Showing papers in "Administration and Policy in Mental Health in 1992"
TL;DR: It was found that policy decisions are based on socioeconomic conditions, supply and demand of mental health services, and organizational structure of the SMHA and the political context of state government.
Abstract: The authors developed and applied multivariate computer models to study factors that determine state mental health agencies' (SMHA) budgets in relation to other state health and welfare expenditures and factors that determine the allocation of SMHA funds between state hospitals and community services. It was found that policy decisions are based on socioeconomic conditions, supply and demand of mental health services, and organizational structure of the SMHA and the political context of state government.
43 citations
TL;DR: The extent and consistency of heavy use of acute psychiatric inpatient services among Medicaid recipients across five years and four sites is explored and the planning of appropriate services for this patient subgroup is discussed.
Abstract: This study explores the extent and consistency of heavy use of acute psychiatric inpatient services among Medicaid recipients across five years and four sites. Approximately 35% of inpatient service users account for approximately 75% of the dollars spent on inpatient services across place and time. Heavy users are distinct from non-heavy users in being comprise of more children and adolescents, in being disproportionately white, and in having more severe disabilities. The study findings are discussed in the context of the planning of appropriate services for this patient subgroup.
39 citations
TL;DR: Performance contracting in Colorado continues to changeBased on changing system goals and finite resources, an earlier 1986–87 model along with its unresolved issues is linked to recent developments.
Abstract: Performance contracting in Colorado continues to change based on changing system goals and finite resources. An earlier 1986–87 model along with its unresolved issues is linked to recent developments. Currently the areas of primary focus include contracting for specific targeted clients, reviewing the manner in which resources are allocated to mental health centers, and developing and implementing a set of performance indicators.
11 citations
TL;DR: This approach can provide a more detailed and comprehensive view of trends and differences in LOS across facilities over time and can be particularly useful in assessing the impact of changes in policy and service delivery strategies.
Abstract: This paper examines the combined use of a prospective view of length of stay (LOS) using life table analysis and examinations of point-in-time data measuring the LOS of individuals hospitalized on a given day. This approach can provide a more detailed and comprehensive view of trends and differences in LOS across facilities over time and can be particularly useful in assessing the impact of changes in policy and service delivery strategies.
11 citations
TL;DR: The principal components of a prospective strategy for management of public mental health systems: single stream funding and prepayment, prevention and promotion programs for the at-risk population, decision support systems to identify at risk populations and interventions such as managed care of high-risk clients and the most severe and persistently mentally ill are identified.
Abstract: This paper identifies the principal components of a prospective strategy for management of public mental health systems: single stream funding and prepayment, prevention and promotion programs for the at-risk population, decision support systems to identify at risk populations and interventions such as managed care of high-risk clients and the most severe and persistently mentally ill. Pertinent literature and major studies are briefly reviewed.
11 citations
TL;DR: Spending and revenue data reveal that federal support for state mental health agencies increased slightly during this period, but solely as a function of the introduction of the Block Grant in 1982.
Abstract: This paper documents expenditure and revenue patterns of state mental health agencies from 1981 to 1987. Expenditure data show an overall decline of mental health expenditures of 4.9% over this period. Revenue data reveal that federal support for state mental health agencies increased slightly during this period, but solely as a function of the introduction of the Block Grant in 1982. Interstate variability in per capita spending on mental health is also described and found to be significant even beyond adjustments for costs of services.
10 citations
TL;DR: This paper addresses changes in the prevalence, type, and severity of problems being presented by adolescents, and the familial, social, and cultural supports and context for adolescent behavior, to identify critical clinical and service system issues needing to be addressed if mental health and substance abuse services are to effectively meet the needs of adolescents and their families.
Abstract: This paper addresses changes in the prevalence, type, and severity of problems being presented by adolescents, and the familial, social, and cultural supports and context for adolescent behavior. Also described are the types of clinical training, financing, service system, and research supports that must be addressed if the field is to adequately meet the needs of adolescents with serious and persistent problems.
