Abstract
A five-year evaluation compared total Medicaid and General Fund behavioral health care costs of a behavioral health home (BHH) model with those of a brokerage model of case management (treatment-as-usual) for the community care of adults with a serious mental illness. The BHH was an interprofessional, team-based intervention that used cognitive behavioral therapy, motivational interviewing, and dialectical behavioral therapy skills as primary interventions. By the third full year, the BHH total cost was less than half that of case management. The difference was due largely to less utilization of inpatient and community residential services among those served by the BHH. Results are limited by the non-randomized assignment among the groups and the availability of only aggregate data, but they strongly suggest the value of further examination of the effectiveness and cost of BHH versus case management-based interventions in a community mental health setting.
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References
https://www.census.gov/quickfacts/fact/table/kentcountymichigan. Accessed .
Holloway F, Carson J. Review article case management: an update. International Journal of Social Psychiatry. 2001;47(3):21-31.
D'Ercole A, Struening E, Curtis JL, et al. Effects of diagnosis, demographic characteristics, and case management on rehospitalization. Psychiatric Services. 1997;48(5):682-688.
Gorey KM, Leslie DR, Morris T, et al. Effectiveness of case management with severely and persistently mentally ill people. Community Mental Health Journal. 1998;34(3):241-250.
Mueser KT, Bond GR, Drake RE, et al. Models of community care for severe mental illness: a review of research on case management. Schizophrenia Bulletin. 1998;24(1):37.
Bedell JR, Cohen NL, Sullivan A. Case management: the current best practices and the next generation of innovation. Community Mental Health Journal. 2000;36(2):179-194.
Beck AT. Cognitive therapy: nature and relation to behavior therapy. Behavior Therapy. 1970;1:184-200.
Miller MR. Motivational interviewing with problem drinkers. Behavioral and Cognitive Psychotherapy. 1983;11(2):147-172.
Blakely T, Dziadosz G. Creating an agency integrated treatment program for co-occurring disorders. American Journal of Psychiatric Rehabilitation. 2007;10:1-18.
Blakely T, Dziadosz G. The chronic care model for behavioral health care. Population Health Management. 2008;11(6):341-346.
Zimmermann G, Favrod J, Trieu VH, et al. The effect of cognitive behavioral treatment on the positive symptoms of schizophrenia spectrum disorders: a meta-analysis. Schizophrenia Research. 2005;77(1)1-9.
Wykes T, Steel C, Everitt B, et al. Cognitive behavior therapy for schizophrenia: effect sizes, clinical models, and methodological rigor. Schizophrenia Bulletin. 2008;34(3):523-537.
Grant PM, Huh GA, Perivoliotis D, et al. Randomized trial to evaluate the efficacy of cognitive therapy for low-functioning patients with schizophrenia. Archives of General Psychiatry. 2012;69(2):121-127.
Drymalski WM, Campbell TC. A review of motivational interviewing to enhance adherence to antipsychotic medication in patients with schizophrenia: evidence and recommendations. Journal of Mental Health. 2009;18(1):6-15.
Barkhof E, Meijer CJ, de Sonneville LMJ, et al. The effect of motivational interviewing on medication adherence and hospitalization rates in nonadherent patients with multi-episode schizophrenia. Schizophrenia Bulletin. 2013;39(6):1242-1251.
Chien WT, Mui JHC, Cheung EFC, et al. Effects of motivational interviewing-based adherence therapy for schizophrenia spectrum disorders: a randomized controlled trial. Trials. 2015;16(1):270.
Linehan MM, Schmidt HI, Dimeff LA, et al. Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. American Journal on Addictions. 1999;8:279–292.
Linehan, Marsha. DBT? Skills training manual. Guilford Publications;2014.
Najavits LM. Seeking safety: a treatment manual for PTSD and substance abuse. Guildford Press;2001.
Sprent P, Smeeton NC. Applied non-parametric statistical methods. 4th ed. Chapman and Hall/CRC; 2007.
Felmingham KL, Bryant RA. Gender differences in the maintenance of response to cognitive behavior therapy for posttraumatic stress disorder. Journal of Consulting and Clinical Psychology. 2012;80(2):196.
Low KG, Giasson H, Connors S, et al. Testing the effectiveness of motivational interviewing as a weight reduction strategy for obese cardiac patients: a pilot study. International Journal of Behavioral Medicine. 2013;20(1):77-81.
Czuchry M, Sia TL, Dansereau DF. Improving early engagement and treatment readiness of probationers: gender differences. The Prison Journal. 2006;86(1):56-74.
Parker G, Blanch B, Crawford J. Does gender influence response to differing psychotherapies by those with unipolar depression? Journal of Affective Disorders. 2011;130(1-2):17-20.
Lundahl B, Burke BL. The effectiveness and applicability of motivational interviewing: a practice-friendly review of four meta-analyses. Journal of Clinical Psychology. 2009;65(11):1232-45.
Bond GR, Witheridge TF, Dincin J, et al. Assertive community treatment for frequent users of psychiatric hospitals in a large city: a controlled study. American Journal of Community Psychology. 1990;18(6):865-91.
Essock SM, Frisman LK, Kontos NJ. Cost-effectiveness of assertive community treatment teams. American Journal of Orthopsychiatry. 1998;68(2):179-90.
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During the previous 12 months Dr. Achtyes has received research grants from Alkermes, Astellas, Biogen, Boehringer-Ingelheim, Innate VR, Janssen, the National Network of Depression Centers, Neurocrine Biosciences, Otsuka, Pear Therapeutics, the Pine Rest Foundation, Takeda, and Vanguard Research Group; and has served on advisory boards or consulted for Alkermes, F. Hoffmann-LaRoche, Janssen, Otsuka/Lundbeck and Sunovion. The other authors have no known conflicts of interest. Prior to data analysis, this study was reviewed by the Michigan Department of Health and Human Services Institutional Review Board and determined to be a non-research program evaluation and because only aggregate data were used, this analysis would not be considered to include humans as subjects. Funding for this evaluation was provided by a Michigan Health Endowment Fund grant G-1605-139850.
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Dziadosz, G., Spykerman, K., Ryskamp, B. et al. Total Cost of Therapy-Based Care Versus a Brokerage Model of Case Management for Persons With a Serious Mental Illness Served in the Community. J Behav Health Serv Res 48, 330–341 (2021). https://doi.org/10.1007/s11414-020-09722-4
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DOI: https://doi.org/10.1007/s11414-020-09722-4