THE ROLE FOR SOCIAL WORKERS IN THE MANAGED HEALTH CARE SYSTEM: A MODEL FOR EMPIRICALLY BASED PSYCHO-SOCIAL INTERVENTIONS

Abstract

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 fundamental paradigm shift with far reaching implications for the effectiveness of health care, the cost-efficiency of health care systems, and the service integration of systems (Masia, Anderson, McNeil, & Hawkins, 1997). These changes are affecting previously segregated delivery systems, specifically those of health and mental health. Increased costs and proposed budget cuts are forcing segregated systems into an overall integrated delivery system.

Successful therapeutic outcomes in psycho-social treatment depend on a number of variables. In this manuscript, the author outlines worker characteristics that are recommended based on various research studies and general outcomes of behavioral change. Issues discussed include the similarity of client and worker characteristics, attributes of professionals versus paraprofessionals, and many common factors of worker efficacy. In addition, many treatment components are discussed such as length of therapy, behavior acquisition procedures, enhancement of treatment technologies, and level of intervention strategies such as individual treatment versus group treatment. A detailed cost analysis of social work follows, including cost benefits and cost effectiveness.

Finally, a profile of the behavioral/health social worker is given that defines what abilities an effective behavioral social worker should possess. Among these are the depth of an acceptable knowledge base, the behavioral skills necessary for an intellectual and conceptual understanding of theories of human development and learning, and the utilization of techniques necessary to bring about behavioral changes in clinical practice. From these characteristics, a basis is formed for the emerging roles for behavioral interventions in primary care that will ultimately increase the quality of mental health care while effectively controlling medical costs.

It has been shown that increasingly health care costs and the effective management of health care are of primary importance and concern to federal, state, and local governments. It is necessary to develop innovative, successful, and cost effective treatments and procedures. This manuscript proposes such a procedure by first defining the problems to be addressed, by applying research and studies for support, and by presenting an innovative model for cost effective managed health care and empirically based psycho-social intervention.