ABSTRACT
The recent debates about health care reform have focused attention on the need to develop organized systems of care capable of delivering comprehensive services which are coordinated or integrated. Achieving service integration has emerged as a central and pressing objective in most mental health systems in response to existing difficulties with fragmentation of care. However, attempts at service integration often fail at the implementation stage as provider agencies zealously guard their organizational boundaries and struggle with each other for power and control. In this article, the authors formulate an organizational development approach to service integration that focuses on reducing the rigid maintenance of agency boundaries by developing informal networks among staff of local provider agencies. Eight strategies, drawn from the research literature on services integration and recently implemented by a local mental health authority, are described as potential tools for use by systems managers in accomplishing these goals.
Subject(s)
Community Health Planning/organization & administration , Community Mental Health Services/organization & administration , Delivery of Health Care, Integrated/organization & administration , Community Mental Health Centers/organization & administration , Connecticut , Health Plan Implementation/organization & administration , Humans , Interinstitutional Relations , Patient Care Team/organization & administration , Power, PsychologicalABSTRACT
Although managed care is an established force in the private sector, there is growing interest and experimentation with this concept in the public sector. This interest has been generated by the increased demand for services, the shrinking resource base due to cutbacks in state budgets, and the fragmentation of care that has accompanied the shift from a centralized, hospital-based model to a decentralized, community-based model for treating individuals with serious mental illness. But despite this interest, no consensus exists about the form or functions of managed care in the public arena. Simply importing private-sector versions of managed care is inadequate given the substantial differences in the patient population and service delivery mechanisms. The authors present a functional analysis of managed care in the public sector. Drawing on their conceptualization of managed care, they outline a functional approach to evaluating the strengths and weaknesses of treatment systems, innovations such as privatization and capitation, and recent health care reform proposals.
Subject(s)
Community Mental Health Services/organization & administration , Health Maintenance Organizations/organization & administration , Public Health , Community Mental Health Services/economics , Deinstitutionalization , Health Care Reform , Humans , Managed Care Programs/organization & administration , Mental Disorders/therapy , United StatesABSTRACT
In this paper we, first, briefly review existing efforts to integrate adult development theory into psychodynamic psychotherapy. Next, we examine the concept of life structure and discuss its evolution across the eras and periods of the adult years. We explore the added concepts of the core self, the vital life structure, and life structure management skills. In so doing, we provide a context for proposing a new definition of the primary task of treatment: to help patients develop life structures that ensure a good fit between internal aspects of the self and the roles, relationships, and activities that comprise their lives. The creation of a life structure that is as fully expressive of the core self as reality permits increases patients' sense of vitality and well-being.
