This article reviews the forces leading to the current emphases on managed mental health systems. Rapidly escalating costs, especially for inpatient care, and associated concerns for quality and patient outcomes, have led third-party payers and employers to demand more eifective cost and quality controls. The article describes and illustrates methodologies for managing mental health costs, and reviews issues related to evaluating the impact of managed care on costs and quality of patient care. This special section is a testament to the fact that managed care is beginning to affect the practice of professional psychologists, and more important, that this trend is likely to continue.To practice effectively within such an environment, psychologists need to understand the forces promoting the growth of managed care and the ways they stand to be affected by and potentially to benefit from this major shift in the way mental health and substance abuse treatment services will be delivered in the future (Bloom, 1990). Although professional psychologists have not been primarily responsible for creating the cost trends that have stimulated managed care in mental health, they, like all other professionals, will be affected. It will not suffice to proclaim professional innocence, although professional sophistication on the issues may have some positive effects.This article has four major purposes: (a) to review national trends in general health care costs and in health service delivery systems reacting to these cost trends; (b) to review comparable trends in mental health, drug, and alcohol treatment costs and service delivery systems that echo those in the general health system; (c) to make the case that managed care in the mental health industry arises as a marketplace response to concerns for service cost, quality, and accessibility on the part of employers and insurers; and (d) to describe a general framework for understanding the structure of managed mental health care, while pointing to opportunities for psychologists who have cost-effective services to offer in a cost-and quality-competitive market.

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While acknowledging the importance of primary prevention, mental health agencies continue to devote their major resources to diagnosis, treatment, and rehabilitation efforts. This paper attempts a comprehensive understanding of the multiple and related barriers to the design and implementation of preventative programs. Barriers are discussed under the categories of definitional problems, systemic complexity, difficulties of demonstration, and lack of constituent demands.

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After the introduction of an operational approach to program evaluation, this article focuses on the application of program evaluation to child mental health services. The current state of assessment plans and techniques is discussed, along with the complications unique to situations in which the client is a child. New directions emerging in the field and mandated by legislation are discussed in terms of implications for new program evaluation planning and the training of family service professionals. (25 ref)