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There was tremendous variance in the number and diversity of the treatment settings covered as categories under the level-of-care criteria sets we reviewed. We recognize that a portion of the variance is due to whether these organizations cover public as well as private populations. We also are well aware that some services may be covered and may have authorization protocols that are not part of a particular vendor's level-of-care criteria. Despite these caveats, the categorization and inclusion of treatment setting information in these criteria
sets has tremendous implications concerning the number and types of services that are available to consumers.
NMHA strongly supports the coverage of a full continuum of care as being the most cost effective, as well as clinically effective, approach to serving the needs of persons who require mental health treatment. This strategy enables care to be provided in the least restrictive, least costly, and most appropriate setting. When there are gaps in the service system, particularly the enormous gaps identified and illustrated in the chart below, funds are wasted. More importantly, the ability to optimize recovery is lost.
The following grid is an illustration of the variance in comprehensiveness among the seven different vendors in the study. Gaps, indicated by a dotted line, are considered worst practices.
| TREATMENT SETTING |
I |
II |
III |
IV |
V |
VI |
VII |
| Crisis Stabilization |
Yes |
Yes |
--- |
--- |
Yes |
Yes |
--- |
| 23-Hour Bed |
Yes |
Yes |
--- |
--- |
Yes |
Yes |
Yes |
| Inpatient |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
| Detoxification |
--- |
--- |
--- |
--- |
Yes |
Yes |
--- |
| Partial Hospitalization |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
| Day Treatment |
Yes |
Yes |
--- |
--- |
--- |
Yes |
--- |
| Residential Treatment/Rehabilitation |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
--- |
| Group Homes |
Yes |
Yes |
--- |
--- |
Yes |
--- |
--- |
| Home Health |
Yes |
Yes |
--- |
--- |
--- |
--- |
--- |
| Assertive Community Treatment |
--- |
Yes |
--- |
--- |
--- |
--- |
--- |
| Case Management |
--- |
Yes |
--- |
--- |
--- |
--- |
--- |
| Therapeutic Foster Care |
--- |
Yes |
--- |
--- |
--- |
--- |
--- |
| Family Therapy/Stabilization |
--- |
Yes |
--- |
--- |
Yes |
Yes |
--- |
| Intensive Outpatient Program |
Yes |
Yes |
Yes |
--- |
Yes |
Yes |
Yes |
| Outpatient Services |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
Yes |
| Group Therapy |
--- |
--- |
--- |
--- |
Yes |
--- |
--- |
| Couples Therapy |
--- |
--- |
--- |
--- |
Yes |
--- |
--- |
| Community Support Services |
--- |
Yes |
--- |
--- |
Yes |
Yes |
--- |
| Psychological Testing |
--- |
Yes |
--- |
--- |
--- |
--- |
--- |
| Employee Assistance Program |
--- |
Yes |
--- |
--- |
--- |
--- |
--- |
| Consumer-Run Services |
--- |
Yes |
--- |
--- |
--- |
--- |
--- |
| Consultation liaison services |
--- |
--- |
--- |
--- |
--- |
--- |
--- |
The following were identified as best practices that we encourage other vendors to adopt:
- One company had by far the most expansive list of community support services covered in its criteria set, including all of the following topics:
- housing programs
- supported education
- vocational rehabilitation
- clubhouses
- prevention services
- representative payee program
- guardianship program
- family support and education
- NMHA is a strong supporter of consumer-run services. They have a very positive impact on compliance, as people are simply more likely to agree to "go along" with a plan the less they view it as being imposed from "outside." Such services can also help consumers gain confidence in their own ability to make decisions and preserve a sense of personal autonomy. In addition, the helper/helpee relationship benefits both participants and can often inspire not only compliance, but also an optimism about recovery. One company had by far the most expansive list of consumer-operated services covered in its criteria set, including the following:
- warm line
- safe house
- peer case management
- drop-in center
- recovery groups
- peer advocacy
- peer-run housing
- peer-run employment services
- Two companies provided detailed criteria across treatment settings for children and adolescents, acknowledging the special considerations for this population. Please see pages 17 and 18 for more detailed information on the quality of attention to children and their families.
- Two companies provided detailed criteria for substance abuse versus mental health treatment services, again, acknowledging the special considerations specific to both populations. One company provided detailed protocols for persons with co-occurring mental health and substance abuse treatment needs. Please see pages 19 and 20 for additional information on coverage of these issues.
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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
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