Contrast-sensitivity testing with scanning-laser ophthalmoscope stimulation in normal, ocular hypertensive, and glaucomatous patients

This article reviews the history, growth, and evolution of managed care in mental health and substance abuse treatment. Specific issues described are stigma, the important social dimensions and chronicity of some types of mental illness and chemical dependency, and reliance on the public sector for care. Opportunities and challenges for occupational therapists in the rapidly changing mental health system are discussed, including the use of interdisciplinary teams, the importance of measuring functional outcomes of interventions, the need to develop clinical guidelines, the importance of the community setting and a continuum of services, ethical dilemmas, and the importance of assertive occupational therapy advocacy and involvement in health care reform.     

Client as colleague: Therapeutic contracting with the seriously mentally ill.

This article introduces the therapeutic contracting program as a comprehensive treatment system for persons with serious mental illness. Therapeutic contracting offers a promising framework for integrating medical, psychological, and social therapies in a manner that fosters clients' active involvement in treatment. This article outlines a multistage therapy program that mobilizes clients' adaptational resources through environmental interventions, structured goal-setting exercises, and skills-building experiences. Data illustrate the effectiveness of therapeutic contracting for (a) securing clients' treatment compliance, (b) promoting positive clinical outcomes, and (c) reducing overall treatment costs. The therapeutic contracting model is discussed as a potential vehicle for expanding the professional role of psychologists in psychiatric settings, particularly in areas of clinical and administrative decision making. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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.     

Interaction, language and the "narrative turn" in psychotherapy and psychiatry

The traditional emphasis in psychiatry about "listening to patients" has recently been added to by the development of what we call the "narrative turn" in mental health care where clients' narratives are emphasised. We shall argue however that both approaches tend to embody similar assumptions about therapeutic transactions and roles, and that much work emphasising narratives reveals little about how therapists and researchers work to reconstruct the clients' accounts. It is therefore vital that the emphasis on narratives be supplemented by a more thoroughgoing approach to shared structures of knowledge which act to prefigure clients' distress, how professional records are a profoundly transformative medium, and how therapeutic encounters work to co-construct clients' narratives, rather than simply reflect or explore them. The radical implications of thinking about therapy in terms of narrative and language need to be more fully discussed in the therapy literature, so the narrative turn does not simply reproduce the common-sense assumptions of more conventional approaches.     

Reassessing Rogers' necessary and sufficient conditions of change.

This article reviews the impact of Carl Rogers' postulate about the necessary and sufficient conditions of therapeutic change on the field of psychotherapy. It is proposed that his article (see record 2007-14630-002) made an impact in two ways; first, by acting as a spur to researchers to identify the active ingredients of therapeutic change; and, second, by providing guidelines for therapeutic practice. The role of the necessary and sufficient conditions in process-experiential therapy, an emotion-focused therapy for individuals, and their limitations in terms of research and practice are discussed. It is proposed that although the conditions are necessary and important in promoting clients' affect regulation, they do not take sufficient account of other moderating variables that affect clients' response to treatment and may need to be balanced with more structured interventions. Notwithstanding, Rogers highlighted a way of interacting with clients that is generally acknowledged as essential to effective psychotherapy practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managed care, brief therapy, and therapeutic integrity.

A major cost-containment strategy of managed mental health care is the mandating of short-term psychotherapy via session limits, dollar caps on mental health benefits, and utilization review mechanisms. It is argued that while brief therapy is a widely useful treatment modality, when it is mandated by a 3rd party it violates the fundamental integrity of the therapeutic relationship. The construct of therapeutic integrity is defined, and the parameters vulnerable to managed care intrusions are identified. The author examines the implications of this analysis for (1) the practice of brief therapy, (2) training in brief therapy, (3) managed care, and (4) organized psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rapid detection and counting of viable bacteria in vegetables and environmental water using a photon-counting TV camera

A physical, cognitive, or mental disability presents significant challenges to an individual in gaining access to a coordinated program of preventive, primary, and secondary health care services. This article describes the health care needs of people with disabilities and discusses how the financial incentives in managed care may threaten access to the health care services they need to maintain their health and functional independence. We argue that despite the shortcomings of present models, managed care has the potential to improve the health care of people with disabilities. Moreover, as health plans become increasingly accountable to consumers (and begin to compete on the basis of quality), they will not be able to ignore the distinct health care needs of people with disabilities.     

Mental health promotion in high-risk groups

This article summarises a systematic review of the literature on promoting mental health in high-risk groups. The review suggests that there are a variety of effective interventions for preventing mental health problems in high-risk groups. This has implications for the scope of practice of nurses and others working in a range of services, including midwifery, health visiting, school health, mental health, terminal care, district nursing and primary health care.     

Improving quality in psychotherapy.

Discusses quality improvement (QI) in psychotherapy, and suggests that the managed care movement may have the effect of stimulating higher quality outpatient care. QI may stimulate better compliance with treatment protocols. Academic clinical psychology has produced treatment protocols and indicators of good psychotherapy but these may be ignored by the practicing psychotherapist as unwieldy and impractical. Continuous QI is a behavioral data-driven technology that can be applied to mental health services. The present article gives an example of nonadversarial data-driven process and outcome improvements. A shift of paradigm toward feedback loops in psychotherapy, collecting data on therapeutic change, and patient satisfaction at each session guide therapy. Data collected may help guide the individual sessions and can be collected to establish a dose–effect relationship for a particular therapist, or for a clinic or group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

All that glitters is not always gold: Medical offset effects and managed behavioral health care.

