The Integrated Behavioral Health Continuum
Theory and Practice
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Until recently, behavioral health was defined within the strict dichotomy of inpatient and outpatient care—a dichotomy that failed to mirror the range and complexity of human experience and clinical needs.
Today's integrated system renders this dichotomy obsolete. Instead, service delivery integration processes offer an organized system of care rooted in a common vision and defined by processes intended to promote continuity and quality of care, coordination of efforts, efficiencies of operation, and seamless patient movement through an otherwise bewildering array of health care services.
Unique in the literature, this volume brings together distinguished clinicians and policymakers who focus on the operational aspects of developing state-of-the-art integrated delivery systems.
- History and concept—Why we need integrated health care delivery systems, including a model of service delivery integration that incorporates current barriers (e.g., ambiguous roles and responsibilities and lack of strategic alignment; how to design integrated delivery systems improving clinical outcomes, achieving fiscal and operating efficiencies, and aligning clinical and fiscal incentives)
- Structural foundations—Access to the system of care for patients, payors, and employers; how to design level-of-care criteria; eight strategies that help clients move along the continuum; how to define level of care in today's managed care world; and the process of following therapeutic processes (i.e., philosophies, procedures, and practices used to create or support recovery and wellness) across the continuum
- Administrative and management processes—How to reorient staff toward minimizing barriers and making the patient central to the system; documentation/information management and reimbursement (rates and rate structures, risk assumption); current research and its enormous potential to improve every aspect of care; quality assessments based on examining the driving forces behind the needs for monitoring and evaluating quality and outcomes; and the relation of behavioral health care systems, which seek to fully integrate clients and families into the fabric of their community and culture, to other systems
A case vignette that highlights—from the consumer's viewpoint—the vital role of self-help during an episode of hospitalization and a discussion of future directions in integrated behavioral health care round out this remarkable volume.
With its wealth of strategic and nuts and bolts information—useful for alliances and single entities alike—on how to harness operational forces in establishing an effective integrated behavioral health continuum, this volume will be welcomed by those who deliver direct services (psychiatric professionals) and those who administer and manage the integrated financing and delivery of quality care from public (U.S. government agencies) and private (managed care and insurance providers) sectors alike.
- Chapter 1. Toward Integration
- Chapter 2. A Model of Service Delivery Integration
- Chapter 3. Barriers to Service Delivery Integration
- Chapter 4. Design of Integrated Delivery Systems
- Chapter 5. Access to the System of Care
- Chapter 6. Designing Level of Care Criteria
- Chapter 7. Movement Along the Continuum of Care
- Chapter 8. Levels of Care
- Chapter 9. Therapeutic Processes Across the Continuum
- Chapter 10. Staffing Across the Continuum of Care
- Chapter 11. Documentation Management
- Chapter 12. Reimbursement: Rates and Rate Structures
- Chapter 13. Reimbursement: Assuming Risk
- Chapter 14. Current Research on Mental Health Systems Integration
- Chapter 15. Assessing Quality of Care
- Chapter 16. A Consumer View of an Episode of Care and How Self-Help Helps
- Chapter 17. Behavioral Health Care Systems Relating to Other Systems
- Epilogue: The Future of Integrated Behavioral Health Care
About the Authors
Laurel J. Kiser, Ph.D., M.B.A., is a psychologist and Associate Professor in the Department of Psychiatry at University of Maryland School of Medicine. She received a doctorate from Indiana University in 1981 and completed internships and postdoctoral training in child clinical psychology. In 1986, she obtained a Master's of Business Administration from University of Memphis. Dr. Kiser's career focus has been on the delivery and evaluation of alternative mental health services. Specifically, she has been involved in developing, directing and researching child and adolescent partial hospitalization services since 1979. In 1994, she expanded her experiential base by organizing an academic, managed care division with responsibility for 33,000 covered lives. She served as a member of the Board of Directors and as President of the Association for Ambulatory Behavioral Healthcare (AABH) (formerly the American Association for Partial Hospitalization). She led development of a conceptual model for ambulatory levels of care and is co-editor of a book on system integration. In addition to her services research on partial hospitalization, Dr. Kiser has directed two statewide studies of the TennCare Partners Program, Tennessee's managed Medicaid behavioral healthcare carve-out. Her current research focus is on the protective role of rituals and routines within families, schools, and neighborhoods. Her articles appear frequently in the professional literature and she is a regular presenter and invited lecturer at national conferences.
Lawrence L. Kennedy, M.D., is a psychiatrist and former Director of Partial Hospitalization at the Menninger Clinic in Topeka, Kansas. Dr. Kennedy has had a long-term association with the Association for Ambulatory Behavioral Healthcare as a presenter at conferences, a board member and a former editor of the journal Continuum: Developments in Ambulatory Behavioral Healthcare. He has been on the faculty of the Karl Menninger School of Psychiatry for over 30 years, is a supervising and training psychoanalyst at the Topeka Institute for Psychoanalysis and the Greater Kansas City Psychoanalytic Institute. He is a Life Fellow of the American Psychiatric Association and a Fellow of the American Group Psychotherapy Association. Dr. Kennedy has taught and supervised individual and group psychotherapy for over 30 years. He has written and presented at a wide array of conferences in the United States and abroad on borderline conditions, group psychotherapy, partial hospitalization, boundary violations in non-hospital settings and program development. He is currently in private practice in Topeka, Kansas.
Paul M. Lefkovitz, Ph.D., is Executive Director of St. Vincent Hospital Stress Centers, a comprehensive behavioral health system located in Indianapolis, Indiana. He also serves as an Associate Professor (Volunteer) in the Department of Psychiatry at the Indiana University School of Medicine. Dr. Lefkovitz is a licensed clinical psychologist. He received his Ph.D. in clinical psychology from the University of Cincinnati in 1974. He was a Board Member and President of the American Association for Partial Hospitalization (currently Association for Ambulatory Behavioral Healthcare) and currently serves as a member of its National Advisory Panel. He is also a Board Member of the Mental Health Association in Indiana and the Indiana Mental Health Memorial Foundation. He was Associate Editor of the journal, Continuum: Developments in Ambulatory Behavioral Health Care and was co-author of Standards and Guidelines for Partial Hospitalization. Since 1974, his work has focused on conceptualizing, researching, and operationalizing the behavioral health continuum of care and has found fruition in frequent contributions to the professional literature, presentations at national conferences and consultative activities.
This book provides the rationale and recipe for the development of a continuum of quality care for the new millennium. Overcoming fragmented, uncoordinated treatment, and episodic treatment is a high priority for patients, family members, clinicians, and especially policy-makers who are concerned about affluent and effective distribution of scarce resources. This book will be a required text for the next generation of behavioral health care-givers. We are challenged by the authors to do a better job in caring for individual patients and families in the complex medical marketplace.—Steven S. Sharfstein, M.D., President and Chief Executive Officer, Sheppard Pratt Health System; Clinical Professor of Psychiatry, University of Maryland
This book is the next step in the discussion of clinical delivery systems—rich in theory and practical contributions, including charts, tables, and tool boxes.—Robert K. Schreter, M.D.
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