Seeking Value Sowers, Wesley E; Ranz, Jules M; Psychiatry, Group for the Advancement of
2020, 2020-11-13
eBook
This comprehensive volume examines the myriad factors that have led to the current state of health care in the United States -- starting with an analysis of the meaning and history of value ...measurement -- but it does not stop there. It offers a holistic vision for health care reform, one in which psychiatric professionals play a pivotal role.
During the past decade or more, there has been a rapid evolution of mental health services and treatment technologies, shifting psychiatric epidemiology, changes in public behavioral health policy, ...and increased understanding in medicine regarding approaches to clinical work that focus on patient-centeredness. These contemporary issues need to be articulated in a comprehensive format. The American Association of Community Psychiatrists (AACP), a professional organization internationally recognized as holding the greatest concentration of expertise in the field, has launched a methodical process to create a competency certification in community psychiatry. As a reference for a certification examination, that effort will benefit enormously from a comprehensive handbook on the subject.
Continuous engagement in treatment and recovery services is one of the most important aspects of addressing acute episodes of severe behavioral health problems and the ongoing disabilities associated ...with them. Traditionally, fragmentation in systems of care has been common, and the transition from one provider, location, or intensity of service to another has not been prioritized in treatment planning. The authors describe a set of guidelines for maintaining continuity of care that was developed by the American Association of Community Psychiatrists. These guidelines embrace a progressive conceptualization of an integrated service system. For each element of the guidelines, a sample outcome indicator is presented that could be used to measure implementation. These guidelines can be used to help form transition plans, quality improvement initiatives, and program evaluations.
Recent legislation restricting disability and other financial benefits for persons with substance related disorders provides the latest chapter in this country's relationship with mind altering ...chemicals and its attempts to control their use. Whether seen from the perspective of a substance user or from that of an angry and insecure public, this relationship seems to lead inevitably to self-destructive processes. This paper will examine the historical context of drug control policy in this country and the impact of current policy on vulnerable populations and on society as a whole. Parallels between factors which drive addictive disorders and those that perpetuate ineffective public policy will be considered along with their moral implications.
Current US drug policy has failed to have a significant impact on the prevalence or deleterious effects of substance abuse disorders. The associated crime, violence, family disruption, & economic ...displacement are felt most acutely by already impoverished & disadvantaged communities. The need for a public health approach to these problems rather than a law enforcement one is discussed here, with special attention on the history & effectiveness of compulsory drug use treatment. A review of current literature reveals the positive & negative aspects of compulsory treatment. Recommendations for expanded use of treatment options for clients involved with the criminal justice system are elaborated. 39 References. Adapted from the source document.
Recent legislation restricting disability and other financial benefits for persons with substance related disorders provides the latest chapter in this country's relationship with mind altering ...chemicals and its attempts to control their use. Whether seen from the perspective of a substance user or from that of an angry and insecure public, this relationship seems to lead inevitably to self-destructive processes. This paper will examine the historical context of drug control policy in this country and the impact of current policy on vulnerable populations and on society as a whole. Parallels between factors which drive addictive disorders and those that perpetuate ineffective public policy will be considered along with their moral implications.
The concept of recovery is not a new one in behavioral health, but it has experienced resurgence since the release of the President’s New Freedom Commission report in 2003 (Hogan 2003). The belief ...that persons with mental illness or substance use disorders can lead productive and satisfying lives has been part of the philosophic core of community psychiatry for many years and was practiced most notably in psychiatric rehabilitation paradigms through the latter part of the twentieth century. While variations on the theme of recovery have been noted since the nineteenth century and perhaps even earlier, they were established more formally in the 1930s with the establishment of the Alcoholics Anonymous and Recovery, Inc. (Sowers 2003).
In previous chapters of this book, we have considered the evolution of behavioral health services over time, influenced both by ethical/philosophical and economic factors. On the one hand, we agree ...that service development should be driven by quality concerns and outcomes. More recently, the choices of the people using services have also become an important source of influence. On the other hand, we have had to recognize that there is expense associated with the provision of quality services and that our resources are not unlimited. Over the last 3 or 4 decades, the conflict between these opposing concerns has been intensifying, and it would appear that this tug-of-war could continue indefinitely. As the costs of providing care rise and economic conditions deteriorate, these issues become even more prominent. Psychiatrists and other behavioral health practitioners, working primarily in publicly funded programs, find themselves in the middle of these struggles, and thus are obliged to think about how they can use available resources wisely and fairly while maintaining a reasonably high quality of care. It is only through these endeavors that we can efficiently use resources to provide sufficient care to the greatest number of people (Frank and McGuire 2005; Pincus et al. 2007).
It is essential for community psychiatrists and other professionals and stakeholders in our community behavioral health system to understand the fundamentals of financing of Community Behavioral ...Health Organizations (CBHO). Healthcare financing in the United States is complex and operates at many levels: from the capture of a simple single fee for service (FFS) to much more complex payment structures and cost management mechanisms that apply to payer system interactions. Government sources play a much more prominent role in the financing of CBHO services than for general healthcare (National Healthcare Expenditures 2003). Medicare, local government grants, and Medicaid are the predominant payers of behavioral health services delivered in the United States. In order to develop a framework from which to understand financing of community mental health care, this chapter begins with describing a rationale for understanding financing, then discusses the essential structural components of CBHO financing, and proceeds to examining the historical development of public funding mechanisms, particularly considering the developmental roles of local, state, and federal governments. From this examination and detailed description of the current state of CBHO funding, speculation is provided into possible future developments, particularly with regards to health policy in the first several decades of the twenty-first century.
