THE DISSEMINATION OF MANUAL-BASED PSYCHOTHERAPIES IN MANAGED CARE - PROMISES, PROBLEMS, AND PROSPECTS

Manual-based, empirically validated psychotherapies potentially have a very important role to play in building quality managed care delivery systems. Unfortunately, managed care systems have been slow to endors e or implement such models of care on widespread basis. The essence of the problem is that manual-based procedures have been developed prima rily to address the needs of clinical science and little attention has been directed toward the three primary end users in applied settings: the behavioral health program director, the line clinician, and the c onsumer of behavioral health services. The result is that manual-based therapies are perceived as highly specialized, cumbersome, time consu ming, expensive, difficult to train/supervise, and not user friendly t o either line clinicians or consumers. Here, the perspectives of the c linical scientist, practitioner, behavioral health program director, a nd consumer are reviewed to highlight how manual-based procedures coul d be tailored to fit the demands of all key stakeholders. If these cha nges are made thoughtfully manual-based procedures may eventually beco me a dominant mode of service delivery in managed care.