Importance There have been recent calls for increased access to mental health services, but access may be limited owing to psychiatrist refusal to accept insurance. Objective To describe recent trends in acceptance of insurance by psychiatrists compared with physicians in other specialties. Design, Setting, and Participants We used data from a national survey of office-based physicians in the United States to calculate rates of acceptance of private noncapitated insurance, Medicare, and Medicaid by psychiatrists vs physicians in other specialties and to compare characteristics of psychiatrists who accepted insurance and those who did not. Main Outcomes and Measures Our main outcome variables were physician acceptance of new patients with private noncapitated insurance, Medicare, or Medicaid. Our main independent variables were physician specialty and year groupings (2005-2006, 2007-2008, and 2009-2010). Results The percentage of psychiatrists who accepted private noncapitated insurance in 2009-2010 was significantly lower than the percentage of physicians in other specialties (55.3% [95% CI, 46.7%-63.8%] vs 88.7% [86.4%-90.7%]; P P P P  = .02). Conclusions and Relevance Acceptance rates for all types of insurance were significantly lower for psychiatrists than for physicians in other specialties. These low rates of acceptance may pose a barrier to access to mental health services.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/1785174/yoi130079.pdf

Acceptance of insurance by psychiatrists and the implications for access to mental health care.

Workplace harassment is a well-researched topic, especially in regard to the antecedents and consequences of the phenomenon. A number of criticisms of this body of research have been raised that influence our understanding of harassment, its causes, and effects. Accordingly, this methodological review was conducted to identify current methodological gaps and propose new strategies for advancing knowledge on harassment at work. A total of 234 samples, from 224 peer-reviewed articles published over a 26-year period (1987-2012 inclusive), which focused on the antecedents, consequences, or process of diverse forms of workplace harassment (e.g., bullying, abusive supervision, mobbing, and victimization), were systematically analysed for methodological content. Our analysis focused on identifying threats to construct, internal, external, and statistical conclusion validity, covering issues such as sample characteristics, research design, measurement, methods of data collection, and techniques to analyse data. Findings on the nature and extent of existing methodological limitations underpin suggestions to advance theory development in this area by improving study validity. These include adopting longitudinal and experimental designs, utilizing within-person approaches, incorporating the perspectives of witnesses and perpetrators of harassment, developing combined group/organizational and individual levels of analysis, and focusing on the dynamic processes of workplace harassment. Practitioner points Limitations in existing research have constrained what we know about workplace harassment, and how to prevent harassment and its negative consequences., This paper provides a comprehensive resource for evaluating the quality of the ever-growing body of research on workplace harassment, which covers issues such as bullying, abusive supervision, aggression, incivility, and other forms of victimization at work.

A methodological review of research on the antecedents and consequences of workplace harassment

Current research has determined that a larger percent of social workers and other counselors are affected by PTSD types of symptoms when working with traumatized clients than the general population. While much of this research addresses workers in specific trauma areas like sexual assault centers or child welfare agencies, little specific thought has been given towards the special stress that working with Substance Abuse Disorders (SA) and trauma may present. This paper takes a brief look at the issues of vicarious trauma and compassion fatigue with SA practice and describes future investigation pathways toward this goal.

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The Unbearable Fatigue of Compassion: Notes from a Substance Abuse Counselor Who Dreams of Working at Starbuck’s

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 requires commercial insurers providing group coverage for substance use disorder services to offer benefits for those services at a level equal to those for medical or surgical benefits. Unlike previous parity policies instituted for federal employees and in individual states, the law extends parity to out-of-network services. We conducted an interrupted time-series analysis using insurance claims from large self-insured employers to evaluate whether federal parity was associated with changes in out-of-network treatment for 525,620 users of substance use disorder services. Federal parity was associated with an increased probability of using out-of-network services, an increased average number of out-of-network outpatient visits, and increased average total spending on out-of-network services among users of those services. Our findings were broadly consistent with the contention of federal parity proponents that exte...

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Federal parity law associated with increased probability of using out-of-network substance use disorder treatment services.

Social workers are needed to implement science-based treatments for alcohol and other drug (AOD) problems. Changes in insurance coverage through the Affordable Care Act will increase the demand for licensed Master of Social Work (MSW) clinicians. This national study of MSW programs (N = 210) examines prevalence of addiction courses and specializations. Web-based analyses showed that only 14.3% of accredited schools offered specialization; only 4.7% of accredited schools had one or more required courses. Social work education has not met addiction workforce development needs; there is no evidence this pattern will change.

