Index
A
Access to care
barriers to, 169-171
for children and adolescents, 152-153, 154
concerns about managed care, 168-169, 316-317
cultural competency as factor in, 174
definition, 171
gender differences, 175
measures of, 4-5, 142, 171-174, 175, 178-180
need for care and, 174-175, 178
negative effects of limiting, 170
as quality assessment component, 168
racial/ethnic considerations in, 175-176, 248
for special populations, 249
universal coverage and, 171
wraparound services, 136-138
Accountability
consensus on quality for, 199
employer coalitions for, 191
in evolution of behavioral health care, 189-190
for outcomes, 237-238
in primary care, 87
public reporting systems for, 198
quality of care and, 184-186
through credentialing and privileging, 187
Accreditation
and clinical practice guidelines, 252-253
cost issues, 214-215
effect on quality of care, 54, 186
findings, 243-244
goal of, 203
government role in, 218-219, 246
of Indian Health Service health centers, 158
for monitoring contracts, 7-8
for monitoring quality of care, 6, 186
organizations for, 32, 204, 214.
See also Accreditation organizations
process, 215-216
quality improvement program requirements, 64
recommendations for, 6-9, 244-247
requirements for, 214
scope of, 186
See also Certification and licensure
Accreditation organizations
Council on Accreditation of Services for Families and Children, 23, 204-205
Joint Commission on Accreditation of Healthcare Organizations, 32, 158, 204, 218
National Committee for Quality Assurance, 190-191, 202, 205-213
Rehabilitation Accreditation Commission, 32, 204
Utilization Review Accreditation Committee, 32, 213-214
Adverse selection, 51-52
Advocacy, consumer, 23-24
Affective disorders, 77
risk among children, 153
Agency for Health Care Policy and Research
activities, 203
recommendations for, 9, 11, 12, 14, 247, 250, 253, 254
Alcohol abuse/dependence, 77
co-occurring disorders, 176-177
disease model, 106
drunk driving, 112
evolution of treatment system, 104-107
measures of local prevalence, 178
mortality, 157
suicide and, 78
treatment effectiveness, 84
trends in insurance coverage, 90-91
See also Substance abuse
Alcohol, Drug Abuse, and Mental Health Administration, 107, 111.
See also Substance Abuse and Mental Health Services Administration
Alcoholics Anonymous, 105, 114, 293
Alternative/innovative healing practices, 10, 248
American Managed Behavioral Healthcare Association, 141-142, 174
quality standards, 190-191
Anxiety disorders, 77, 177, 191
Auditing activities, 187-188, 245
B
Behavioral health problems among seniors, 156
co-occurring, 176-177
cost of care trends, 141
historical development of treatment system, 96, 103
negative effects of restricted access, 170
prevalence and incidence, 1, 15, 77
public perception/understanding, 20-21, 23-24, 170
risk among children, 153
service needs, 80-84
social stigma, 170
suicide and, 78
terminology, 22
underdiagnosed/underestimated, 3, 76, 78-80, 170
utilization patterns, 28
Benefits consulting, 31-32
C
Capitated payments
as barrier to access, 168, 169
definition, 46
in Medicaid, 47
prevalence, 46
role of, 46
soft, 48
Case management, 49
Center for Mental Health Services, 201-202, 247
Center for Substance Abuse Prevention, 201
Center for Substance Abuse Treatment, 85, 112-113, 201
Centers for Disease Control and Prevention, 11, 250
Certification and licensure
credentialing and privileging, 123, 187
peer review for, 186
quality of care issues, 57-58
state activities, 54-56, 186-187
for substance abuse counselors, 58-59, 294-295
substance abuse treatment, 57-58
transition of public services into managed care, 59
types of practitioners, 123
Child abuse, 153
Child and Adolescent Service System Program, 154
Children and adolescents
adolescent treatment issues, 155
findings, 251-252
health screening, 153
with impaired parents, 152-153
mental health care trends, 141
military health services for, 149-150, 151
prevalence of behavioral health problems, 77
principles of care for, 154
program financing, 153-154
recommendations regarding, 11-12, 252
risk for abuse, 153