9 citations
TL;DR: The author describes the application of single-subject design evaluation procedures to a quality assurance framework and their compatibility with treatment planning and progress recording methods is examined.
Abstract: The author describes the application of single-subject design evaluation procedures to a quality assurance framework. Compatibility with treatment planning and progress recording methods and contributions to treatment effectiveness are examined.
9 citations
TL;DR: In this article, the roles of individual organizations in shaping federal mental health policy are reviewed as well as the effects of their advocacy and the implications for mental health administrators in relation to their advocacy at the federal level.
Abstract: This article examines some of the mental health associations and public interest groups in relation to their advocacy at the federal level. The roles of individual organizations in shaping federal mental health policy are reviewed as well as the effects of their advocacy and the implications for mental health administrators.
8 citations
TL;DR: The mental health group was perceived to be the most divided and least effective, of the five communities, and the author suggests advocacy strategies than can be helpful at all levels of government.
Abstract: This article discusses the results of a survey of U.S. Congressional staff about the effectiveness of the mental health, developmental disabilities, aging, childrens, and AIDS communities in Washington, D.C. The mental health group was perceived to be the most divided and least effective, of the five. The author suggests advocacy strategies than can be helpful at all levels of government.
6 citations
TL;DR: The approaches used to handle the cuts are described, specific strategies that were developed using information and research are outlined, and priorities for future service system research are discussed.
Abstract: The Massachusetts Department of Mental Health (DMH) has experienced dramatic budget reductions over the past few years. These cutbacks have been managed using a variety of management tools. This article describes the approaches used to handle the cuts, outlines specific strategies that were developed using information and research, and discusses priorities for future service system research.
TL;DR: This paper focuses on nine overlapping topics dealing with improving mental health and substance abuse services for adolescents and their families and offers a specific position statement on each.
Abstract: This paper focuses on nine overlapping topics dealing with improving mental health and substance abuse services for adolescents and their families. Depending on the state of knowledge of each topic, the authors either highlight the importance of the area or offer a specific position statement. It is intended that these statements be reviewed for possible endorsement by the American College of Mental Health Administration (ACMHA) and for transmission to other professional organizations, federal and state governmental agencies and the field in general.
TL;DR: The author suggests that administrators should develop relationships not only with the leaders of these groups but with the grassroots members as well, and how administrators can work with them.
Abstract: This article describes the interests and priorities of major mental health advocacy groups, and how administrators can work with them. The author suggests that administrators should develop relationships not only with the leaders of these groups but with the grassroots members as well.
TL;DR: The history of this conflict as it relates to the medical profession is traced and through a case vignette, a variety of ethical issues and dilemmas presented by the growth of this rapidly expanding industry are raised.
Abstract: Any discussion of ethics is inherently a discussion of values and choices. The emergence of for-profit healthcare, especially in the field of mental health and substance abuse treatment for adolescents, has heightened this discussion as it relates to appropriate and necessary care. This paper traces the history of this conflict as it relates to the medical profession and through a case vignette, raises a variety of ethical issues and dilemmas presented by the growth of this rapidly expanding industry.
TL;DR: The authors discuss ethical issues faced by mental health administrators, among the primary concerns are patient rights, marketing, privatization, managed care, serving the poor.
Abstract: The authors discuss ethical issues faced by mental health administrators. Among the primary concerns are patient rights, marketing, privatization, managed care, serving the poor. It is suggested that professional organizations develop ethical guidelines to help administrators maintain their ethical positions.
TL;DR: This paper describes Project Prevention, an initiative of the American Academy of Child and Adolescent Psychiatry, which will assume the highest budgetary priority for mental health and substance abuse programming.
Abstract: This paper describes Project Prevention, an initiative of the American Academy of Child and Adolescent Psychiatry. By combining new thinking on prevention with the advances in integrated systems of community care, prevention will assume the highest budgetary priority for mental health and substance abuse programming.
