Behavioral Managed Care - 20 Insider Tips

May 3, 4, 5 2006, Interface Consultation Services very own Kathlene B. LaCour will be providing day long seminars at three locations in Pennsylvania and New Jersey through PESI. Come and join us! There's still time to sign up and learn some of the inside scoop on how to get what you need for your clients and increase your credibility with managed care organizations.

The Stigma of Mental Illness

Many people suffering from mental illness feel that society does not want them or understand them. As mental health professionals, we are here to educate families and society about mental illess.

At some point in our lives most people are touched by mental illness with a family member, friend or even ourselves.

May is Mental Health Awareness Month! Spread the news of healing and support for those suffering from mental illness.

Continuity of Care

There are research findings that indicate that adequate Continuity of Care is related to better symptom control and decreased length of hospitalization and evidence suggests that it may be associated with improved mental health, functioning, and quality of life, as well as better medication compliance and decreased emergency room visits and rehospitalizations. Continuity of Care means different things for different people but we are speaking hear about the continuity of working with an individual agency and an individual service provider.

The relationship between the provider and the patient or client provides an increased understanding and trust of each other. Providers say things like, “I know that he has not been taking his medications, he has had a run in with his mother and he is starting to decompensate when he starts talking about religion. It’s a trigger for me to ask him about these things. He doesn’t usually bring them up on his own.” Other providers report that some of their clients seem really sick to others but they are functioning adequately at their baseline with continued symptoms of hallucinations or delusions without interference in there baseline level of functioning.

So, what is the value of Continuity of Care? It appears that for clients diagnosed with severe and persistent mental illness, children diagnosed with severe emotional disturbance and their families and most people seeking mental health care, benefit significantly from having an individual who consistently provides their care and knows them and their symptoms. We have found our experience in alignment with the research in this area. When clients are seen by service providers other than those with whom they have a relationship for crisis or other services this can cause fragmentation in the client’s services, increased insecurity in the patient and service provider. The bottom line, whenever possible continuity of care provides better treatment for our clients!

Alzheimers Disease & Dementia

According to an article by the Alzheimer’s Association titled, Think About Future, Maintain Your Brain Today our brain health is as important as our physical health. When people think about staying fit, they generally think from the neck down. But the health of your brain plays a critical role in almost everything you do: thinking, feeling, remembering, working, and playing – even sleeping.

The good news is that we now know there’s a lot you can do to help keep your brain healthier as you age. These steps might also reduce your risk of Alzheimer’s disease or other dementia.
Simple lifestyle modifications also would have an enormous impact on our nation's public health and the cost of healthcare. If you make brain-healthy lifestyle changes and take action by getting involved, we could realize a future without Alzheimer's disease.

1. Stay mentally active


2. Remain socially involved


3. Stay physically active


4. Adopt a brain-healthy diet

Alzheimer’s disease is the most common form of dementia – brain disorders that affect your ability to function effectively in daily living. Well-established risk factors for Alzheimer’s disease are genetics and aging (10 percent of those over age 65 and 50 percent of those over 85 have Alzheimer’s). Unfortunately, aging and genetics are two risk factors you can’t control.

For more details on Alzheimer’s Disease, visit www.alz.org/overview.asp

To Err is Human

None of us are perfect, though many strive for this lofty goal. Making “mistakes” is a normal part of human behavior, it is the crux of learning for most yet for others it is the bane of their existence. Perfectionist individuals tend to constantly assess their performance, measuring their outcomes by some internalized, rigid standards of right and wrong, best and worst, success and failure, etc. Recent clinical findings suggest there is an area of the human brain where neurologists have isolated processes related to mistake-making. "We have been interested in how the brain processes error," explained lead author Dr. Stephan Taylor, an associate professor of psychiatry at the University of Michigan, Ann Arbor. Reporting in the April 12 issue of the Journal of Neuroscience, his team found that an area of the brain called the rostral anterior cingulate cortex (rACC) becomes very active when people realize they've made a mistake that carries negative consequences -- for example, losing money.

Depressive and obsessive-compulsive disordered individuals are of particular interest in this research. An evidence-based practice, such as Cognitive Behavioral Therapy, is hypothesized to modify a persons preoccupations and perfectionistic thought processes, hence changing how the brain reacts to or processes this information. For more information regarding this study, link to Brain 'Oops' Center

ADHD Patch

The FDA has recently approved the first patch called Daytrana to treat ADHD. This patch contains the stimulant methylphenidate (the same active ingredient in Ritalin) and is designed to be worn for 9 hours. The FDA recommends it's use only when taking the oral medication by mouth has been a hardship.

Nearly 3.3 million Americans age 19 and younger used an ADHD drug last year, according to Medco Health Solutions Inc., a prescription drug benefit program manager.

A panel of outside experts recently recommended to the FDA that the drugs bear labels that caution users in plain language about possible dangers, including stroke and hallucinations. Earlier, another FDA panel recommended that the medicines include so-called "black-box" warnings. That is the strongest warning a prescription drug can bear.

Teens, Epilepsy & Depression

As we have previously written, the area of medical illness and associated mental health disorders is an emerging and important issue. Not unlike substance abuse and mental illness and their respective practices, the medical and the mental health communities are increasingly cognizant that co-occurring disorders in their areas may be more the norm than the exception. In particular, recent clinical findings suggest that adolescents with epilepsy may suffer higher rates of depression. This is just one of many medical/mental health concerns that is gaining professional and public attention.