risk for mental health problems, 153
school-based intervention, 153
service needs, 152-153
Civilian Health and Medical Program of the Uniformed Services, 148, 149-150, 151, 152, 189
Clinical outcomes information system, 230, 233
Clinical practice
alternative/innovative techniques, 10, 248
coverage design/limitations and, 26
credentialing and privileging, 123, 187
cultural competence in, 159-162
duration of treatment, 319-320
effectiveness of, 84-85
findings, 252-253
focus of outcomes research, 84
in managed behavioral health care, 318-320
peer review, 186
prescription patterns, 320
recommendations for, 12-13, 253
standardization, 26-27
state licensure and effectiveness of, 57-58
structural measures of quality, 122
substance abuse counselors, 26, 58-59, 123, 294-295
terminology, 22
types and characteristics of practitioners, 25-26, 123
use of hospitals, 319
Clinical practice guidelines
as accreditation issue, 252-253
current extent of use, 60
current limitations, 252
outcomes research and, 235
potential effects, 60-61
Community Mental Health Centers Act of 1963, 103, 104
Comprehensive Alcohol Abuse and Alcoholism Prevention,Treatment, and Rehabilitation Act.
See Hughes Act
Comprehensive Drug Abuse Prevention and Control Act of 1970, 110
Confidentiality, 35
in carve-outs, 88
concerns, 67-68
in substance abuse treatment, 68
Consultants
health benefits, 188
for regulatory compliance, 144-145
See also Benefits consulting
Consumer protection, 2
confidentiality rights, 67-68
government role in, 8-9, 219, 245-246
in managed care system, 241
meaning of, 21
patient autonomy, 69
recommendations for, 8-10, 245-246, 248
strategies, 241-242
structural/process models, 219
Consumers and families
advocacy efforts by, 23-24
diversity, 25
involvement in health care system, 247-248
Consumer satisfaction
as measure of quality, 189, 245
media dissemination of findings, 189
Continuity of care/coverage, 6, 93, 245
Contracts/contracting
public sector-managed care, 48-49
quality assessment provisions, 29
quality of care and, 66
scope of coverage, 66-67
soft capitation, 48
Cost of care
adverse selection effects, 51-52
behavioral health problems, 77-78, 80
behavioral health trends, 141
concerns about quality of care, 16-17, 312
financing of child and adolescent programs, 153-154
indirect costs, 80-84
integration of service systems for, 146
managed care containment strategies, 42-45, 168
preventive interventions in workplace to reduce, 147
regional disparities, 176
spending trends, 28
substance abuse treatment expenditures, 28, 135
for substance-abusing criminal offenders, 113-114
Council on Accreditation of Services for Families and Children, 32, 204-205
Coverage design/limitations
adverse selection effects, 51
benefits consultants, 31-32
competition for enrollees, 45-46
current status, 91
effect on quality of care, 54
employer-sponsored plans, 94, 184-185
historical limitations on mental health services, 313-314
Medicaid, 128-129
Medicare, 130-131
private sector trends, 93-95
purchaser influence, 28-29
to restrict access, 169-170
substance abuse counseling, 26
treatment planning and, 26
universal coverage, 171
Criminal justice system
alcoholism intervention, historical development of, 105-106
cost of behavioral health problems, 78
drug abuse intervention, historical development of, 107-109, 112
implications of limiting access to care, 170
managed care contracts, 114
public addiction treatment system and, 112
substance abuse by criminals, 112-113, 114
substance abuse treatment in, 113-114
Cultural competence
as ethical issue, 254
findings, 248
meaning of, 159
military health services, 150
models for practice, 160
need for, 159
resource networks, 162
threshold issues, 160-161
D
Data collection and management
admissions/discharge forms, 236
clinical outcomes information system, 230
confidentiality issues, 67-68
Mental Health Statistics Improvement Program, 201-202
for outcomes measurement, 233, 236-237
private sector quality standards, 191-199
public sector performance standards, 199-200
for quality improvement, 64
