Outcomes and payment models in crisis intervention

Here are a few notes and reflections about some of the things I'm thinking about today.

Treating Complex PTSD

I started out today reading about complex PTSD and DESNOS (Cloitre et al 2011). [quick rabbit trail: The layers of the crisis intervention field are deep. Makes me wonder about the history of the field and how it would be constructed.] The purpose of the article is to present a model for treatment of complex PTSD based in best practices. The authors explore how to treat the problem and in what order. Task 1: is "patient safety, symptom stabilization, and improvement in basic life competencies"; Task 2: "the exploration of traumatic memories for the purposes of first reducing acute emotional distress resulting from the memories and then reappraising their meaning and integrating them into a coherent and positive identity." Education about trauma, mindfulness & meditation, and symptom management CBT (cognitive behavioral treatment) seemed to rank pretty high as useful interventions.

Payment for Services

From there I jumped to a discussion at Shrink Rap about the pros & cons of capitated fee structures versus fee-for-service. The commentators quickly began promoting the Canadian healthcare system and calling each other names. Result: no decision.

Since this an interesting and timely topic (and I can write what I want in this space) let me opine also.

Capping payments (e.g., per member/per month model) is designed to allow providers flexibility in treating patients. A real plus of this system is that it allows budgeting to be based in reality. When you know your income resources can be allocated. The risk for providers is in managing the patient load by balancing the number of patients and the amount of care provided. Too few patients is risky for returning unearned funds, too many patients is risky for resentment and burnout. One other downside is the disconnect between each of the three poles: patient, funder, and provider.

Fee-for-service is designed to control costs using market factors. This system allows folks to buy whatever services they think they want/can afford. One risk is that patient's are often rely on their provider(s) (and marketing companies) for recommendations about health related purchases. A real plus is theoretical flexibility in provider and service selection. This system is favored by those who want to be rewarded directly for the number (and quality) of the services they provide.

Obviously, each model has benefits based on point of view.

Reflection

Prominently, outcomes and evidence-supported (based?) treatments are themes relative to both discussions. For a behavioral health care system to be most useful a requirement that patients can judge providers equally while providers can rely on treatment models.

So, I'm working in a crisis stabilization unit/detox at a standalone psychiatric hospital and I'm in a doctoral program in counselor education. I keep turning over what I'm doing and how I'm going to graduate. The answer is to write up what I'm interested in; what I'm interested in is usually whatever I'm doing. In this case I am interested in evaluating my presentation materials: what material is best to present to patients in withdrawal/early recovery with a 7-10 day average length of stay?

This isn't what brought me to school, but is a familiar idea. And a good one to keep in my back pocket. The patients are post-crisis intervention, so part of the evaluation could include the relationship of initial assessment/presenting problem to the admitting diagnosis and the discharge plan. How is the patient better prepared to return back to their environment after the intervention?