The integration of psychiatric rehabilitation services in behavioral health care structures: A state example

  • Marsha Langer Ellison
  • William A. Anthony
  • John L. Sheets
  • William Dodds
  • William J. Barker
  • Joseph Massaro
  • Nancy J. Wewiorski
Regular Articles


This article describes a model for integrating psychiatric rehabilitation services in a managed behavioral health care structure. Psychiatric rehabilitation and managed care are two distinct developments in the provision of mental health services that have proceeded independently though they can have compatible methods and outcomes. Descriptive detail is provided about a state initiative in Iowa to provide psychiatric rehabilitation services to those with serious mental illness through the state-contracted managed behavioral health care corporation. The article describes factors leading to the program's implementation, service delivery structures, reimbursements, personnel requirements, and performance indicators. Evidence for supporting this innovation is provided through a case-controlled outcomes study of mental health service units used and their costs for participants and matched controls.


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  1. 1.
    Ray C, Anthony WA, Graham S. Why would psychiatric rehabilitation agencies want to shift to managed care? In: Peterson C, ed. Psychiatric Rehabilitation and Managed Care. Linthicum, MD: International Association of Psychosocial Rehabilitation Services. In press.Google Scholar
  2. 2.
    Mechanic D. Emerging trends in mental health policy and practice.Health Affairs. 1998;17(6):82–97.Google Scholar
  3. 3.
    Anthony WA, Cohen MR, Farkas MD.Psychiatric Rehabilitation. Boston: Center for Psychiatric Rehabilitation, Boston University; 1990.Google Scholar
  4. 4.
    Anthony WA.Community Support Systems: Lessons for Managed Care. Boston: Center for Psychiatric Rehabilitation, Boston University; 1996.Google Scholar
  5. 5.
    American Managed Behavioral Healthcare Association and National Association of State Mental Health Program Directors. Public mental health systems Medicaid re-structuring and managed behavioral healthcare.Behavioral Healthcare Tomorrow. September/October 1995:63–69.Google Scholar
  6. 6.
    Wells SM. Exploring the promises and pitfalls of managed care.Access: Information from the National Resource Center on Homelessness and Mental Illness. 1995;7(1):3–5.Google Scholar
  7. 7.
    Substance Abuse and Mental Health Services Administration.Cooperative Agreements for Managed Care and Vulnerable Populations: Guidance for Applicants. Washington, DC: SAMHSA, Center for Mental Health Services April 1996. No. TI 96-01.Google Scholar
  8. 8.
    Samuels J, Goldman H. Survey study findings. Paper presented at the Seventh Annual National Conference on State Mental Health Agency Services Research and Program Evaluation; February 1997; Arlington, VA.Google Scholar
  9. 9.
    Effective public management of mental health care. Accessed August 1, 2000.Google Scholar
  10. 10.
    Folcarelli C. Medicaid section 1115 waivers: their approaches to mental health and substance abuse services.Policy in Perspective. 1995;1:3–4.Google Scholar
  11. 11.
    Human Services Research Institute.Evaluating Managed Mental Health Care: A Sourcebook. Cambridge, MA: HSRI; 1995.Google Scholar
  12. 12.
    Minkoff K, Pollack D, eds.Managed Mental Health Care in the Public Sector. Amsterdam B.V. The Netherlands: Harwood Academic Publishers; 1997.Google Scholar
  13. 13.
    Hughes R. The future of psychosocial rehabilitation under managed care.Community Support Network News. 1995;10(4):3.Google Scholar
  14. 14.
    Hogan M. A state perspective—rehabilitation within managed care: can this relationship succeed?Community Support Network News. 1995;10(4):3. Published by the Center for Psychiatric Rehabilitation, Boston University Boston, MA.Google Scholar
  15. 15.
    DeLeon PH, VandenBos GR, Bulatao EQ. Managed mental health care: a history of the federal policy initiative.Professional Psychology: Research and Practice. 1991;22(1):15–25.Google Scholar
  16. 16.
