Managed care and the rationalization of mental health services

Managed care represents a response to the wider institutional demand for technical rationality and efficiency, and it may be in conflict with professionally generated logics of mental health care which emphasize the delivery of quality care, as well as providing services to all who need care. The organizational and policy conundrum is to balance conflicting institutional demands for efficiency (cost savings) and effectiveness (access and quality). This paper examines managed care in one public sector mental health care system that has attempted to incorporate the principles of managed care into a community based system of care and to overcome the potential contradictions between demands for efficiency and professional logics of care. Both qualitative and quantitative data are used to examine changes in organizational structure and service offerings; providers' experience of managed care, and the effect of managed care on working conditions and work experiences, and changes in the goals of the organization as measured by the specification of client outcomes. I find that, while increased performance accountability and outcome assessment (in keeping with demands for efficiency) have the potential to improve mental health care services, in fact, providers report that the primary effect of managed care has been an emphasis on cost containment, and there has been a corresponding de-emphasis on the provision of community based services for clients with long term care needs. However, there is potential for professional logics to be maintained by larger institutional forces demanding quality care.     

Tasks in Acceptance: Mothers of Lesbian Daughters

Eleven mothers were interviewed to explore their processes of coming to accept their lesbian daughters’ sexual orientation. Qualitative research analysis yielded five domains: (1) What stayed the same after the daughter's coming out, (2) What changed after the daughter's coming out, (3) Ongoing tasks in the acceptance process, (4) Resources identified and utilized, and (5) Emotional struggles. The mothers’ ongoing tasks in acceptance were: respecting their daughters’ processes of coming to terms with their sexuality, not being concerned with other people's judgments, advocating for their daughters and the GLBT population, and regarding their daughters’ sexual orientation as only one part of them.     

The Unique Culture of Gullah/Geechee Families on the Southern Coast of the United States

The Gullah/Geechee people are a distinct group of African Americans that have been more successful in maintaining customs and traditions from Africa than any other subset of African Americans. This group's unique language is often the first characteristic that brings them to the attention of outsiders; however, upon closer look, their uniqueness is revealed in their art, folklore, music, religion, food, and overall culture. An exploration of the uniqueness of this subgroup of African Americans can provide valuable insight for social workers assisting clients from the Gullah/Geechee culture.     

Marital Quality,Gender, and Markers of Inflammation in the MIDUS Cohort

Marital quality is an important factor for understanding the relationship between marriage and health. Low‐quality relationships may not have the same health benefits as high‐quality relationships. To understand the association between marital quality and health, we examined associations between two indicators of marital quality (marital support and marital strain) and two biomarkers of inflammation (interleukin‐6 and C‐reactive protein) among men and women in long‐term marriages using data from the Survey of Midlife in the United States (N = 542). Lower levels of spousal support were associated with higher levels of inflammation among women but not men. Higher levels of spousal strain were weakly and inconsistently associated with higher levels of inflammation among women and men; the effects were diminished with the addition of psychosocial and behavioral covariates. These findings suggest marital quality is an important predictor of inflammation, especially among women.     

A statewide introduction of trauma-informed care in a child welfare system

Most children in the care of the child welfare system have been exposed to multiple traumas in addition to the stressor of being removed from their home. Because the risk for mental health problems following exposure to trauma is high, a critical need exists to introduce trauma-informed practices into the child welfare system. The purpose of this study is to evaluate initial stages of a trauma-informed training program for the Arkansas Division of Child and Family Services (DCFS). In Phase 1, 102 (75%) of DCFS area directors and supervisors participated in 10 regional, two-day workshops modeled after the National Child and Traumatic Stress Network (NCTSN) trauma-informed training for child welfare. Pre- and post-training evaluations demonstrated significant improvements in participants' knowledge of trauma-informed practices. A three-month follow-up with directors and supervisors indicated that use of trauma-informed practices increased significantly and that such changes were correlated with pre- versus post-training improvement in knowledge. Most participants were able to partially implement action steps established at the time of training; however, a number of barriers were cited as preventing full implementation, including time constraints, heavy caseloads, lack of staff, and limited resources. Results are discussed in light of plans under way for Phase II training for all DCFS front-line staff.     

DO MERGERS REALLY REDUCE COSTS? EVIDENCE FROM HOSPITALS

In this paper, we compare potential and realized cost savings from hospital mergers. Our approach isolates changes in realized cost savings due to different output mixes from systematic changes due to time and also provides a measure of the potential cost savings due to scale economies. Our findings suggest that economies of scale are present for merging hospitals and they realize these cost savings immediately following a merger. However, we also show that over time, cost savings from the merger decrease and the proportion of hospitals experiencing positive cost savings declines.     

Trends in Late-Life Activity Limitations in the United States: An Update From Five National Surveys

This article updates trends from five national U.S. surveys to determine whether the prevalence of activity limitations among the older population continued to decline in the first decade of the twenty-first century. Findings across studies suggest that personal care and domestic activity limitations may have continued to decline for those ages 85 and older from 2000 to 2008, but generally were flat since 2000 for those ages 65–84. Modest increases were observed for the 55- to 64-year-old group approaching late life, although prevalence remained low for this age group. Inclusion of the institutional population is important for assessing trends among those ages 85 and older in particular.     

Schnable A.: Amateurs Without Borders: The Aspirations and Limits of Global Compassion

VOLUNTAS: International Journal of Voluntary and Nonprofit Organizations -