Abstract
Over the past decade, a new paradigm in behavioral health care has emerged. It places emphasis on cost control, evidence-based practice, patient safety, access to care, treatment relevance for diverse populations, consumerism, and quality of care. Unfortunately, graduate education and training programs have had difficulty keeping pace with the dramatic changes in the field. As a consequence, there is concern that the graduates of many of these programs are not being adequately prepared to practice in current health care systems. This article reviews the nature of recent changes in behavioral health care, the current status of graduate education programs with respect to these changes, and offers 15 recommendations for increasing the relevance of graduate education to contemporary clinical practice.
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REFERENCES
Agency for Healthcare Research and Quality. (2001, October 11). HHS announces $50 million investment to improve patient safety [press release]. Rockville, MD: Author.
American College of Mental Health Administration. (2000). Sounding a call to action. Behavioral Healthcare Tomorrow, 9, 43–44.
American Nurses Association. (1996). Managed behavioral health care curriculum guidelines for psychiatricmental health and addictions nurses. Washington, DC: Author.
American Nurses Association. (1998). A review of and recommendations for standards and guidelines for the delivery of substance abuse and mental health services, curricula and training models for working in managed care and other primary care settings. Washington, DC: Author.
American Psychiatric Association, Commission on AIDS. (1998). HIV/AIDS psychiatric residency training: HIV-related neuropsychiatric complications and treatment. Washington, DC: Author.
American Psychiatric Association. (2000). Practice guidelines for the treatment of psychiatric disorders: Compendium 2000. Washington, DC: Author.
American Psychological Association. (1996). Guidelines and principles for accreditation of programs in professional psychology. Washington: DC: Author.
American Psychological Association. (1998). Interprofessional health care services in primary care settings: Implications for the education and training of psychologists. Washington, DC: Author.
American Psychological Association Office of Rural Health. (1995). Caring for the rural community: An interdisciplinary curriculum. Washington, DC: American Psychological Association.
American Society of Addiction Medicine. (1996). Patient placement criteria for the treatment of substancerelated disorders (2nd ed.). Chevy Chase, MD: Author.
Bennett, M.J. (1993). The importance in teaching the principles of managed care. Behavioral Healthcare Tomorrow, 2, 28–32.
Blumenthal, D., Gokhale, M., Campbell, E.G., & Weissman, J.S. (2001). Preparedness for clinical practice: Reports of graduating residents at academic health centers. Journal of the American Medical Association, 286, 1027–1034.
Blumenthal, D., & Their, S.O. (1996). Managed care and medical education (editorial). Journal of the American Medical Association, 276, 725–727.
Borus, J.F. (1994). Economics and psychiatric education: The irresistible force meets the moveable object. Harvard Review of Psychiatry, 2, 15–21.
Brooks, D., & Riley, P. (1996). The impact of managed health care policy on student field training. Smith College Studies in Social Work, 66, 307–316.
Busch, A.B., & Shore, M.F. (2000). Seclusion and restraint: A review of recent literature. Harvard Review of Psychiatry, 8, 261–270.
Casto, R.M., & Julia, M.C. (1994). Interprofessional care and collaborative practice. Pacific Grove, CA: Brooks/Cole.
Chester, J.G., Vincenzo R., Sanguineti, V.R., & Best, K. (1998). Teaching managed care: Philosophy and technique. Academic Psychiatry, 22, 36–40.
Chinman, M.J., Rosenheck, R., & Lam, J.A. (1999). The development of relationships between homeless mentally ill clients and their case managers. Psychiatric Rehabilitation Journal, 23, 47–55.
Council on Social Work Education & National Association of Social Workers. (1996). Managed care and workforce training: Social work strategic action plan. Washington, DC: National Association of SocialWorkers.
Crits-Christoph, P., Chambless, D.L., Frank, E., Brody, C., & Karp, J.F. (1995). Training in empirically validated treatments: What are clinical psychology students learning? Professional Psychology: Research and Practice, 26, 514–522.