for quality measurement, 217-218
for report cards, 66
research priorities, 331
shortcomings of, 217-218
Defense, Department of, 4, 189
historical development of mental health care, 148-149
managed care services in, 151-152
TriCare program, 151-152
See also Military programs
Deinstitutionalization, 103
Delivery system
alcoholism intervention, historical development of, 104-107
behavioral health disability management plans, 145
in criminal justice system, 113-114
current functioning, 76-77
drug abuse intervention, historical development of, 107-111
employee assistance programs, 114-115
fragmented nature of, 76-77, 80, 96, 153-154, 163
historical development, 96, 103-111
Indian Health Service, 157-159
integration of public-private services, 49, 59, 115-116
managed care, 29-31
military managed care programs, 151-152
organizational interactions, 4
primary care in, 87-89
for rural areas, 162-163
service sector boundaries, 91-93
for special populations, 10
state level, 95-96
structural measures of quality, 122
wraparound services, 138-139
Demand management, 147
Depression/depressive disorders
among seniors, 156
primary care treatment, 87, 89
Disability
access to care, 249
behavioral, management of, 145
Medicare coverage, 130
substance abuse-related, 25
Drug Abuse Office and Treatment Act of 1972, 110
Drug Abuse Prevention, Treatment, and Rehabilitation Act, 68
E
Employee assistance programs, 114-115, 143-144, 146
Employee Retirement Income Security Act of 1974, 90-91
Employer-sponsored health plans
behavioral health disability management, 145
control of competition in, 45-46
coverage design, 94
current status, 27-28
employer coalitions for quality accountability, 191
enrollment patterns, 46, 93-94
historical development, 184-185
mechanisms to restrict access in, 169-170
as purchasers of behavioral health care, 190-191
See also Workplace service systems
Enabling services.
See Wraparound services
Enrollment patterns
behavioral health care, 20-21
employee assistance programs, 115
employer-sponsored plans, 46, 93-94
health maintenance organizations, 31
indemnity insurance, 46
insured population, 28
managed behavioral health care, 1, 15, 45, 313
managed care, 1, 15, 31, 41-42
market influences, 45-46
Medicare, 129, 131, 156-157, 202
private insurance, 31
substance abuse programs, 134-135
Ethical concerns, 71
confidentiality, 67-68
findings, 254
patient autonomy, 69
recommendations for, 13-14, 254
therapeutic relationship, 69-70
F
Families
with impaired parents, 152-153
military programs for, 149, 150
as substance abuse rehabilitation outcome factor, 290
Federal government
confidentiality regulations for substance abuse treatment, 68
consumer advocacy for behavioral health care, 24
consumer protection role for, 8, 9, 219, 245-246
current regulation of managed behavioral health care, 89-90
funding for substance abuse treatment, 135
historical development of alcoholism treatment, 104-107
historical development of delivery system, 96, 103, 104, 148
historical development of drug abuse treatment, 107-111
parity legislation, 24, 170-171, 314
recommendations for, 8, 9, 245-246
regulatory compliance by employers, consultants for, 144-145
research role, 249
role in quality assurance, 218-219
state level implementation, 95, 96
Foundation for Accountability, 191-198
G
Gender differences, 175
H
Harrison Narcotic Act, 107-108
Health Care Financing Administration, 29, 128
auditing activities, 187-188
quality management activities, 202
responsibilities and authorities, 202
Health maintenance organizations
accreditation requirements, 214
behavioral health care in, 45, 314
characteristics, 42
current regulation, 89-90
enrollment trends, 31
staff model, 45
Health Plan Employer Data and Information Set, 171-174, 198, 202, 217
Health Resources and Services Administration, 9, 11, 12, 247, 250, 252
Healthy People 2000, 200-201
Homeless mentally ill, 103
Housing, 83
Hughes Act, 57, 68, 106-107, 114-115
I
Indemnity insurance
enrollment trends, 46
in managed care system, 31
reimbursement system, 41
Independent practice associations, 42
