social determinants. Senescence is a progressive loss of adaptability due to an interaction between intrinsic (genetic) processes with extrinsic factors in environment and lifestyle. There are grounds for postulating that a policy of postponement of the onset of disability, by modifications of lifestyle and environment, could reduce the average duration of disability before death. The new political structures of Europe offer under exploited-unexploited opportunities for the necessary research.     

Reality perspectives for psychological services in a hospice program.

As a psychologist administering a hospice program, the author shares his concerns regarding the provision of psychological services in the hospice setting. Six major areas of importance are discussed: terminal terminology, romanticizing death, sex-role socialization, defining goals, financial problems of patients, and grief. For each of these topics, the author analyzes ways in which psychologists have veered from a more reality-oriented perspective in pursuing an ideal of alleviating the emotional suffering that terminally ill persons and their families may encounter. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of a bilingual interpreter program: An alternative model for Spanish-speaking services.

Traces the development and growth of an innovative program designed to help English-speaking therapists evaluate and treat Spanish-speaking patients. Difficulties and successes encountered in implementing a bilingual interpreter program are described. Specific issues examined include the roles of language proficiency, language recall, and language distortion; the role of psychological education; and transference problems in a triadic interaction. It is argued that the training and use of bilingual interpreters is an effective and feasible alternative model for providing Spanish-speaking services. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Applying for the predoctoral internship: Training program strategies to help students prepare.

The predoctoral internship signifies the culmination of applied training in professional psychology. With the increasing supply and demand gap, securing an internship has become competitive and has resulted in many students employing a wide variety of steps in an attempt to ensure a successful internship application. However, little is known about how academic training programs assist students in applying for an internship. The purpose of this study was to describe what activities training programs engage in to prepare their students for the internship application process, and to better understand students' perception of their preparedness to apply as well as to understand their experience applying. The results suggested that training programs prepared students well for general aspects of the process but did not adequately prepare them for the more specific tasks related to the application process. Results also suggested that while the students didn't find the application process confusing or difficult they found it stressful and anxiety provoking. Suggestions for programs to inform and assist their students in preparing for applying are presented as well as recommendations for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

Comprehensive provision of psychological services to students on a university campus.

A conceptual framework for a total delivery system of psychological services on a University Campus was proposed. In relation to the implementation of the Kirk Committee Report on "Standards for University Counseling Services," the objectives of intervention by provision of service were described as a) achievement by the student of a developmentally more mature level of homeostatic relationship with his environment or b) returning the student to autonomous functioning. Some of the issues involved in implementing such a system were considered, and the provision of trained staff capable of operating such a system discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Survey of Medicaid child dental services in Washington state: preparation for a marketing program

The authors surveyed Washington state dentists to gain an understanding of their participation in the Medicaid dental program, their willingness to learn more about the program and the degree of importance they attached to preventive care for preschool-aged children. They found that concerns about fees and administrative aspects predominated and concerns about client behaviors were expressed less often. Many dentists indicated a willingness to learn more about the program. These findings will be used to develop a plan to market the Medicaid program to Washington state dentists.     

Evaluation of an occupational health education program among 11th grade students

BACKGROUND: There is a paucity of publications on occupational health as part of the educational curricula in high schools. We investigated the extent to which a new occupational health education program for 11th graders succeeded in achieving changes in their knowledge and attitudes. METHODS: Six classrooms were randomly assigned to either 96 participating students or to a control group (n = 100) that did not participate. Data on knowledge, attitudes, and beliefs were collected before and 4 months after completion of the course by means of an anonymous self-reported questionnaire. One point was assigned to each answer that was either correct or in the desired direction. Scoring was measured by adding up the points and then converting the total into a scale of 100. RESULTS: The experimental group had a statistically higher mean score (from 24.56 to 80.74) after completing the course. The control group had low scores at both time 1 (20.15) and time 2 (17.00). At least 50% more students of the experimental group gave correct answers after the course, while there was no such change in the control group. CONCLUSIONS: Our findings indicate that occupational health learning can occur in the secondary school setting and confirm the program's effectiveness in achieving desired changes in the immediate outcome of knowledge, attitudes, and beliefs in different areas of occupational health. The subject of occupational health is a topic with relevance to larger educational objectives and policies. In many countries all over the world as well as in Israel, this curriculum can potentially be integrated into the body of the current instruction of "Life Abilities," which are courses that cover topics that prepare the youngsters for adult lifestyles.