Evaluating Treatment Environments describes how to assess the quality of psychiatric and substance abuse programs and how to use that information to monitor and improve these programs. Its aim is to identify environments that promote opportunities for personal growth, simultaneously enhancing both physical and psychological well-being. Although treatment programs are diverse, Moos asserts that a common conceptual framework can be used to evaluate them, and more emphasis should be placed on the process of matching personal and program factors and on the connections between such matches and patients' outcomes. The book is divided into three main parts. Part I focuses on hospital programs, using a sample of 160 programs throughout the United States. Part II evaluates community programs. Moos describes how to monitor and improve these programs, and assesses program implementation. Part III considers treatment environments, examining factors that shape the treatment environment, patients' satisfaction with and participation in program activities, patients' adaptation and community living skills, and patient-program congruence and the influence of treatment environments on patients with different levels of impairment. It also highlights the importance of the health care workplace and its impact on staff and the treatment environment. Treatment programs vary substantially in their policies and services, especially in what they expect of clients, rules about clients' daily life choices, and to what extent clients must be governed by the program, and whether or not the programs provide health and treatment services. Comparison studies are becoming more important as clients move more quickly from acute in-patient to community residential care. Moos stresses the need to pay special attention to how programs and services affect clients when conducting evaluations. Evaluating Treatment Environments will be a necessary addition to the libraries of mental health service professionals, as well as sociologists, psychiatrists, psychologists, and social workers.

By 1994 the total cost of health care in the United States approached $900 billion annually. In reaction to this explosive growth, the managed care industry, acting as the agent and administrator for government and health care payers, has taken an increasingly aggressive stance on controlling costs with a view toward hospitalization as the last option for mental health treatment. This new emphasis on cost containment demands effective and less costly alternatives to hospitalization. Although most clinicians have grudgingly accepted the inevitability of both managed care and cost controls, the question remains: How can we develop a coherent mental health care system that controls costs while working effectively for both patients and clinicians? In Managing Care, Not Dollars, leading clinical experts argue that in order to survive, psychiatric institutions must offer a full range of services to large numbers of patients. Rather than concentrating on budget issues, clinicians and hospital administrators should use advances in treatment and technology to develop a coherent continuum of mental health care capable of delivering a wide variety of effective treatment options and alternatives to hospitalization. This guide to the creation and use of the emerging continuum of care provides an in-depth examination of the individual components of seven state-of-the-art treatment programs including suitable patients, treatment goals, staffing, physical plant, and special adaptations for children and the elderly. It also offers decision-making tools for managers to use to adapt their existing programs to survive in this new era and reviews the various public policy issues arising out of the health care transformation. By reading this book, clinicians, policymakers, and administrators can begin to grapple with the problem of learning to do more with less.

Managed care has produced dramatic changes in the treatment of mental health and substance abuse problems, known as behavioral health. Managing Managed Care offers an urgently needed assessment of managed care for behavioral health and a framework for purchasing, delivering, and ensuring the quality of behavioral health care. It presents the first objective analysis of the powerful multimillion-dollar accreditation industry and the key accrediting organizations. Managing Managed Care draws evidence-based conclusions about the effectiveness of behavioral health treatments and makes recommendations that address consumer protections, quality improvements, structure and financing, roles of public and private participants, inclusion of special populations, and ethical issues. The volume discusses trends in managed behavioral health care, highlighting the emerging role of the purchaser. The committee explores problems of overlap and fragmentation in the delivery of behavioral health care and discusses the issue of access, a special concern when private systems are restricted and public systems overburdened. Highly applicable to the larger health care system, this volume will be of particular interest to all stakeholders in behavioral healthâ€"federal and state policymakers, public and private purchasers, health care providers and administrators, consumers and consumer advocates, accrediting organizations, and health services researchers.

Approximately 4 million U.S. service members took part in the wars in Afghanistan and Iraq. Shortly after troops started returning from their deployments, some active-duty service members and veterans began experiencing mental health problems. Given the stressors associated with war, it is not surprising that some service members developed such mental health conditions as posttraumatic stress disorder, depression, and substance use disorder. Subsequent epidemiologic studies conducted on military and veteran populations that served in the operations in Afghanistan and Iraq provided scientific evidence that those who fought were in fact being diagnosed with mental illnesses and experiencing mental healthâ€"related outcomesâ€"in particular, suicideâ€"at a higher rate than the general population. This report provides a comprehensive assessment of the quality, capacity, and access to mental health care services for veterans who served in the Armed Forces in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn. It includes an analysis of not only the quality and capacity of mental health care services within the Department of Veterans Affairs, but also barriers faced by patients in utilizing those services.