Clinician Experiences of Managed Mental Health Care: A Rereading of the Threat

Ware, Norma C.; Lachicotte, William S.; Kirschner, Suzanne R.; Cortés, Dharma E.; Good, Byron J.

doi:10.1525/maq.2000.14.1.3

Cited by 100 publications

(27 citation statements)

References 47 publications

(33 reference statements)

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“…Knowing this and feeling forced to evaluate children in much shorter time periods likely causes some psychiatrists professional distress that is hard to reconcile. Psychiatrists in this practice context may risk suffering from what Ware, Lachicotte, Kirschner, Cortes, and Good (2000) called a loss of moral vision of good mental health treatment. In order to reduce the tension caused by the feeling that they may be forced to provide what they consider inadequate care, psychiatrists may re-define in their own minds what adequate care looks like.…”

Section: Discussionmentioning

confidence: 99%

A Crisis of Credibility: Professionals’ Concerns about the Psychiatric Care Provided to Clients of the Child Welfare System

McMillen¹,

Fedoravicius²,

Rowe

et al. 2006

Adm Policy Ment Health

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These findings underscore the adverse effects of modern marketplace medicine coupled with low Medicaid reimbursement rates on quality of care for vulnerable groups. Child welfare and mental health professionals and their associated stakeholders may together possess substantial clout to advocate for a reimbursement system and structure that promotes quality service. The findings also point to a crisis of credibility toward psychiatric practice among social service and other non-psychiatrist mental health professionals. Efforts are needed to increase the capacity for psychiatrists and child welfare professionals to communicate effectively with each other and for psychiatrists to receive the information that they need from their child welfare partners to ensure accurate diagnosis and effective treatment.

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Section: Discussionmentioning

confidence: 99%

A Crisis of Credibility: Professionals’ Concerns about the Psychiatric Care Provided to Clients of the Child Welfare System

McMillen¹,

Fedoravicius²,

Rowe

et al. 2006

Adm Policy Ment Health

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show abstract

“…An ethnographic approach proved well suited to examine changes in mental health care and policies (Morgen & Maskovsky, 2003). This approach has been employed successfully in major anthropological studies of managed care reform (Donald, 2001;Kirschner & Lachicotte, 2001;Lamphere, 2005;Robins, 2001;Ware et al, 2000). Implemented over 2 years, our research clarified the complex and often contradictory ways that SNI personnel and clients in privileged and unprivileged social positions made sense of and experienced mental health policy.…”

Section: Methods Overviewmentioning

confidence: 99%

“…Undocumented and immigrant clients remained for the most part excluded from the public mental health system. SNIs and providers became increasingly "disciplined" to accept the constraints of managed care and negotiated the contradictory practices of managed care and delivering services to clients (Ware et al, 2000). They found ways to navigate the health care system through flexibility, accommodation, and coordination.…”

Section: Policy Implicationsmentioning

confidence: 99%

Medicaid Managed Care for Mental Health Services: The Survival of Safety Net Institutions in Rural Settings

2008

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Few accounts document the rural context of mental health safety net institutions (SNIs), especially as they respond to changing public policies. Embedded in wider processes of welfare state restructuring, privatization has transformed state Medicaid systems nationwide. We carried out an ethnographic study in two rural, culturally distinct regions of New Mexico to assess the effects of Medicaid managed care (MMC) and the implications for future reform. After 160 interviews and participant observation at SNIs, we analyzed data through iterative coding procedures. SNIs responded to MMC by nonparticipation, partnering, downsizing, and tapping into alternative funding sources. Numerous barriers impaired access under MMC: service fragmentation, transportation, lack of cultural and linguistic competency, Medicaid enrollment, stigma, and immigration status. By privatizing Medicaid and contracting with for-profit managed care organizations, the state placed additional responsibilities on "disciplined" providers and clients. Managed care models might compromise the rural mental health safety net unless the serious gaps and limitations are addressed in existing services and funding.

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“…40,41 Publications describe strategies for sampling, [42][43][44][45] analyzing, reporting, [45][46][47][48][49] and combining qualitative and quantitative methods 50 ; and a growing body of health care research reports fi ndings from studies using in-depth interviews, [51][52][53][54] focus groups, [55][56][57] observation, [58][59][60] and a range of mixed-methods designs. [61][62][63] As part of a project to evaluate health care improvements, we identifi ed a need to help health care researchers, particularly those with limited experience in qualitative research, evaluate and understand qualitative methodologies.…”

Section: Crit Er Ia F or Qu A L Itat Iv E R Ese A Rchmentioning

confidence: 99%

Evaluative Criteria for Qualitative Research in Health Care: Controversies and Recommendations

Cohen¹,

Crabtree²

2008

The Annals of Family Medicine

636

489

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PURPOSE We wanted to review and synthesize published criteria for good qualitative research and develop a cogent set of evaluative criteria. METHODSWe identifi ed published journal articles discussing criteria for rigorous research using standard search strategies then examined reference sections of relevant journal articles to identify books and book chapters on this topic. A cross-publication content analysis allowed us to identify criteria and understand the beliefs that shape them. RESULTSSeven criteria for good qualitative research emerged: (1) carrying out ethical research; (2) importance of the research; (3) clarity and coherence of the research report; (4) use of appropriate and rigorous methods; (5) importance of refl exivity or attending to researcher bias; (6) importance of establishing validity or credibility; and (7) importance of verifi cation or reliability. General agreement was observed across publications on the fi rst 4 quality dimensions. On the last 3, important divergent perspectives were observed in how these criteria should be applied to qualitative research, with differences based on the paradigm embraced by the authors. CONCLUSIONQualitative research is not a unifi ed fi eld. Most manuscript and grant reviewers are not qualitative experts and are likely to embrace a generic set of criteria rather than those relevant to the particular qualitative approach proposed or reported. Reviewers and researchers need to be aware of this tendency and educate health care researchers about the criteria appropriate for evaluating qualitative research from within the theoretical and methodological framework from which it emerges.

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Clinician Experiences of Managed Mental Health Care: A Rereading of the Threat

Cited by 100 publications

References 47 publications

A Crisis of Credibility: Professionals’ Concerns about the Psychiatric Care Provided to Clients of the Child Welfare System

A Crisis of Credibility: Professionals’ Concerns about the Psychiatric Care Provided to Clients of the Child Welfare System

Medicaid Managed Care for Mental Health Services: The Survival of Safety Net Institutions in Rural Settings

Evaluative Criteria for Qualitative Research in Health Care: Controversies and Recommendations

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