Addiction Training in Social Work Schools: A Nationwide Analysis

The impact of substance abuse on society is wide ranging and costly. According to a Robert Wood Johnson Foundation (RWJF, 2001) report, substance abuse, including tobacco use, is the cause of more deaths, illnesses, and disabilities than any other preventable health condition. This same report indicates that approximately 25 percent of the more than 2 million deaths each year in the United States are attributable to alcohol, illicit drugs, or tobacco. The Department of Health and Human Services (HHS) estimates that drug and alcohol abuse contribute to more than 120,000 deaths in the United States each year (HHS, 2002). According to Healthy People 2010 (HHS, 2000), alcohol and illicit drug use are associated with a wide range of health and social welfare problems, including child and spousal abuse, sexually transmitted diseases, teenage pregnancy, school failure, motor vehicle crashes, low worker productivity, increasing health care costs, and homelessness. Furthermore, long-term heavy alcohol use can lead to heart disease, cancer, liver disease, pancreatitis, and fetal alcohol syndrome (HHS, 2000). In 1995 the cost of alcohol and drug abuse to society was conservatively estimated at more than $275 billion per year (RWJE 2001). These figures reflect costs associated with illness, deaths, medical care, crime, other related costs (for example, motor vehicle crashes), and special conditions related to substance abuse (for example, HIV/AIDS attributable to substance abuse). According to a Substance Abuse and Mental Health Services Administration (SAMHSA) report, it is estimated that 18 to 26 million Americans were in need of substance abuse treatment in 2002 (SAMHSA, 2003). The 2002 National Survey on Drug Use and Health estimated that 22 million people age 12 or older were classified with substance abuse or dependence, supporting the need for substance abuse treatment in the United States. Estimates from SAMHSA indicate that the need for substance abuse services for individuals with an illicit drug problem are increasing (SAMHSA, 2002a). Furthermore, abuse of alcohol and drugs (both legal and illicit) affects nearly 17 percent of adults age 60 or older (SAMHSA, 2002b). Although the need for treatment is documented, it is estimated that only 3 million people actually received substance abuse treatment in 2002 (SAMHSA, 2003). Literature Review: The Role of Social Workers A Bureau of Labor Statistics (BLS) report indicates that there were 477,000 social work positions in 2002 (BLS, 2004). Of these positions, 95,000 were in mental health and substance abuse. A 1993 HHS report suggested that only 6 percent of all staff in substance abuse treatment programs in the United States were social workers at the master's level or higher. According to the BLS report, employment of social workers is expected to increase faster than the average for all occupations through 2012, and employment of social workers in substance abuse settings will grow rapidly between 2002 and 2012 (BLS).This projected increase is due to a variety of factors, including placement of substance abusers, particularly abusers of illicit drugs, into substance abuse treatment programs instead of into the criminal justice system; recognition of the need to provide substance abuse treatment in the United States; and increased comorbidity of substance abuse disorders with other problems (for example, mental health disorders, HIV/AIDS and other sexually transmitted diseases, child welfare cases). For instance, Hall and colleagues (2000) found that at least half of all hospitalized patients in urban areas have substance abuse--related problems. Often, social workers are the first service providers to come in contact with substance abusers in the various service delivery systems, including child welfare, employee assistance programs, hospitals, schools, programs for elderly people, and community-based services. Social workers often provide key assessment and referral services in an array of health and mental health care settings (Hall et al. …

Social Workers in the Substance Abuse Treatment Field: A Snapshot of Service Activities

Objective: This non-experimental, cross-sectional study examined social workers' perceptions of bullying work relationships and their ability to construct effective coping responses to perceived workplace bullying. Methods: Quantitative data were gathered through the use of a mailed questionnaire, and qualitative data resulted from semi-structured individual interviews. Participants: The quantitative sample consisted of 111 social workers from the metropolitan, Washington, DC area, who were employed in organizations. Two self-identified targets of bullying participated in the interviews. Results: Nearly three of five social workers (58%) in the sample reported being the targets of demeaning, rude, and hostile workplace interactions more than once in the previous year. Targets were more likely to work in government agencies/military and mental health outpatient organizations (19% and 18% respectively). More than a third of targets (35%) held a direct service role (clinical/direct practice), whereas almost a third (29%) identified their role as administration or management. Conclusion: The findings from this study suggest that workplace bullying may be a problem for social workers and that the social work profession may need to develop tools and guidelines to help practitioners identify, confront and extinguish these behaviors. Language: en

Social workers and workplace bullying: Perceptions, responses and implications

Two current congressional bills mandate parity for benefits for mental disorders with benefits for medical/surgical conditions in private insurance when mental health benefits are provided; the bills differ in regard to benefit levels and access to out-of-network coverage. This study assessed clinicians’ and beneficiaries’ participation in managed care networks in the national capital area under the Federal Employees Health Benefits (FEHB) parity program. Approximately one-third of the clinicians studied participated in FEHB networks, and only 44 percent of FEHB patients received care from network clinicians. Out-of-network mental health benefits are an important policy consideration to ensure access to mental health treatment under parity proposals.

Parity And The Use Of Out-Of-Network Mental Health Benefits In The FEHB Program

Parents receive social work services (both voluntary and involuntary) in a variety of settings. Although the parents may have come to need social work interventions for different reasons, one reason is constant: They are experiencing some difficulty with their children. Children are likely to benefit when parenting ability is strengthened. In all settings, social workers have a unique opportunity to assist parents in establishing, restoring, or maintaining healthy family dynamics.

Keeping Parents in the Driver's Seat

This article describes the National Association of Social Workers' (NASW) strategies for providing social workers with important practice and policy information about palliative and end-of-life care. With funding from a Soros Foundation's Project on Death in America grant, NASW developed practice standards, a Web-based continuing education course, and drafted a new policy statement to guide social workers in end-of-life care practice. The article provides an in-depth view of the development and scope of these resources for professional social workers.

Tracy Whitaker

Papers

Social Workers in the Substance Abuse Treatment Field: A Snapshot of Service Activities

Social workers and workplace bullying: Perceptions, responses and implications

Parity And The Use Of Out-Of-Network Mental Health Benefits In The FEHB Program

Keeping Parents in the Driver's Seat

Developing practice tools for social workers in end-of-life care.