Daniels, A.S., & Stukenberg, K.W. (2001). Assessing quality of care. In L.J. Kiser, P.M. Lefkovitz, & L.L. Kennedy (Eds.), The integrated behavioral health continuum: Theory and practice (pp. 257–268). Washington, DC: American Psychiatric Publishing.
Donovan, J.M., Steinberg, S.M., & Sabin, J.E. (1994). Managed mental health care: An academic seminar. Psychotherapy, 31, 201–205.
Drake, R., Essock, S., Shaner, A., Carey, K., Minkoff, K., Kola, L., Lynde, D., Osher, F., Clark, R. & Rickards, L. (2001). Implementing dual diagnosis services for clients with severe mental illness. Psychiatric Services, 52, 469–476.
Drake, R.E., Goldman, H.H., Leff, H.S., Lehman, A.F., Dixon, L., Mueser, K.T., & Torrey, W.C. (2001). Implementing evidence-based practices in routine mental health service settings. Psychiatric Services, 52, 179–182.
Feldman, S. (1978). Promises promises or community mental health services and training: Ships that pass in the night. Community Mental Health Journal, 14, 83–91.
Feldman, S., & Goldman, W. (Eds.). (1997). Special issue. Managed behavioral health and academia: Is there a “fit” between services and training? Administration and Policy in Mental Health, 25, 3–98.
Fox, A. (2000). MBHO/EAP enrollment reaches 220 million in 2000. Open Minds, 12, 7–8.
Frank, E. (Ed.). (2000). Gender and its effects on psychopathology. Washington, DC: American Psychiatric Press.
Gabbard, G.O. (1992). The big chill: The transition from residency to managed care nightmare. Academic Psychiatry, 16, 119–126.
Group for the Advancement of Psychiatry, Committee on Psychiatry and the Community (2000). Now that we are listening. Dallas, TX: Author.
Himelein, M.J., & Putnam, E.A. (2001). Work activities of academic clinical psychologists: Do they practice what they teach? Professional Psychology: Research and Practice, 32, 537–542.
Hoagwood, K., Burns, B.J., Kiser, L., Ringeisen, H., & Schoenwald, S.K. (2001). Evidence-based practice in child and adolescent mental health services. Psychiatric Services, 52, 1179–1189.
Hoge, M.A. (1997). Training the existing workforce. Administration and Policy in Mental Health, 25, 17–22.
Hoge, M.A. (in press). Professional training and workforce retraining in an era of managed care. In S. Feldman (Ed.), Managed mental health services (2nd ed.). Springfield, IL: Charles C. Thomas.
Hoge, M.A., Jacobs, S.C., & Belitsky, R. (2000). Psychiatric residency training, managed care, and contemporary clinical practice. Psychiatric Services, 51, 1001–1005.
Institute of Medicine, Committee on Quality Health Care in America. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.
International Association of Psychosocial Rehabilitation Services. (1997). Practice guidelines for the psychiatric rehabilitation of persons with severe and persistent mental illness in a managed care environment. Columbia, MD: Author.
Karam-Hage, M, Nerenberg, L. & Brower, K.J. (2001). Modifying residents' professional attitudes about substance abuse treatment and training. The American Journal on Addictions, 10, 40–47.
Katon, W., Rutter, C., Ludman, E.J., Von Korff, M., Lin, E., Simon, G., Bush, T., Walker, E., & Unutzer, J. (2001). A randomized trial of relapse prevention of depression in primary care. Archives of General Psychiatry, 58, 241–247.
Katon, W., Von Korff, M., Lin, E., Unutzer, J., Simon, G., Walker, E., Ludman, E., & Bush, T. (1997). Population-based care of depression: Effective disease management strategies to decrease prevalence. General Hospital Psychiatry, 19, 169–178.
Kohn, L.T., Corrigan, J.M., & Donaldson, M.S. (Eds). (2000). To err is human: Building a safer health system. Washington, DC: National Academy Press.
