Skip to main content
SpringerLink
Log in

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

  • Articles
  • Published:
The Journal of Behavioral Health Services & Research Aims and scope Submit manuscript

Abstract

Capitated managed care contracts for behavioral health services are becoming more prevalent across the country in both public and private sectors. This study followed the transition from a demonstration project for child mental health services to a capitated managed behavioral health care contract with a for-profit managed care company. The focus of the study was on the impact—at both the service system and the individual consumer level—pertaining to the start-up and maintenance of a capitated managed behavioral health program. A case study using multiple methods and multiple sources of information incorporated a program fidelity framework that examined micro to macro levels of program implementation. The findings of this study include the following: access to services decreased, the lengths of stay and average daily census in the more intensive levels of treatment declined, difficult-to-treat children were shifted to the public sector, and ratings of service system performance and coordination fell.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Behar LB, Bickman L, Lane T, et al.: Fort Bragg Child and Adolescent Mental Health Demonstration Project. In: Roberts N (Ed.):Model Programs in Child and Family Mental Health. Mahwah NJ: Lawrence Erlbaum, 1996, pp. 351–372.

    Google Scholar 

  2. Bickman L, Guthrie PR, Foster EM, et al:Evaluating Managed Mental Health Services: The Fort Bragg Experiment. New York: Plenum, 1995.

    Google Scholar 

  3. Heflinger CA: Implementing a system of care: Findings from the Fort Bragg Evaluation Project.Journal of Mental Health Administration 1996; 23:16–29.

    Google Scholar 

  4. Chen H:Theory-Driven Evaluations. Newbury Park, CA: Sage, 1990.

    Google Scholar 

  5. Bickman L (Ed.):Using Program Theory in Evaluation. San Francisco: Jossey-Bass, 1987.

    Google Scholar 

  6. Rezmovic EL: Assessing treatment implementation amid the slings and arrows of reality.Evaluation Review 1987; 8:187–204.

    Google Scholar 

  7. Mazmanian DA, Sabatier PA:Implementation and Public Policy. Glenview, IL: Scott, Foresman, 1983.

    Google Scholar 

  8. Bickman L, Summerfelt WT, Bryant D: The quality of services in a children's mental health managed care demonstration.Journal of Mental Health Administration 1996; 23:30–39.

    Google Scholar 

  9. Foster ME, Summerfelt WT, Saunders RC: The costs of mental health services under the Fort Bragg Demonstration.Journal of Mental Health Administration 1996; 23:92–106.

    Google Scholar 

  10. Heflinger CA, Northrup DA:Interim Report of the Implementation Study of the Transition to Managed Mental Health Services at Fort Bragg, North Carolina. Nashville, TN: Center for Mental Health Policy, Vanderbilt University, 1997a.

    Google Scholar 

  11. Department of Defense Contract No. N00140-94-CA60/N00140-95-C-L035, p. 8.

  12. Yin RK:Case Study Research: Design and Methods. Second ed. Thousand Oaks, CA: Sage, 1994.

    Google Scholar 

  13. Yin RK: Case study evaluations: A decade of progress?New Directions for Evaluation 1997, 76:69–78.

    Google Scholar 

  14. Northrup DA: Experiences of families of children targeted for major case management. In:Final Report of Transition to Capitated Managed Mental Health Services at Fort Bragg, North Carolina. Nashville, TN: Center for Mental Health Policy, Vanderbilt University, 1997.

    Google Scholar 

  15. Heflinger CA, Northrup DA:Measuring Change in Mental Health Service System at Fort Bragg 1992–1996: A Network Analysis. Nashville, TN: Center for Mental Health Policy, Vanderbilt University, 1997. Documents published by the Vanderbilt Center for Mental Health Policy can be ordered at www.vanderbilt.edu/VIPPS/CMHP/cmhphome.html.

    Google Scholar 

  16. Heflinger CA, Northrup DA: Measuring change in mental health services coordination under managed mental health care for children and adolescents. In: Morrissey, JP (Ed.):Research in Community Mental Health (Volume 9): Social Networks and Mental Health. Greenwich, CT: JAI, 1998, pp. 69–88.

    Google Scholar 

  17. Scheirer MA: Program theory and implementation theory: Implications for evaluators. In: Bickman L (Ed.):Using Program Theory in Evaluation. San Francisco: Jossey-Bass, 1987, pp. 59–76.

