Wm. Thomas Summerfelt

Evaluating managed mental health services: The Fort Bragg experiment.

Introduction. Methods. Description of the Evaluation Sample. Access and the Intake and Assessment Process. The Treatment Process and Service Utilization. Mental Health Outcomes. Cost Outcomes. Implications and Conclusions. Index.

Long-term effects of a system of care on children and adolescents

This study evaluates an exemplary system of care designed to provide comprehensive mental health services to children and adolescents. It was believed that the system would lead to more improvement in the functioning and symptoms of clients compared to those receiving care as usual. The project employed a randomized experimental five-wave longitudinal design with 350 families. While access to care, type of care, and the amount of care were better in the system of care, there were no differences in clinical outcomes compared to care received outside the system. In addition, children who did not receive any services, regardless of experimental condition, improved at the same rate as treated children. Similar to the Fort Bragg results, the effects of systems of care are primarily limited to system-level outcomes but do not appear to affect individual outcomes such as functioning and symptomatology.

The Fort Bragg managed care experiment: Short term impact on psychopathology

Many concerns have been raised about mental health services for children and adolescents. These concerns have included not treating those in need and providing inappropriate services to those who are treated. The continuum of care philosophy purports to remedy these problems by offering a comprehensive and coordinated range of services emphasizing community-based treatment. Services in the continuum include alternatives to trditional restrictive forms of care such as hospitalization. The provision of more appropriate care is hypothesized to improve the clinical outcomes of children treated in a continuum of care. The Fort Bragg Evaluation compared quality, use, outcome, and cost of the continuum of care model to a more traditional, fragmented system of care. This paper presents the effects of a service delivery system on short term psychopathology outcomes.

The costs of mental health services under the Fort Bragg demonstration

This article examines the costs of treatment under the Fort Bragg Demonstration. It focuses on the direct costs of mental health services and suggests that expenditures on those services were much higher at the Demonstration. Increased access and greater “doses” of services provided at the Demonstration are identified as the proximal causes of the system-level cost difference. Consideration is given to whether these differences in costs and in service use can be attributed to the continuum of care per se or to differences in the financial arrangements under which care was provided. Supplemental analyses suggest that these expenditures were not offset by cost savings elsewhere. Implications for mental health policy are discussed.

The quality of services in a children's mental health managed care demonstration.

The Fort Bragg Demonstration and evaluation was designed to test the cost-effectiveness of a continuum of care model of service delivery for children and adolescents. A crucial aspect of the evaluation was the measurement of the quality of services provided in the Demonstration. Two key service components were examined: intake assessment and case management. It was concluded that these key components of the continuum of care were implemented with sufficient quality to have the theoretically predicted effects on mental health.

Mental health services utilization in a children's mental health managed care demonstration.

Service delivery under two systems of care—a traditional Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) reimbursement system and an innovative continuum of care—was examined along six dimensions: access, type, mix, volume, timing, and continuity of services received by children and adolescents. It was found that the Demonstration served over three times as many children as the Comparison. In addition to serving more children, the Demonstration also provided more and different types of services to each child treated. Finally, the Demonstration appears to have delivered services in a more timely fashion and made a considerable effort to match children’s and families’ needs with services.

Predicting level of care in mental health services under a continuum of care

Abstract In an effort to control the spiraling costs of mental health care, public and private sectors have moved rapidly toward managed mental health care. An important feature of many managed mental health care systems is the use of alternative or “intermediate” services in place of costly residential services. The introduction of these intermediate services affords clinicians a wider range of treatment options. Little is known, however, about the decision making process in assigning children to these services. Using data on an innovative system that made those services available, this article identifies predictors of intermediate service use. Multivariate analyses are based on different variants of logistic regression; the analysis illustrates the use of multinominal and nested logistic regression.