Indian Health Service, 157-159
Infant mortality, 157
Institute for Behavioral Healthcare, 142
J
Job training, 83
Joint Commission on Accreditation of Healthcare Organizations, 32, 158, 204, 218
K
Kassebaum-Kennedy bill, 24, 170-171
L
Legal issues, 188
Length of stay, 319-320
M
Managed behavioral health care
adverse selection, 51
barriers to effective primary care, 88-89
choice of practitioner in, 315-316
clinical practice in, 318-320
competition, 50
conceptual approach to, 33-35
concerns about access, 169, 316-317
concerns about quality, 17, 47-48, 241, 312, 321
cultural competence issues, 160-161
current coverage, 91
current regulatory environment, 89-90
demands for quality, 53
effectiveness of, 50, 241, 242
employee assistance programs integrated with, 144, 146
ethical issues, 71
goals, 47
health promotion programs, 56-57, 146-147
historical growth, 31, 45, 314
integration of public-private services, 49-50, 59, 115-116
mechanisms to restrict access in, 169-170
in military health services, 151-152
See moral hazard. Adverse selection
outcomes of care, 321-324
performance measurement, 141-142
population needs assessment, 174-175
practitioner resistance to, 27
principal issues, 19-20
quality improvement programs, 65
quality monitoring mechanisms, 41, 45
quality standards in private sector, 191-199
research priorities, 325-330
service sector boundaries, 91-93
skimming, 53
spending, 141
treatment planning in, 26
treatment trends, 15-16
Managed care
accreditation, 186
challenges to confidentiality, 67-68
concerns about access, 168-169
consumer concerns, 24
cost management strategies, 42-45, 168
enrollment trends, 15, 28, 31, 41-42
evolution of structure, 42
financial incentives in, 46
in Indian Health Service programs, 158-159
industry stakeholders, 31-32
influence on health care system, 40, 90-91
insurance industry in, 31
measuring local needs and access, 178-179
outcome studies, 229
patient autonomy and, 69
quality of care concerns, 16-17, 312
in rural areas, 162-163
structure and operations, 29-31, 41-45
terminology, 21
therapeutic relationship in, 69-70
See also Managed behavioral health care
administrative structure, 129, 202
auditing activities, 188
capitated payment system in, 47
child health screening, 153
cost containment in, 129
enrollment trends, 129
funding, 128
managed behavioral health care in, 94
managed care enrollment, 45, 128, 129, 202, 314
mental health care expenditures, 129
performance assessment, 130
recipients, 128
spending trends, 129
structure and operations, 128
in system of behavioral health care, 80, 104
auditing activities, 188
benefit design, 130-131
costs, 131
disabled population, 130
enrollment, 31, 129, 131, 156-157, 202
managed care plans, 31, 129, 131, 202
mental health care provisions, 131
performance assessment, 130
quality improvement program, 64
Mental Health Statistics Improvement Program, 201-202
Military programs
child and adolescent services, 149-150, 151
coordination of treatment in, 149
cultural competence, 150
family services, 149
historical development, 148-149
older adult services, 150
services for chronic relapsing conditions, 150
See also Defense, Department of ;
Veterans Affairs, Department of
N
Narcotic Addict Rehabilitation Act of 1966, 109
Narcotics Anonymous, 293
National Alliance for the Mentally Ill, 246
National Association for Research on Schizophrenia and Depression , 246
National Committee for Quality Assurance, 190-191, 202, 205-213
National Depressive and Manic Depressive Association, 246
National Drug and Alcohol Treatment Utilization Survey, 131-133, 134
National Institute of Mental Health alcohol abuse research, 106, 111
Community Support Program, 103-104
historical development, 103
recommendations for, 9, 11, 247, 250, 252
National Institute on Alcohol Abuse and Alcoholism, 106, 114-115
National Institute on Drug Abuse, 110-111, 250, 252
National Institutes of Health, 9, 11, 12, 247, 250, 252
National Mental Health Association, 246
O
Obsessive-compulsive disorder, 177
Older adults/senior citizens coordination of services for, 156
