The role for social workers in the managed health care system: A model forempirically based psycho-social interventions

The health care industry is changing rapidly, and with it will come changes to managed health care as it is now known. This article addresses a fundam ental paradigm shift with far reaching implications for the effectiveness o f health care, the cost-efficiency of health care systems, and the service integration of systems (Masia, Anderson, McNeil, & Hawkins, 1997). These ch anges are affecting previously segregated delivery systems, specifically th ose of health and mental health. Increased costs and proposed budget cuts a re forcing segregated systems into an overall integrated delivery system. Successful therapeutic outcomes in psyche-social treatment depend on a numb er of variables. In this manuscript, the author outlines worker characteris tics that are recommended based on various research studies and general out comes of behavioral change. Issues discussed include the similarity of clie nt and worker characteristics, attributes of professionals versus paraprofe ssionals, and many common factors of worker efficacy. In addition, many tre atment components are discussed such as length of therapy, behavior acquisi tion procedures, enhancement of treatment technologies, and level of interv ention strategies such as individual treatment versus group treatment. A de tailed cost analysis of social work follows, including cost benefits and co st effectiveness. Finally, a profile of the behavioral/health social worker is given that def ines what abilities an effective behavioral social worker should possess. A mong these are the depth of an acceptable knowledge base, the behavioral sk ills necessary for an intellectual and conceptual understanding of theories of human development and learning, and the utilization of techniques neces sary to bring about behavioral changes in clinical practice. From these cha racteristics, a basis is formed for the emerging roles for behavioral inter ventions in primary care that will ultimately increase the quality of menta l health care while effectively controlling medical costs. It has been shown that increasingly health care costs and the effective man agement of health care are of primary importance and concern to federal, st ate, and local governments. It is necessary to develop innovative, successf ul, and cost effective treatments and procedures. This manuscript proposes such a procedure by first defining the problems to be addressed, by applyin g research and studies for support, and by presenting an innovative model f or cost effective managed health care and empirically based psycho-social i ntervention.