Best and Worst Practices In Private Sector Managed Mental Healthcare

Best (& Worst) Practices In Private Sector Managed Mental Healthcare Part I: Level-Of-Care Criteria May 1999 Child and family issues
The following are the substantive areas of concern the panelists identified concerning children and the families of both child and adult consumers. Recognition that children are not just "small adults" Attention to the special needs of children and adolescents was highly variable among the different criteria sets. The continuum ran the gamut from those that did not mention children or adolescents (a worst practice), to those that incorporated statements about children and adolescents in some of their criteria, to those that developed distinct criteria across each type of treatment setting for different age groupings. The panel clearly unanimously agreed that the latter approach is by far the better practice. And the best practice, identified in two criteria sets, included attention to ensuring that clinicians treating children and adolescents have appropriate training and experience in serving this special population. Family support for consumers who are parents Only one criteria set addressed the important need to provide family support for mental health consumers who are also parents. This best practice includes discussion of family support/treatment programs to help adults diagnosed with mental illnesses work toward parenting goals. Services included education, training, support groups, and rehabilitation services. For individuals at risk of having their child removed from the home and placed in foster care, criteria set language encourages having services coordinated with the local Social Services Agency. Support for consumers' family members Three criteria sets addressed family education and support, while four did not (although one of these four did discuss the need for family therapy and another included text concerning education and therapy for consumer's significant others/partners). One best practice criteria set included all of the following elements: Regular "crisis" meetings; Supportive family training; and Educational programs on: coping with a family member's illness; consumer and family independence; medications; advocacy; stigma; benefit concerns; and stress management. A second best practice document has distinctive criteria for family stabilization programs that included "programs that provide short-term flexible services to assist caregivers in stabilizing children and adolescents in their home settings. The services are designed to prevent repeated hospitalizations or to allow individuals to move from the hospital to a less restrictive setting more quickly. The supportive services of a family stabilization program are delivered during an episode of acute mental illness or after out of home treatment, such as inpatient hospitalization. Family stabilization programs can be used as an independent level-of-care or as an adjunct to another level-of-care." Involvement of the adult consumer's family This was another area where panelists noted tremendous variation among the level-of-care criteria sets. One best practice we identified was an up-front consideration of whether the consumer had a family/support network in place. In fact, two criteria sets included an inadequate support system as factors for consideration in their criteria for acute admission. There was also one worst practice that the panelists identified in this area (beyond those that excluded the subject matter altogether): lack of attention to whether the family's involvement is appropriate and/or desired by the adult consumer.		Introduction Key findings "Report card" on information sharing Methodology Development process Comprehensiveness Corporate philosophy Access issues Compliance Child and family issues Substance abuse and co-occurring disorders Cultural competence Provider autonomy Coordination/ consultation among providers Denial notification and appeal processes More observations, recommendations and areas for further study Acknowledgments