    Google Scholar 

  18. Department of Defense Contract No. N00140-94-CA60/N00140-95-C-L035, p. 8.

  19. Friedman RM, Katz-Leavy J, Manderscheid R, et al.:Prevalence of Serious Emotional Disturbance in Children and Adolescents. Rockville, MD: SAMHSA/CMHS, June 1996.

    Google Scholar 

  20. Roberts RE, Attkisson C, Rosenblatt A: Prevalence of psychopathology among children and adolescents.American Journal of Psychiatry 1998; 155:715–725.

    Google Scholar 

  21. Department of Defense Contract No. N00140-94-CA60/N00140-95-C-L035, p. 2.

  22. Roberts N (Ed.):Model Programs in Child and Family Mental Health. Mahwah, NJ: Lawrence Erlbaum, 1996.

    Google Scholar 

  23. Stroul BA, Friedman RM:A System of Care for Severely Emotionally Disturbed Youth. Washington, DC: CASSP Technical Assistance Center at Georgetown University, revised, 1986.

    Google Scholar 

  24. Heflinger CA, Northrup DA: Community-level changes in behavioral health care following capitated contracting.Children and Youth Services Research 2000; 22:175–193.

    Google Scholar 

  25. Heflinger CA:Final Report of the Implementation Study of the Fort Bragg Evaluation Project. Nashville, TN: Center for Mental Health Policy, Vanderbilt University, 1993.

    Google Scholar 

  26. Principles of Family Involvement in the Development and Operation of Managed Health and Mental Health Care Systems for Children and Youth. Alexandria, VA: Federation of Families for Children's Mental Health Board of Directors, 1995.

  27. Elements Supporting Ethical Reform and Effective System of Care. Alexandria, VA: National Mental Health Association, 1995.

  28. Solberg LI, Mosser G, McDonald S: The three faces of performance measurement: Improvement, accountability, and research.Journal on Quality Improvement 1997; 23:135–147.

    Google Scholar 

  29. Institute of Medicine:Managing Managed Care: Quality Improvement in Behavioral Health. Washington, DC: National Academy Press, 1997.

    Google Scholar 

  30. The Final Report of the Mental Health Statistics Improvement Program Task Force on a Consumer-Oriented Mental Health Report Card. Washington, DC: Center for Mental Health Services, SAMHSA, 1996.

  31. Smith GR, Manderscheid RW, Flynn LM, et al.: Principles for assessment of patient outcomes in mental health care.Psychiatric Services 1997; 48:1033–1036.

    Google Scholar 

  32. Thompson JW, Bost J, Ahmed F, et al.: The NCQA's quality compass: Evaluating managed care in the United States.Health Affairs 1998; 17:152–158.

    Google Scholar 

  33. Newell AR, Saltzman GM: The impact of managed mental health care on women.JAMWA 1997; 52:69–74.

    Google Scholar 

  34. Westermeyer J: Problems with managed psychiatric care without a psychiatrist-manager.Hospital and Community Psychiatry 1991; 42:1221–1224.

    Google Scholar 

  35. Schlesinger M, Dorwart RA, Epstein SS: Managed care constraints on psychiatrists' hospital practices.American Journal of Psychiatry 1996; 153:256–260.

    Google Scholar 

  36. Norton EC, Lindroth MA, Dickey B: Cost shifting in a mental health carve-out for the AFDC population.Health Care Financing Review 1997; 18:95–108.

    Google Scholar 

  37. Stroul BA, Pires SA, Roebuck L, et al.: State health care reforms: How they affect children and adolescents with emotional disorders and their families.Journal of Mental Health Administration 1997; 24:386–399.

    Google Scholar 

  38. The Civilian Health and Medical Program of the Uniformed Services, a benefits program authorized by Congress to provide medical and psychological services necessary to authorized beneficiaries. In the community described in this study, the beneficiaries were primarily the children of active duty and retired military personnel.

Download references

Author information

Authors and Affiliations

  1. Vanderbilt Institute of Public Policy Studies and George Peabody College of Vanderbilt University, Box 90, 37203, Nashville, TN

    Craig Anne Heflinger Ph.D.

  2. the Vanderbilt Center for Mental Health Policy in Nashville, Tennessee

    Denine A. Northrup Ph.D.

Authors
  1. Craig Anne Heflinger Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Denine A. Northrup Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Craig Anne Heflinger Ph.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Heflinger, C.A., Northrup, D.A. What happens when capitated behavioral health comes to town? The transition from the fort bragg demonstration to a capitated managed behavioral health contract. The Journal of Behavioral Health Services & Research 27, 390–405 (2000). https://doi.org/10.1007/BF02287821

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02287821

Keywords

Search

Navigation