This article urges caution in using broadly predicted medical offset effects in marketing managed behavioral care services. Three analyses of a health maintenance organization population who were provided managed mental health services showed that the use of simple percentage change in cost and use of hospital care may give deceptively positive results. The use of such methods may eventually undermine rather than support the credibility of managed care contracts for professional psychology. Results are discussed in the context of professional psychology's future role in guiding quality assurance and cost-effectiveness studies in regional, multiprofessional primary practice groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Older adults, reimbursement, and referrals: Implications for psychologists after Medicare reimbursement changes and before health care reform.

Psychologists' current provision of mental health services to older adults was investigated by a mail survey. One half of licensed psychologists in a metropolitan region in the Northeast were randomly sampled, with a return rate of 61% (n?=?37). 75% saw older adult clients (aged 65 and over), and 72% accepted Medicare payments. Older adults composed 8% of their practice. Solopracticing physicians were the chief referral link to and from the medical community. Barriers to providing mental health services included client's lack of social support network and low levels of reimbursement. The challenges of continuing psychologists' recent advances in serving the mental health needs of older adults in an era of health care reform and managed care are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Outreach interventions for the homeless mentally ill

There has been a steady rise in the number of homeless mentally ill in Britain. This article reviews the scale of the problem and identifies the need for change within mental health services in order to address this challenge. It is argued that mainstream psychiatric services need to become more diverse and open in their approach to this potentially isolated group of users. The authors suggest that this could be achieved by embracing assertive outreach interventions. Innovative projects using a range of care providers, including voluntary workers, past users of the service and professional mental health workers, are discussed as an alternative framework to traditional services. In conclusion, the article highlights some of the professional and social implications for psychiatric nurses and mental health practice.     

The managed care movement and the future of psychotherapy.

Examines the effects of managed health care (MHC) on the practice of psychotherapy. MHC has led to new models for intervention that fit the clients' needs within the context of their environment rather than interpreting client behavior to fit a model. Characteristics of MHC psychotherapy include a goal-directed, problem-solving orientation; efficient use of time; outpatient orientation; egalitarian distribution of services; conscious collaboration in the therapeutic alliance; the use of group, self-help, and community resources; and cost effectiveness and high quality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A computer simulation for teaching critical thinking skills

Telephone-based health services is a fast growing subspecialty of nursing practice. It is used in demand management and managed care organizations in a highly unregulated environment. The article presents background information and identifies the need for systematic studies of ethical implications inherent in telephone-based practice. Conclusions suggest that nurses need to become actively involved in ethical decision making related to this area of practice.     

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)     

Does the use of telemental health alter the treatment experience? Inmates' perceptions of telemental health versus face-to-face treatment modalities.

In corrections, where staffing limitations tax an overburdened mental health system, telemental health is an increasingly common mode of mental health service delivery. Although telemental health presents an efficient treatment modality for a spectrum of mental health services, it is imperative to study how this modality influences key elements of the treatment experience. In this study, the authors compared inmates' perceptions of the working alliance, postsession mood, and satisfaction with psychiatric and psychological mental health services delivered through 2 different modalities: telemental health and face-to-face. Participants consisted of 186 inmates who received mental health services (36 via telepsychology, 50 via face-to-face psychology, 50 via telepsychiatry, and 50 via face-to-face psychiatry). Results indicate no significant differences in inmates' perceptions of the work alliance with the mental health professional, postsession mood, or overall satisfaction with services when telemental health and face-to-face modalities were compared within each type of mental health service. Implications of these findings are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The problem-oriented research laboratories of the Military Medical Academy

1. Extending cultural care beyond language enhances the use of mental health services and fosters a mutually agreed-on plan of care. 2. Understanding cultural characteristics facilitates an understanding of behavior, family and social dynamics, and adaptation patterns to stress that can empower clients to work toward their goals and validate the impact of emotions and behaviors on others. 3. Culturally appropriate mental health care reflects a synthesis among communication, space, social organization, time, environmental control, and biological variables.     

Mental health and managed care: Training for the 21st century.

Discusses some of the difficulties future clinicians may encounter as they make the transition from graduate training to clinical work, and suggests that many traditional pre-doctoral psychology internships inadequately prepare trainees for the prospective practice of psychology in the era of managed mental health care. Graduate training programs need to integrate clinical work in a managed care setting during internship training utilizing the scientist-practitioner model to (1) more effectively prepare trainees for future work in managed care, (2) expand professional psychology's unique contributions to mental health treatment, and (3) apply the research methodology of psychology to evaluate clinical efficacy and treatment outcomes within the managed care environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of a two-week anti-orthostatic hypokinesia on the cardiac function and on the latter''s regulation in monkeys

Medical practice guidelines are being developed rapidly and advocated as a crucial component in transforming and improving the delivery of health care services. However, little is known about the ability of hospitals to institute guidelines outside of experimental settings. This article approaches guideline implementation from the viewpoint of process innovation assimilation and presents specific recommendations for organizational tactics leading to successful implementation of practice guidelines.