    Freeman MA, Trabin T. The policy challenges of managed behavioral healthcare.Policy in Perspective. 1995;1:3–4.Google Scholar
  17. 17.
    Anthony WA, Cohen MR, Farkas MD, et al.Psychiatric Rehabilitation. 2nd ed. Boston: Center for Psychiatric Rehabilitation, Boston University; 2002.Google Scholar
  18. 18.
    Lamberti JS, Melburg V, Madi N. Intensive psychiatric rehabilitation treatment (IPRT): an overview of a new program.Psychiatric Quarterly. 1998;69(3):211–235.Google Scholar
  19. 19.
    Anthony WA, Brown MA, Rogers ES, et al. A supported living/employment program for reducing the number of people in institutions.Psychiatric Rehabilitation Journal. 1999; 23(1), 57–61.Google Scholar
  20. 20.
    Unger KV, Anthony WA, Sciarappa K, et al. A supported education program for young adults with long-term mental illness.Hospital and Community Psychiatry. 1991;42(8):838–842.Google Scholar
  21. 21.
    Rogers ES, Sciarappa K, MacDonald-Wilson K, et al. A benefit-cost analysis of a supported employment model for persons with psychiatric disabilities.Evaluation and Program Planning. 1995;18(2):105–115.Google Scholar
  22. 22.
    Rogers ES, Walsh D, Masotta L, et al.Massachusetts Survey of Client Preferences for Community Support Services: Final Report. Boston: Center for Psychiatric Rehabilitation, Boston University; 1991.Google Scholar
  23. 23.
    Anthony WA, Cohen M, Vitalo R. The measurement of rehabilitation outcome.Schizophrenia Bulletin. 1978;4:365–383.Google Scholar
  24. 24.
    Anthony WA. Psychiatric rehabilitation: key issues and future policy.Health Affairs. Fall 1992:164–171.Google Scholar
  25. 25.
    Hughes R. Advocating for psychosocial rehabilitation services in a managed care environment.Community Support Network News. 1995;10(4):7.Google Scholar
  26. 26.
    Research Committee of the International Association of Psychosocial Rehabilitation Services.Toolkit for Measuring Psychosocial Outcomes. Columbia, MD: International Association of Psychosocial Rehabilitation Services; 1995.Google Scholar
  27. 27.
    DeJong G. Independent living: social movement to analytic paradigm.Archives of Physical and Medical Rehabilitation. 1979;60:435–446.Google Scholar
  28. 28.
    Rohland B. Quality assessment in a Medicaid managed mental health care plan: an Iowa case study.American Journal of Orthopsychiatry. 1999;69(3):410–414.Google Scholar
  29. 29.
    Sabin J, Daniels N. Public-sector managed behavioral health care: VI. The Iowa approach to profit and community investment.Psychiatric Services. 2000;51(10):1239–1247.Google Scholar
  30. 30.
    Sabin J, Daniels N. Public-sector managed behavioral health care: V. Redefining “medical necessity”—the Iowa experience.Psychiatric Services. 2000;51(4):445–459.Google Scholar
  31. 31.
    Dodds W, Sheets J. Psychiatric rehabilitation and managed care. Speech delivered to the Advisory Council Meeting of the Boston University Center for Psychiatric Rehabilitation; November 1997; Brookline, MA.Google Scholar
  32. 32.
    Sheets J, Yamin Z. Intensive psychiatric rehabilitation services: a best practice service design for managed care. In:1999 Medicaid Managed Behavioral Care Sourcebook. New York: Faulkner & Gray, Healthcare Information Center; 1998.Google Scholar
  33. 33.
    D'Agostino RB. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group.Statistics in Medicine. 1998;17:2265–2281.Google Scholar
  34. 34.
    American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: APA; 1994.Google Scholar

Copyright information

© Association of Behavioral Healthcare Management, NCCBH 2002

Authors and Affiliations

  • Marsha Langer Ellison
    • 2
  • William A. Anthony
    • 1
    • 3
  • John L. Sheets
    • 4
  • William Dodds
    • 5
  • William J. Barker
    • 6
  • Joseph Massaro
    • 1
  • Nancy J. Wewiorski
    • 1
  1. 1.Center for Psychiatric RehabilitationBoston
  2. 2.Sargent College of Health and Rehabilitation SciencesUSA
  3. 3.Sargent College of Health and Rehabilitation SciencesUSA
  4. 4.Psychiatric Rehabilitation ServicesUSA
  5. 5.ResCare of IowaUSA
  6. 6.Community RelationsMagellan Behavioral Care Corporation of IowaUSA

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