Recent clinical study results in the Journal of Neurology (March 2006) indicate that up to 60 percent of all teens with epilepsy will experience depression or another psychiatric illness. What's worse, only about 33 percent of those teens will receive treatment, according to the study. That lack of treatment may put teens with epilepsy at a higher risk for suicide as well. The study reported that up to 30 percent of people with epilepsy had attempted suicide, compared to about 7 percent of people without the disorder. According to the Neurology report, it has been known for some time that teens with chronic illnesses are more likely to suffer from depression. However, the association between teens with epilepsy and depression appears to be even stronger.

The bottom line is that parents and medical professionals increased awareness of depression and an increased risk of suicide are common among teens with epilepsy is paramount. For more on this topic, go to Teens, Epilepsy & Depression

The Importance of Differential Diagnosis - ADHD

A Differential Diagnosis is a determination of what problem a person has in contrast to all the other possible problems that might produce similar symptoms.

As mental health clinicians and professionals our training and clinical judgment provides with the ability to understand and access for differential diagnosis. Any clinician or lay person can read the symptom check lists in the DSM-IV (Diagnostic and Statistical Manual for Mental Disorders) and on websites listing these symptoms. Often people will do this and figure this that they have the diagnosis or another diagnosis they are reading about “self diagnosis”. But the key to completing a thorough assessment is not only knowing specific criteria for these disorders but also ruling out other possible reasons or diagnosis that has similar symptoms.

For example, ADHD for the past decade or more has become known to the general population and school personnel thorough education and media coverage of this childhood disruptive disorder. The diagnostic criteria include symptoms related to inattention and hyperactivitimpulsivelyty such as talking excessively, not listening when spoken to directly, etc. A thorough clinician would what to rule out any possible medical/neurological diagnosis such as a seizure disorder, lead poisoning, tic disorder, medication side effects for example, antihistamines, and fetal alcohol syndrome. Clinicians would want to rule out other mental disorders such as developmental disabilities, pervasive developmental disorders such as autism, anxiety, other disruptive disorders such as oppositional defiant disorder, conduct disorder, mood disorders (depression and bipolar - childhood symptoms can include, irritability, poor concentration, inattention, etc) as well as adjustment disorders. Children who have had multiple stressors and environmental stressors in their lives may exhibit symptoms that appear similar to the diagnostic criteria for ADHD. An accurate diagnosis means digging deeper than reading the symptom checklist.

Massachusetts - Health Care for All!

Earlier this week, Massachusetts made a bold move to sign a bill that would provide health care for everyone within the state. There is much being said about the this plan - naysaying, backslapping and feelings of relief. The bill appears very complicated with a mixture of both public and commercial entities coming together to ensure everyone is covered under a health benefit. This mixing has been happening for years and continues with fire frequency. The "big flip" that continues from public health care insurances being managed by commercial insurance carriers. i.e. Medicaid Managed Care programs and Medicare Managed Care programs all being provided by commercial insurance carriers, United Healthcare (Behavioral Health in our field), Mallegan, Humana, Cigna and many many more. While I agree that reform of this system means that not only is everyone covered but that the coverage has some oversight into what a medically necessary service would be for a specific patient. For example, performing an MMPI (personality testing on every client that is seen at a clinic) is would not be necessary yet this has been a practice in the past of some clinics. I am concerned with the complication and fragmentation of the bill. As we have seen with Medicare Part D with 30 + insurance plans per state our providers, elders and disabled population are overwhelmed being lost in the confusion of multiple plans. If you are having difficulty navigating Behavioral Managed Care Systems PESI is providing a seminar to assist clinicians with tips to getting what their patients need.

I tip my hat to Massachusetts for being willing to take a step towards Universal Health Care and try and make it work. The consensus I have heard from others and that I agree with is this feeling of hope right or wrong towards change whether it works or not; It is a opening.

Let's Chat!

University of Michigan Brairwood Clinic, Henry Ford Health System, The Wall Street Journal, Cigna Healthcare..Come on...What are you waiting for?

Over the last couple of weeks we have continued to see the flood of medical facilities (physicians, clinics, hospitals and home health care) providing Online Medical Consultations, Webvisits, E-scripts and general medical care. Cigna Healthcare Insurance has been encouraged by Cisco in California to pay for online health services. Cigna has agreed to reimburse online medical and behavioral health services.

Online behavioral health services have been around for several years but have been seen as a adjunct to face to face services at best and at worst seen as unlicensed charlatans. There are many reparable online therapy services with codes of ethics and guidelines for online services with consent for treatment.

Counseling Connections is an Online mental health service that is not waiting! Counseling Connections provides E-therapy, E-counseling, Chat and phone therapy. The newer technologies are opening up doors to providing services to people. People, employees and businesses are demanding these services!

So come on…what are you waiting for?....

Sexual Addiction

Sex sells! Sex excites! Sex get people's attention! Sex motivates! Sex is normal! Sex is connecting!

Sex addiction has become more and more prevalent due to easy access to pornography on the internet. Treatment for sexual compulsive behaviors are often similar to other addictive behaviors and compulsions. There are 12 step groups to assist people with sexual addictions. Therapist indicate like other addictive behaviors the first step is acknowledgement of the problem and a willingness to do something about it. A therapist may assist the patient in understanding and expressing feelings because like most addictions sexual addictions are used to numb the self from feelings. Therapist assist patients in understanding what triggers these behaviors.

Sexual addictions can be as destructive to families and relationships as other addictions such as alcoholism, gambling, etc. Often times sexual addictions can interfere with healthy sex lives and exposure of children to unhealthy sexual outlets. See the link above to read an article in Therapy Today addressing this addiction and others.