Leibenluft, E. (Ed.). (1999). Gender differences in mood and anxiety disorders: from bench to bedside. Washington, DC: American Psychiatric Press.
Leslie, D.L., & Rosenheck, R. (1999). Shifting to outpatient care? Mental health care use and cost under private insurance. The American Journal of Psychiatry, 156, 1250–1257.
Lewis, J.M., & Blotcky, M.J. (1993). Living and learning with managed care. Academic Psychiatry, 17, 186–193.
Meyer, R.E., & McLaughlin, C.J. (1998). The educational missions of academic Psychiatry. In R.E. Meyer & C.J. McLaughlin (Eds.), Between mind, brain, and managed care: The now and future world of academic psychiatry (pp. 49–76). Washington, DC: American Psychiatric Press.
Minkoff, K. (1998). Co-occurring psychiatric and substance disorders in managed care systems: Standards of care, practice guidelines, workforce competencies, and training curricula. Washington, DC: The Center for Mental Health Services, Substance Abuse Services Administration.
Minkoff, K., & Pollack, D. (Eds.). (1997). Managed mental health care in the public sector: A survival manual. Amsterdam: Harwood Academic Publishers.
Moffic, H.S. (2000). Training psychiatric residents in managed care. The Psychiatric Clinics of North America, 23, 451–459.
Morris, J.A., & Hanley, J.H. (2001). Human resource development: A critical gap in child mental health reform. Administration and Policy in Mental Health, 28, 219–227.
National Association of Social Workers. (1998). Social work roles, standards/guidelines, curricula, training, and service models for the delivery of substance abuse and mental health services in managed care and other primary care settings. Washington, DC: Author.
Perez, J.E. (1999). Clients deserve empirically supported treatments, not romanticism. American Psychologist, 54, 205–206.
Public Health Service Agency for Health Care Policy and Research. (1993). Depression in primary care: Volume 2. Treatment of major depression. Rockville, MD: U.S. Department of Health and Human Services (AHCPR Publication No. 93-051).
Randolph, F., Blasinsky, M., Leginski, W., Parker, L.B., & Goldman, H.H. (1997). Creating integrated service systems for homeless persons with mental illness: The ACCESS program. Access to Community Care and Effective Services and Supports. Psychiatric Services, 48, 369–373.
Raskin, M.S., & Blome, W.W. (1998). The impact of managed care on field instruction. Journal of Social Work Education, 34, 365–374.
Richards, R.R. (Ed.). (1996). Building partnerships: Educating health professionals for the communities they serve. New York: Jossey-Bass.
Rickel, A.U., & Wise, T.N. (1999). Understanding managed care: An introduction for health care professionals. Basel, Switzerland: S. Karger Publishers.
Robinson, J.C. (2001). The end of managed care. Journal of the American Medical Association, 285, 2622–2628.
Ross, D.R. (1997). Training residents in the era of managed care. In R.K. Schreter, S.S. Sharfstein, & C.A. Schreter (Eds.). Managing care, not dollars. Washington, DC: American Psychiatric Press.
Sabin, J.E. (1991). Clinical skills for the 1990s: Six lessons from HMO practice. Hospital and Community Psychiatry, 42, 605–608.
Sabin, J.E., & Borus, J.F. (1992). Mental health teaching and research in managed care. In J.L. Feldman, & R.J. Fitzpatrick (Eds.), Managed mental health care. Washington, DC: American Psychiatric Press.
Schreter, R.K. (1997). Essential skills for managed behavioral health care. Psychiatric Services, 48, 653–658.
Schuster, J.M., Lovell, M.R., & Trachta, A.M. (Eds.). (1997). Training behavioral healthcare professionals: Higher learning in the era of managed care. San Francisco: Jossey-Bass.
Shueman, S.A., & Shore, M. (1997). A survey of what clinicians should know. Administration and Policy in Mental Health, 25, 71–81.