as health care consumers, 156-157
health perceptions of, 156
military health services for, 150
risk for chronic conditions, 156
risk for mental health problems, 156
substance abuse patterns, 177
Opiate addiction/detoxification, 277, 278
Outcomes measurement/research accountability for findings, 237- 238
analytical framework for, 231-232
clinical outcomes information system, 230
clinical practice guidelines and, 235
criteria for evaluating, 235-236
effect on quality of care, 54
efficacy/effectiveness assessments, 234
employee assistance program performance, 143-144
general measures, 230-232
indicators of access, 173-174
limitations of, 5, 84, 85, 233-234, 238-239, 249
long-term and short-term objectives, 228-229
in managed behavioral health care, 321-323
managed care research, 142, 229
as measure of quality, 3, 61, 198
multidimensional context, 226, 228
new approaches, 229-230
performance indicators for, 233
population-based, 327
practitioner characteristics, 123
process variables, 232
prospects for, 237-238
public dissemination of findings, 237
public expectations for treatment and, 227-228
quality improvement and, 234-235
quality indicators, 272-274
significance of, 5-6, 226, 232, 239, 324-325
stakeholder perspective as factor in, 20
standardized instruments for, 230, 236
structural variables, 232
substance abuse findings, 271-272
substance abuse rehabilitation indicators, 282-287
substance abuse treatment, 84-85
substance abuse treatment quality indicators, 272-273, 299-304
treatment effectiveness, current understanding of, 84-85
treatment goals and, 226-227
treatment setting as variable, 230
P
Peer review, 186
Performance-Based Measures for Managed Behavioral Healthcare, 174, 217
Pharmacotherapy
prescription patterns in managed care, 320
prospects, 85
for substance abuse rehabilitation, 281-282, 295-297
Physician-patient relationship, 69-70
cultural resource networks, 162
Planning Systems Development Program, 154
Point-of-service plans, 15, 42, 44
Preferred provider organizations, 15, 42, 43
President's Commission on Mental Health, 101
Preventive intervention(s), 56-57
with children in schools, 153
cultural competence in, 160
demand management as, 147
educational, in workplace, 147
health promotion plans, 56-57, 146-147
opportunities in workplace, 142-143
Primary care
barriers to behavioral health assessment, 88, 170
child/adolescent behavioral problems in, 153
definition, 87
in delivery of behavioral health care, 3, 76, 87
diagnostic accuracy in, 87
findings, 253
in integration of services, 87, 116
practitioners, 25
quality assurance in, 89
quality of behavioral health care in, 76
utilization, 87
vs. managed care carve-outs, 88
Private systems of care accountability, 184-186
alcoholism intervention, historical development of, 105
coverage trends, 93-95
in delivery of behavioral health care, 3, 4
drug abuse intervention, historical development of, 109
employee assistance programs, historical development of, 115
health benefits consultants, 188
measures of quality in, 5, 184, 190-191
public sector services and, 91-93
quality standards, 191-199
strengths and limitations of, 94
Process measures of quality, 3, 5, 61
as outcome variables, 232
Provider inclusion
determinants of, 317-318
managed care practice, 46, 168
recommendations for, 9, 246-247
Public Health Service, 200-201
Public perception/understanding of behavioral health care, 20-21, 23-24
as factor in outcomes measurement, 227-228
of mental illness, 170
Public services
characteristics of substance abuse treatment programs, 133-134
for children and adolescents, 153-154
concerns with managed care contracts for, 47-48, 49-50
contracting with managed care organizations for, 47-49, 67, 94
criminal justice system and, 112
eligibility criteria for mental health services, 169
funding for, 76, 80, 111, 122, 242-243
historical development of alcoholism treatment, 104-107
historical development of delivery system, 96, 103-104
historical development of drug abuse intervention, 107-111
integration with private services, 49, 59, 115-116
measures of quality in, 5, 184