TL;DR: The authors found total episodes in psychiatric units decreased, but became more homogeneous by concentrating on the treatment of schizophrenia and affective disorders, and a shift towards treatment in hospitals with no formal specialty units was observed.
Abstract: Changes in inpatient treatment in short-term, non-federal, general hospitals from 1980 to 1985 are investigated. Using the Hospital Discharge Survey, the authors found total episodes in psychiatric units decreased, but became more homogeneous by concentrating on the treatment of schizophrenia and affective disorders. Specialty hospitals decreased treatment of mental disorders, but increased treatment of chemical dependency. A shift towards treatment in hospitals with no formal specialty units was observed. However, the increase was more than accounted for by hospitals with organized psychiatric services, although not a formal unit meeting AHA standards. The influence of external factors, such as Medicare's Prospective Payment System, is discussed.
TL;DR: In this paper, the authors describe legislators' attitudes about the propriety of contracting for the involuntary treatment of the mentally ill. Explanations are also offered concerning the pattern of the responses, as well as factors that are most likely to affect legislators who view as proper such contracting.
Abstract: This study describes legislators' attitudes about the propriety of contracting for the involuntary treatment of the mentally ill. Explanations are also offered concerning the pattern of the responses, as are factors that are most likely to affect legislators who view as proper such contracting.
TL;DR: For example, this article found that Mexican Americans often encounter barriers to the utilization of mental health services, including unfamiliarity with services, language obstacles and cultural insensitivity in service delivery.
Abstract: Mexican Americans often encounter barriers to the utilization of mental health services, including unfamiliarity with services, language obstacles and cultural insensitivity in service delivery. (Atencio, 1971; Gibson, 1983; Miranda & Kitano, 1986). Research suggests that Mexican Americans may not be receiving an equitable share of service benefits relative to their need (Cuellar & Weeks, 1980). Culturally sensitive social policies and mental health programs can address this utilization problem. For example, Hispanic fraternal benefit societies have flourished, based on their appeal to group values (Rivera, 1987). Yet, historically Mexican Americans have been underrepresented on the policy boards of human service organizations, thus limiting Mexican American perspectives in the policy development of these organizations. In many communities the same few Mexi-
TL;DR: This article describes managing mental health service contracts by identifying strategies or methods that have the potential to complement and strengthen service strategies and determining whether a strategic management approach is useful.
Abstract: This article describes managing mental health service contracts. Specific strategies or methods are selected based on their fit with the organization's overall framework, congruence with internal strengths and external opportunities, and the potential to complement and strengthen service strategies. Criteria are proposed for deciding whether a strategic management approach is useful.
TL;DR: The author examines the mental health advocacy role of professional and organized provider associations at the federal level and discusses the primary policy and legislative issues of interest to them.
Abstract: The author examines the mental health advocacy role of professional and organized provider associations at the federal level. He discusses the primary policy and legislative issues of interest to them, how these issues are selected, the resources and staff effort they devote to advocacy, and how all this affects mental health administrators.
TL;DR: Modifications to the mental health financing system in the state of New York have emphasized policies and regulations to influence provider behavior, or to improve access to services by the severely mentally ill.
Abstract: This paper describes the modifications to the mental health financing system in the state of New York. Changes have emphasized policies and regulations to influence provider behavior, or to improve access to services by the severely mentally ill. Intensive case management has been introduced to change service use and promote long-term stabilization and recovery.
TL;DR: The authors describe a turnaround management plan implemented at a 60 bed psychiatric hospital, and the implications for turnaround management in other mental health organizations are discussed.
Abstract: Recent changes in the psychiatric hospital industry are generating a substantial demand for turnaround management strategies. The authors describe a turnaround management plan implemented at a 60 bed psychiatric hospital. Key operating and financial indicators are reviewed, and the steps taken to address the turnaround are described. Results after one year are presented, and the implications for turnaround management in other mental health organizations are discussed.
TL;DR: An innovative model benefit plan is proposed for children's mental health services for children and adolescents and the rationale for coverage and payment features is provided.
