What happens when capitated behavioral health comes to town? The transition from the Fort Bragg demonstration to a capitated managed behavioral health contract

Capitated managed care contracts for behavioral health services are becomin g more prevalent across the country in both public and private sectors. Thi s study followed the transition from a demonstration project for child ment al health services to a capitated managed behavioral health care contract w ith a for-profit managed care company. The focus of the study was on the im pact-at both the service system and the individual consumer level-pertainin g to the start-up and maintenance of a capitated managed behavioral health program. A case study using multiple methods and multiple sources of inform ation incorporated a program fidelity framework that examined micro to macr o levels of program implementation. The findings of this study include the following: access to services decreased, the lengths of stay and average da ily census in the more intensive levels of treatment declined, difficult-to -treat children were shifted to the public sector and ratings of service sy stem performance and coordination fell.