mental health care expenditures, 80
mental health treatment system, 135-136
performance measurement for, 199-200
private sector insurance boundaries, 91-93
state-federal relationship, 95, 96
substance abuse screening, 56-57
substance abuse treatment program funding, 135
in system of behavioral health care, 3, 4, 76, 80, 91
wraparound services, 138-139
Purchasers, group
adverse selection effects, 51-52
assessments of access by, 179-180
competition for enrollees, 45-46
employer coalitions, 191
influence of, 28-29
potential for savings, 48
price sensitivity, 51-52
purchasing alliances, 28
quality of care as issue for, 53
state governments as, 47
See also Employer-sponsored plans
Q
Quality assessment
access to care as measure for, 168
consensus on measurement of, 199
consumer involvement in, 9-10, 17-18, 189, 219, 248
contract provisions, 29
by corporate purchasers, 190-191
in Department of Defense TriCare program, 152
of employee assistance programs, 143-144
goals of, 199
historical development in behavioral health care, 189-190
information infrastructure for, 217-218
managed care industry activities, 32-33, 141-142
managed care monitoring mechanisms, 41, 45
Medicaid, 130
Medicare, 131
methods, 186-187
participants, 6
private sector quality standards, 191-199
in public sector, 199, 202, 203
stakeholder perspective as factor in, 19-20, 21, 184
Quality assurance, 61
good program qualities, 223
government role, 218-219
limitations of, 62
in primary care, 89
Quality control, 61
Quality improvement, 72
applications in behavioral health care, 65
applications in health care, 64-65
goals, 53
outcome measurement and, 234-235
principles of, 62-64
role of, 35
tools for, 64
Quality indicators
definition, 272
good qualities of, 273-274
for substance abuse detoxification, 278-279
for substance abuse rehabilitation, 287-298
for substance abuse treatment, 272-273, 299-304
Quality of care
accountability and, 184-186
competition and, 95
components, 35-36
concerns about managed care, 16-17, 47-48, 312, 321
consumer advocacy for, 24-25
contracting and, 66-67
definition, 17
determinants of, 21
goals, 33
legal considerations, 188
management trends, 189-190
market forces, 53
measurement approaches, 2-3, 5, 17-18
in primary care settings, 76
purchaser standards, 28-29
recommendations for monitoring, 7, 244-245
responsibility for, 54
role of accreditation systems, 6
system determinants, 54
treatment setting as variable in, 87
R
Race/ethnicity
patterns of substance abuse, 175-178
See also Cultural competence
Reagan administration, 103-104
Rehabilitation Accreditation Commission, 32, 204
Rehabilitation medicine, 83
goals for substance abuse, 279-282
outcome indicators for substance abuse rehabilitation, 282-287
quality indicators for substance abuse rehabilitation, 287-298
Report cards
market demands, 198
public sector initiatives, 201-202
role of, 66
standardization of, 66
Research
child and adolescent interventions, 155
choice of provider, 329
current status, 249
population-based outcomes, 327
priorities, 325-330
problem recognition, 328
recommendations for, 10-11, 250
strategies for, 331-333
structure of managed care, 327-328
targeting high-risk patients, 330
on treatment strategy, 329-330
See also Outcomes measurement/research
Risk sharing, 50
S
Screening policies
for adults, 56-57
for children, 153
Skimming, 53
Social Security Disability Income, 25
Special Action Office for Drug Abuse Prevention, 110
Special populations
cultural competence issues, 159-162
findings, 249
goals for, 35
recommendations regarding, 10, 249
rural services, 162-163
See also Children and adolescents
State government
alcoholism treatment requirements, 90
certification and licensure activities, 54-56, 186-187
current regulation of managed behavioral health care, 89-90
funding for mental health treatment, 136
funding for substance abuse treatment, 135
historical development of alcoholism treatment, 106-107
historical development of behavioral health care, 104
historical development of drug abuse treatment, 110, 111
integration of public-private services, 116
