Total Cost of Therapy-Based Care Versus a Brokerage Model of Case Management for Persons With a Serious Mental Illness Served in the Community.

A five-year evaluation compared total Medicaid and General Fund behavioral health care costs of a behavioral health home (BHH) model with those of a brokerage model of case management (treatment-as-usual) for the community care of adults with a serious mental illness. The BHH was an interprofessional, team-based intervention that used cognitive behavioral therapy, motivational interviewing, and dialectical behavioral therapy skills as primary interventions. By the third full year, the BHH total cost was less than half that of case management. The difference was due largely to less utilization of inpatient and community residential services among those served by the BHH. Results are limited by the non-randomized assignment among the groups and the availability of only aggregate data, but they strongly suggest the value of further examination of the effectiveness and cost of BHH versus case management-based interventions in a community mental health setting.

Attachment Theory and Neuroscience for Care Managers.

This article describes a model for care managers that is based on attachment theory supplemented by knowledge from neuroscience. Together, attachment theory and basic knowledge from neuroscience provide for both an organizing conceptual framework and a scientific, measureable approach to assessment and planning interventions in a care plan.

Provider Agency Practices as a Source of Social Work EBP.

Through this article the authors propose that agency service provider systems may be a source of evidence-based practices (EBP). One agency's design and implementation of a program entitled Community Treatment and Rehabilitation is presented as an example. The elements of this program conform to the creation of EBPs. It was formulated with consideration of clients' values and judgments through their participation at every step in the assessment and treatment process. Staff clinicians were trained in established EBP interventions, such as cognitive therapy, embedded in a system of ordered assessment, treatment, and outcome evaluation. A controlled research design was used to gather outcome data to inform clinicians' decisions about interventions that were then systematically applied with clients. The delivery system was organized for clinical supervisors to guide staff clinical practices so that all were operating on the same set of guidelines allowing for similar outcomes to occur with similar interventions. This method of developing EBPs makes them available for application immediately and successfully eliminates the delay between development and implementation that usually occurs with other sources of EBPs.

Application of Attachment Theory in Clinical Social Work.

This article proposes the use of attachment theory in clinical social work practice. This theory is very appropriate in this context because of its fit with social work concepts of person-in-situation, the significance of developmental history in the emergence of psychosocial problems, and the content of human behavior in the social environment. A literature review supports the significance of the theory. Included are ideas about how attachment styles and working models may be used in assessment and treatment to help clients achieve a secure attachment style.

Social Role Theory and Social Role Valorization for Care Management Practice.

This article proposes that social role theory (SRT) and social role valorization (SRV) be established as organizing theories for care managers. SRT is a recognized sociological theory that has a distinctive place in care management practice. SRV is an adjunct for SRT that focuses on people who are devalued by being in a negative social position and supports behavior change and movement to a valued social position.

Integrating behavioral and physical health services and organizational merger.

This article describes the process of the merger of two mental health agencies with a primary care physical health provider to establish within the merged structure an integrated behavioral and physical health delivery system. The purpose of this article is to share our experience with those administrators and staff of agencies planning an integration initiative of behavioral and physical health services.

Combining evidence-based practices for improved behavioral outcomes: a demonstration project.

This article describes a demonstration project carried out by a special team at a mental health agency serving adults with a serious psychiatric condition. The project consisted of combining the evidence-based practices of cognitive therapy, Motivational Interviewing and Stages of Change with Social Role Theory and the Chronic Care Model that were the organizing concepts of the agency's assessment and treatment program. Measures of the results of clients' improved mental health and social functioning indicated the successful use of this combination.

Attachment as a function of the case manager-client relationship.

This article reports an exploratory study of the relationship between case manager's attachment styles and outcomes of client services. The primary purpose of this study was to discover whether a measure of attachment could be used as part of a preemployment screening process for potential case managers. Two attachment measures were completed by a group of randomly selected staff. Each of them was also asked to complete a valid outcomes measure for clients. The scores for the attachment measures and the outcomes measures were correlated. The results supported the hypothesis that these attachment scales could be used effectively as part of preemployment screening.

The Chronic Care Model for behavioral health care.

This paper describes the successful application of the Chronic Care Model (CCM) at Touchstone innovaré, a large mental health agency serving a population of persons with a serious psychiatric condition. Based on our experience with the CCM, it is proposed that it could be applied in behavioral health care in the same manner as it is in physical health care. It is our contention that "chronic condition" should be the key phrase, and that there should not be a distinction in the application of a treatment model, whether the chronic condition is behavioral or physical.

Case management and social role theory as partners in service delivery.

This article proposes a reorganized model of case management for persons with a serious psychiatric illness, including a substance abuse disorder. The model was designed as a response to the changing demands of federal laws public funding sources, and social work licensure requirements in some states. It partners case management with social role theory and uses the person-in-situation paradigm and social functioning as organizing concepts. This model may be helpful for those adult mental health agencies serving this population who are faced with making adjustments to changing demands of federal law, public funding sources, and the requirements of social work licensure in some states, all of which place restrictions on service delivery. An important feature of the model is partnering case management with social role theory in a way that enhances the delivery of case management services. It is being implemented at Touchstone innovaré, a mental health agency serving adults who have a serious psychiatric condition or a co-occurring disorder.

Adoption of evidence-based practices in community mental health: a mixed-method study of practitioner experience.

This mixed method study examined practitioners as they adopted four evidence-based practices (EBPs) in a community mental health center. In-depth semi-structured interviews; a measure of EBPs attitudes; and a final focus-group were used over a 2-year study period to assess 14 mental health practitioners on one immersion team. The framework for data collection was adapted from organizational theories that view culture and climate as mediating factors. Analysis of practitioner themes demonstrated that there were facilitating and impeding factors in the adoption process. Practitioners reported positive changes in their individual competency but two years was inadequate for training on four EBPs. Involvement of agency administration and consistent supervision were regarded by practitioners as crucial to successful adoption of EBPs.

An agency-generated outcome measure.

This article describes the development of an original outcomes measurement scale titled Psychiatric Well-Being (PWB). The scale is a series of statements that are characteristics of the agency's product ofpsychiatric well-being for an adult population of persons with a serious psychiatric disorder, many of whom also have a substance abuse disorder. Validity, reliability, and internal consistency of the PWB scale have been determined The scale may be adapted directly to measuring outcomes of agencies serving similar populations or its characteristics may be modified for measurement use with other populations.

Community treatment and rehabilitation: one agency's model of case management.

This article describes one agency's model of delivering case management services to an adult population of seriously and persistently mentally ill persons. It was developed following improvements in psychotropic medications that have resulted in considerable symptom relief for many clients. The treatment program, both medical and psychosocial aspects, is focused on recovery rather than maintenance. Outcome measures of treatment and rehabilitation objectives demonstrated that the program has been successful.