Journal of mental health administration最新文献

Client satisfaction with services obtained at a clinical psychology training center was assessed. A modified version of the Client Satisfaction Questionnaire was developed to obtain information about levels of satisfaction in such a setting and to evaluate training clinic-specific questions of interest, such as the impact of therapists' experience on satisfaction. Results indicated that client satisfaction is multidimensional. Consistent with other studies, satisfaction was greater among clients who were in therapy for longer periods of time, who completed treatment, and who sought therapy rather than an evaluation. Reasons for dissatisfaction included a wish for more directiveness or advice in therapy and concerns over videotaping procedures. Implications of these results for clinic administrators are discussed.

This article reports psychometric properties of a decision-support scale designed to quantify the decision-making process for allocating psychiatric care. The authors developed a scale to evaluate the level of care needed for patients requiring psychiatric treatment in a health maintenance organization (HMO) setting. This study examines the reliability and validity of that scale by measuring interrater agreement among utilization reviewers from the HMO and between those reviewers and the clinicians who evaluated the patients directly. Agreement (kappa) among the five clinical raters acting in a utilization review capacity on dimensions of the scale ranged from .71 to .98. Kappas for agreement between the treatment intensity proposed by the reviewer/rater and used by the treating clinician were .41, .38, .40, .35, .36, and .39, respectively. The scale is reliable in the hands of trained personnel. Although there were important differences between clinicians' ratings and those of utilization review raters, these differences do not suggest that use of the scale would limit patient access to care.

In general, people with dual diagnoses account for a significant proportion of both the mental health and substance abuse populations. Most published information on dual diagnosis comes from research on selected treatment programs that are largely funded from public sources. This analysis uses private health insurance claims and eligibility files for 1989 to 1991 for three large firms to identify individuals with both substance abuse and mental health claims and to examine their characteristics, charges, and utilization. More than half of people with dual diagnoses incurred significant charges over three years in both mental health and substance abuse. These individuals with high mental health charges were more likely to be male than were patients with mental health claims alone; they were less likely to be male than were patients with claims for substance abuse and no mental health services. They were also significantly younger than were patients with substance abuse or mental health utilization only for two of the firms. The average charges for people with dual diagnoses were higher than those for patients with substance abuse or mental health claims only.

Numerous bureaus of mental health, drug addiction, and alcoholism are designated to provide service to persons who have discrete singular disorders of mental illness, drug addiction, or alcoholism. Mental health and substance abuse programs (nationally and internationally) have evolved with this singular limited-service capacity. Contrasting incompatible philosophies and treatment methods across the systems have resulted in minimal services for persons with dual diagnoses. The project the authors have outlined is an example of the development of a dual/multiple-disorder program that integrates these diverse systems and provides comprehensive services within each of the programs of each delivery system. These programs are cost-effective, use existing facilities, train and cross-train existing staff, correct the issues of incompatible treatment interventions, and end the dilemma of gaps in services systems and limited referral resources. As a result, the availability and quality of care for persons with dual diagnoses is greatly improved.

This article demonstrates how unique local factors affect implementation of commitment statutes and, consequently, the extent to which implementation supports fundamental treatment philosophies. Four local variations in the implementation of Ohio's commitment statute are examined with a methodology designed to describe commitment processes. Qualitative case studies highlight factors that appear to contribute to variability across these sites. The authors contend that this information can be used as a system management tool at the state and local levels to (1) suggest needed changes in local service systems, (2) identify specific options/interventions for effecting change in desired directions and (3) assess the extent to which changes affect commitment processes in predictable ways that are consistent with philosophical principles.

In a previous article, rationale and procedures were presented for a model needs assessment of community-based services for children and youth with emotional and behavioral disorders and their families. In this article, the authors describe initial needs assessment planning activities, examine the implementation of the proposed model, provide a general overview of the results, and review how the community that conducted the assessment used the information to identify system development priorities and action plans. Quantitative data are provided on the population demographics and parent and direct services provider surveys. Qualitative data are presented on the semistructured interviews with key stakeholders and direct service providers.

The Fort Bragg Evaluation Project hypothesized that the mental health of children treated in the Demonstration's continuum of care would improve more than that of children receiving traditional mental health services at a comparison site. Program theory further predicted site differences in outcome for certain subgroups of children, such as those with severe mental health problems. These hypotheses were tested at 6-month and 1-year follow-ups in several ways, but results showed only slightly more site differences than expected by chance. For the evaluation sample of N = 984 treated children aged 5-17, site differences favored the Comparison about as often as the Demonstration. Children at both sites improved, but there was no overall superiority in mental health outcomes at the Demonstration.

Traditional and ethnographic content analyses of 23 position papers on mental health care reform issued during 1993 yield a comprehensive overview of the specific subjects and broad policy issues that were of concern at that time. Five concrete aspects of mental health service delivery systems and eight policy issues were identified as most important in position papers by service provider organizations and advocacy groups. These analyses identified overall similarities in the content of the position papers, although interesting differences among organizations emerged. The analyses also identified a measure of the quality of policy discussions that is derived from comparing the frequency of concrete references to aspects of mental health care with references to broader policy issues.