Patients' and providers' perceptions of outpatient treatment termination in a managed behavioral health organization

Perceived barriers to treatment and psychotherapy attendance in child community mental health centers

Poor psychotherapy attendance is a major problem facing most child community mental health centers. However, post-treatment perspectives on reasons for premature termination are rarely sought from either families or clinicians. In the present study, we collected parent data and clinician data regarding 72 and 153 clients, respectively, from four child and adolescent community mental health centers serving diverse families. Problems regarding (a) the perceived relevance of treatment and (b) the quality of the therapist-family relationship emerged as the two most consistent factors related to premature dropout. Possible interventions to increase psychotherapy attendance are highlighted.

The impact of evidence-based guideline dissemination for the assessment and treatment of major depression in a managed behavioral health care organization

This study tests whether a managed behavioral health care organization can influence adherence to practice guidelines for the treatment of major depression in a randomized trial of guideline dissemination. Guidelines were disseminated to mental health clinicians (N = 443) under one of three conditions: (1) a general mailing of guidelines to clinicians, (2) a mailing in which guidelines were targeted to a patient starting treatment with the clinician, and (3) no mailing of guidelines. The results showed no effects of guideline dissemination as measured by self-report of patients and clinicians and through episode characteristics derived from claims data, despite sentinel effects. Results also showed high rates of clinician-reported guideline adherence that were not detected in the claims data, indicating significant undertreatment of depression. Results suggest that mental health systems must look to other dissemination strategies to improve adherence to standards of care and raise the performance of independent practicing clinicians.

Providing therapy when managed care organizations deny reimbursement: are private practitioners and their clients taking the fall?

Sampled private practitioners from the Register of Clinical Social Workers, American Psychological and Psychiatric Associations were used to evaluate what percentage of these practitioners' caseloads are made up of clients who have been denied reimbursement by managed care organizations for ongoing therapy. The results indicate that 39% of the respondents' caseloads are of managed care insured clients, of whom nearly one-third have been denied reimbursement for ongoing therapy, and of whom 42% later reenter therapy with an acute exacerbation of symptoms. The results have potential ethical and legal complications for private practitioners treating clients insured by managed care organizations.