With the advent of CalAIM in California, Medi-Cal treatment of behavioral health will be based on episodes of care. To further explain, the traditional approach of “fee-for-service” care allows a provider to treat a client as long as they deem necessary, without consideration of cost or outcome. The future will change this approach where counties as “health plans” will act as managed care organizations, determining the appropriate length of care for each client.
This approach can be likened to the old television show, “Name That Tune.” In the show, a contestant would receive information about a song and then guess how many notes they would need to guess it. Translated into the managed care world, a behavioral health agency will be responsible for the care of clients assigned to their agency. Based on geographic, company historical data, and diagnosis, they may be asked to project the length of stay for clients. This alone can cause nightmares for organizations, let alone their staff. But it isn’t as difficult as it may sound.
Currently, in California, STRTPs are conducting a particular form of Name That Episode of Care. The general length of stay for youth in an STRTP is around six months. When the youth arrives at the facility, the Social Worker or Therapist develop their treatment plans and gives an estimate of treatment scrutinized by county and state officials. If the staff believes the youth will need more time due to higher needs, they indicate it and may receive additional services to help the youth. Monthly, the Child and Family Team meet to discuss whether this episode length is realistic; if not, it is modified along with treatment plans.
The same can be done in an outpatient setting. The first step is identifying the client, their symptoms, acuity, and desired goals. Suppose a 16-year-old with a diagnosis of major depression and a history of psychiatric hospitalizations due to suicide attempts is assigned to a clinician. How long will it take for them to be in the program? How can they name the episode of care? As indicated above, they can look at their historical data on clients with a history of major depression and hospitalizations. They can also determine how stabilized the client already is. Questions such as, “What is the length of time since the last hospitalization?” Are they stable on anti-depressant medications?” Then based on this information, the clinician, in their assessment, can determine an estimated length of stay, the number of sessions necessary, and adjunctive services (therapy, medication management, behavioral modification). This estimate can then be calculated in time and the cost of services as a preliminary projection. Then as the clinician continues to work with the youth monthly, they can evaluate the costs, the progress, and whether their projection is realistic or needs reassessment.
Behavioral health organizations will need to shift their focus from “treatment based on fees” to “treatment based on outcomes and costs.” Naming the Episode of Care will need to be a skill mastered by all those serving the client. But this approach, although appearing to do a disservice to the client, holds all parties accountable for improving their care. Changing the emphasis from fees (how much do I get paid) to outcomes (how do I get this client better) improves all participants’ approaches to help the client.
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PRAXES is a nationwide behavioral health software, consulting, and training company. No one in the behavioral health industry has a better reputation, and if you give us the chance, we’ll show you why! At PRAXES, our services improve the efficiency and structure of behavioral health agencies serving children and families nationwide. PRAXES brings over 45 years of administrative and clinical expertise. With more than 100 client companies nationwide, we offer the expertise to advance the quality of behavioral health services. We accomplish these goals through our new clinical decision software, our training of best practices, and helping companies meet regulatory standards. At PRAXES, we believe in being creative and fostering new ways to serve children and their families. Our vision is to empower the families our agencies serve with skills that not only improve their functioning, but help them to thrive in their everyday lives. When you give us the chance, you’ll be connected directly to our friendly staff, so you can expect immediate attention to your inquiry. So, don’t wait, call now!
Dan Thorne has unique perspectives on the field of mental health. As a clinician, he has had over 40 years of experience working with clients in the Southern California area. After obtaining his Bachelor’s degree from the University of California at Irvine, he worked with children in the Orange County Juvenile Hall. Here he honed his earliest techniques on at-risk children. After that, he obtained his Master’s degree in Counseling from California State University, Fullerton.
In the 1990’s, Dan turned his attention to the clinical and administrative side of behavioral health organizations. For three years, he was the Assistant Administrator of Starting Point, a chemical dependency facility in Costa Mesa, CA. In 2001, he took an opportunity to be the Director of Harbor View Community Services Center in Long Beach. When he arrived, the Center had only 80 clients and 13 staff. When he left, there were over 400 clients and 75 staff. Dan created several programs through their contract with the Los Angeles County Departments of Mental Health and Child and Family Services. Under his guidance, Harbor View became one of the leading providers of children’s services in Los Angeles County.
While improving the results of the client’s parents at the Center, Dan reflected on his experiences as a parent. His children themselves had special needs such as mental and intellectual challenges, and Dan knew the toll it takes on the parent. In order to help the child, the parent has to be healthy. From this concept, he created his parenting program. After years of refining it, teaching it to his staff at the Center, and then taking the results and comments from these efforts, he became the developer of the current PRAXES program. It is a culmination of Dan’s personal trials and tribulations as a parent along with empirical results and research of over 40 parenting programs.
Our vision at PRAXES is to advance the strength of parents and caregivers of children with special needs (mental health, intellectual, or physical) through education, support, and empowerment. Thus, they can live healthy and functional lives while caring for the child.
Apogee is a clinical decision software designed to help behavioral health practitioners with their treatment and patient engagement. It provides evidence-based and research-based components. Not only do they consist of elements from such practices as Cognitive Behavior Therapy, Seeking Safety, Dialectical Behavior Therapy, Motivational Interviewing, Functional Behavior Analysis, but also the Intensive Models for Parents, Youth, and Children.
PRAXES has over 30 years of accreditation experience. We know what it takes to get your organization accredited. Whether it’s Joint Commission, CARF, or COA, our team can provide an evaluation of your current status and review the standards which need improvements. We will assist you with the policies, documentation, and training required to be accredited.
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