Simon, S.R., Pan, R.J., Sullivan, A.M., Clark-Chiarelli, N., Connelly, M.T., Peters, A.S., Singer, J.D., Inui, T.S., & Block, S.D. (1999). Views of managed care: A survey of students, residents, faculty, and deans at medical schools in the United States. The New England Journal of Medicine, 340, 928–936.
Spruill, J., Kohout, J., & Gehlman, S. (1997). Changes in the health care delivery system: Recommendations for the education, training, and continuing professional education of psychologists. Washington, DC: American Psychological Association.
Strom, K., & Gingerich, W.J. (1993). Educating students for the new market realities. Journal of Social Work Education, 29, 78–87.
Strom-Gottfried, K. (1997). The implications of managed care for social work education. Journal of Social Work Education, 33, 7–18.
Stuart, G.W. (2001). Evidenced-based psychiatric nursing practice: Rhetoric or reality. Journal of the American Psychiatric Nurses Association, 7, 103–111.
Susser, E., Valencia, E., Conover, S., Felix, A., Tsai, W., & Wyatt, R.J. (1997). Preventing recurrent homelessness among mentally ill men: A “critical time” intervention after discharge from a shelter. American Journal of Public Health, 87, 256–262.
Talbott, J.A. (2001). Business as usual-no way to enter 2001. Psychiatric Services, 52, 7.
Technical Assistance Collaborative and the University of Pennsylvania Center for Mental Health Policy and Services Research. (1997). Managed behavioral healthcare: A training curriculum for administrators in public mental health and substance abuse organizations. Washington, DC: U.S. Center for Mental Health Services.
U.S. Center for Mental Health Services. (1993). Workforce training and development for mental health systems. Washington, DC: Author.
U.S. Department of Health and Human Services. (2000). Report of the Surgeon General' conference on children' mental health: A national action agenda. Rockville, MD: Author.
U.S. Department of Health and Human Services. (2001a). Older adults and mental health: Issues and opportunities. Rockville, MD: Author.
U.S. Department of Health and Human Services. (2001b). Mental health: Culture, race, and ethnicity-A supplement to mental health. A report of the Surgeon General. Rockville, MD: Author.
Von Korff, M., Katon, W., Bush, T., Lin, E.H.B., Simon, G.E., Saunders, K., Ludman, E., Walker, E., & Unutzer, J. (1998). Treatment costs, cost offset, and cost-effectiveness of collaborative management of depression. Psychosomatic Medicine, 60, 143–149.
Walter, D.A., deGroot, C.M., Ulven, T.P., Rosenquist, P., Daniels, A., Dewan, N.A., & Weathers, V. (2000). A new teaching program: Telemedicine, psychiatric residents, and issues germane to managed care. Academic Psychiatry, 24, 209–213.
Yager, J., Docherty, J., & Training psychiatric residents for managed care: Fundamental values and proficiencies, and an outline for a model curriculum. American Association of Directors of Psychiatric Residency Training Newsletter, Fall, 3–6.
Yager, J., Zarin, D.A., Pincus, H.A., & McIntyre, J.S. (1997). Practice guidelines and psychiatric education: Potential implications. Academic Psychiatry, 21, 226–233.
Zlotnik, J.L., McCroskey, J., Gardner, S., Gil de Gibaja, M., Taylor, H., George, J., Lind, J., Jordan-Marsh, M., Costa, V., & Taylor-Dinwiddie, S. (1999). Myths and opportunities: An examination of the impaact of discipline-specific accreditation on interprofessional education. Alexandria, VA: Council on Social Work Education.
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Hoge, M.A., Jacobs, S., Belitsky, R. et al. Graduate Education and Training for Contemporary Behavioral Health Practice. Adm Policy Ment Health 29, 335–357 (2002). https://doi.org/10.1023/A:1019601106447
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DOI: https://doi.org/10.1023/A:1019601106447