Abstract: The rising costs of mental health services for children and adolescents are a growing concern for insurers and employers alike. Several studies have indicated that the costs for children's treatment continue to grow, while others have reported that only a small number of the children diagnosed with mental disorders receive treatment. The authors propose an innovative model benefit plan and briefly provide the rationale for coverage and payment features.
TL;DR: The extent these authorities use rational planning methods was found to be positively associated with the rated quality of their community mental health system, particularly in states with greater deinstitutionalization and privatization of community mentally health services.
Abstract: State mental health authorities have progressively upgraded their planning capabilities during the 1980s The extent these authorities use rational planning methods was found to be positively associated with the rated quality of their community mental health system, particularly in states with greater deinstitutionalization and privatization of community mental health services
TL;DR: A number of new theories regarding how best to organize public mental health systems are proposed in this paper, drawing on the experience of delivering other public and human services; observations on which menta l heal th systems seem to "work best"; and applications of techniques used for supplying privately financed heal th care.
Abstract: Recent developments in research on the organization and f inancing of care for individuals with severe menta l illness suggest that there is much to be optimistic about in terms of developing a knowledge base that will support policy decisions aimed at improving the delivery of public menta l health care. There are three reasons for my optimism. (1) A n u m b e r of new theories regarding how best to organize public mental health systems. These theories draw on: (a) the experience of delivering other public and human services; (b) observations on which menta l heal th systems seem to "work best"; and (c) applications of techniques used for supplying privately financed heal th care. (2) A new spirit of innovat ion by many public menta l heal th systems. This is perhaps the most exciting development for both researchers and consumers of public mental
TL;DR: For example, Stern and Gibelman as mentioned in this paper pointed out the risks associated with acquiring external funding without appropriate consideration of attendant consequences to clients, staff, and the community, and suggested that agencies consciously adapt their programs to whatever causes are politically fashionable at the time.
Abstract: Fifteen years have elapsed since Ewalt and Cohen (1975) warned mental health administrators about the hidden costs of securing short-term grants. Scattered throughout the literature are more recent attempts to caution social service agencies about the risks associated with acquiring external funding (Kramer & Grossman, 1987; Patti, 1983). However, these admonitions have been more than offset by proponents of government-funded grants and purchase of service contractual arrangements as essential ways of weathering fiscal crises. One observer has gone so far as to suggest that agencies consciously adapt their programs to whatever causes are politically fashionable at the time (Salancik, 1981). A more common-bu t still t roubling--reaction has been to indiscriminately pursue external funding without appropriate consideration of attendant consequences to clients, staff, and the community (Stern & Gibelman, 1990).
TL;DR: The author presents mathematical models to determine the optimal time for an efficacy evaluation of clozapine, based on the presumption that clinical considerations as well as limited resources will preclude treating for an indefinite length of time a person who has not shown improvement.
Abstract: Clozapine's efficacy, side effect profile, and cost raise numerous clinical, administrative, and ethical concerns. The author presents mathematical models to determine the optimal time for an efficacy evaluation. The models are based on the presumption that clinical considerations as well as limited resources will preclude treating for an indefinite length of time a person who has not shown improvement. This quantitative approach to decision making also suggests what types of data should be obtained in future research on clozapine.
TL;DR: The move from supervised to supported housing and funding factors including a housing development grant from the RWJF, introduction of the “housing as housing” policy of the Ohio Department of Mental Health (ODMH), and the county-wide development and implementation of community support services are discussed.
Abstract: This article describes the policy change regarding residential services funded by the public community mental health system, its implementation, and its apparent effect upon the utilization and costs of residential and inpatient services in Cincinnati, Ohio from 1982–1991. The move from supervised to supported housing and funding factors including a housing development grant from the Robert Wood Johnson Foundation (RWJF), introduction of the “housing as housing” policy of the Ohio Department of Mental Health (ODMH), and the county-wide development and implementation of community support services are discussed.