Medicaid administration, 128, 129
as purchaser of managed care services, 47
role in quality assurance, 218-219
shortcomings of behavioral health care delivery, 96
structure of delivery system, 95
substance abuse treatment regulation, 57-58
support for purchasing alliances, 28
Structure of behavioral health care system
access to care as component of, 168
accreditation review, 214
for child and adolescent services, 153-154
findings, 242-243
fragmented nature of, 163
as measure of quality, 3, 61, 122
mental health treatment, 135-136
organizational linkages, 3, 76-77
as outcome variable, 232
research needs, 327-328
in rural areas, 162-163
substance abuse service systems, 131-135
workplace services, 142-148
wraparound services, 136-139
See also Delivery system
Substance abuse
among children and adolescents, 77, 177
co-occurring mental health problems, 176-177
criminal behavior and, 112-113
gender differences, 175
measures of local prevalence, 178-179
by older adults, 177
parental, 152-153
racial/ethnic differences in, 175-178
research needs, 304
risk among children, 153
screening policies, 56-57
social costs, 77-78
See also Alcohol abuse/dependence ;
Substance abuse treatment
Substance Abuse and Mental Health Services Administration, 18, 134-136
managed care initiatives, 201
Mental Health Statistics Improvement Program, 201-202
quality standards, 188, 190-191
recommendations for, 9, 10, 11, 12, 14, 247, 249, 250, 252, 253, 254
Substance abuse treatment
client characteristics, 134-135
confidentiality regulations for, 68
counselor practitioners, 26, 58-59, 123, 294-295
coverage patterns, 169
credentialing of practitioners, 123
detoxification and stabilization, 274-279
disparities in delivery, 176
effectiveness of managed care programs, 50
effectiveness research, 84
employee assistance programs, 114-115
employment-related outcome factors, 289-290
family-related outcome factors, 290
future prospects for, 85
goals, 227
historical development of system, 96, 103, 107-111
long-term and short-term goals, 228-229
military service system, 149
outcomes research findings, 271-272
patient-related outcome factors, 285, 288-289
pharmacotherapy, 281-282, 295-297
program enrollment, 134-135
program funding, 135
psychiatric problems as outcome factor, 286-287
public sector managed care initiatives, 201
quality indicators, 272-273, 299-304
rehabilitation goals, 279-282
rehabilitation outcome indicators, 282-287
rehabilitation quality indicators, 287-298
severity of abuse as outcome factor, 285-286
state regulation of, 57-58
treatment-related outcome factors, 290-298
types and characteristics of practitioners, 123
types and characteristics of service systems, 131-135
wraparound services, 138-139, 251
See also Alcohol abuse/dependence
Suicide
among seniors, 156
behavioral health problems and, 78
prevention among adolescents, 252
Supplemental Security Income, 25
Synanon, 109
U
Uniform Alcoholism and Intoxication Treatment Act, 57, 107
Uninsured individuals, 92-93
Universal coverage, 171
Utilization
estimates of, 28
gender differences, 175
measurement of, for quality assessment, 217
primary care, 87
substance abuse treatment, 133
Utilization effect, 50-51
Utilization management
effectiveness of, 190
as mechanism to restrict access, 169-170
role of, 46
tools of, 46
Utilization Review Accreditation Commission, 32, 213-214
V
Veterans Affairs, Department of, 4
historical development of mental health care, 148-149
managed care services in, 151
services for chronic relapsing conditions, 150
See also Military programs
W
Workplace service systems, 4
behavioral health disability management, 145
consultants for regulatory compliance, 144-145
demand management, 147
findings, 250
health promotion plans, 146-147
health training and education, 147
significance of, 142-143, 147-148
special needs of, 145
See also Employee assistance programs;
Employer-sponsored health plans
Wraparound services
findings, 251
funding, 138-139
historical development, 136-138
recommendations for, 11-12, 245, 251
types and characteristics of, 138-139