Showing papers by "Joan R. Bloom published in 2000"

Managed care and service capacity development in a public mental health system.

Abstract: Developing a continuum of care is considered to be one of the first steps in the process of implementing managed care strategies. This study summarizes the results of a final survey that focused on the ability of Colorado community mental health centers (CMHCs) to build service capacity and create new programs as a result of Medicaid capitation financing. Capitated agencies, compared to those that remained fee-for- service during the study period, reported a much greater ability to develop services as a result of capitation. Decreases in services were minimal for all agencies. Some differences in managed care organizational models were noted, as were differences in the speed of implementation. Gaps in some services still remain. These findings point to important program implementation issues for publicly funded managed care.

Implementing capitation of Medicaid mental health services in Colorado: is "readiness" a necessary condition?

Abstract: Two consortia of community mental health centers in Colorado varied in their administrative readiness for changing to a capitated system and, ultimately, implemented capitation using different organizational arrangements. The objective was to assess the impact of this natural experiment on administrative change, costs, and utilization of services during the first two years postcapitation. Prior to capitation, one was rated as having greater “readiness” than the other and received a capitation contract from the state, while the other did not. A private, for-profit managed behavioral health organization was awarded a contract and formed a joint venture with the less “ready” consortium, providing managed care expertise to complement the consortium's expertise in delivering mental health services. Two years later, these consortia do not look different either administratively or in their patterns of service utilization and costs. These findings suggest alternative ways of successfully implementing a capitated public mental health system.

The effect of risk notification on mood in long-term survivors of Hodgkin's disease

Abstract: Risk notification was the initial step in a larger study to determine (1) the prevalence of cardiovascular disease as a late effect of mediastinal irradiation, and (2) whether a brief support group intervention would mitigate any negative effects of risk notification. 323 HD survivors attended a 45 minute risk notification session prior to a routine follow-up medical visit. When they arrived at the clinic and following the risk notification session, they completed surveys that included measures of mood dysphoria, sense of coherence, knowledge of late effects of treatment, and demographic factors. Two analytic models were proposed to look at the effects of risk notification: (1) psychosocial state when arriving at the clinic, and (2) psychosocial change in state following risk notification session. Pre-intervention mood distress was not significantly affected by time since the initial diagnosis, age, education, or gender. Person's who worked and those with better coping skills had lower initial mood distress. Knowledge of the late effects of treatment was not related to mood distress. Following the intervention, the more distressed a person was initially, the better the coping skills, the greater the decrease in mood distress. Partnered survivors experienced less of a decrease in distress. Knowledge of the late effects of treatment (regardless of their knowledge of cardiovascular disease as a consequence), did not effect change in mood distress. Findings were contrary to expectations. Findings are consistent with Self-Regulation theory and the Health Belief Model and are not explained by anxiety related to the medical visit itself. Limitations of the study design are discussed. The method through which risks are conveyed can reduce the psychosocial impact of risk notification.