This commentay focuses on the three components involved in the therapeutic process, the therapist, the treatment process, and the consumer, and addresses the impact of manual-based treatment on all three from the perspective of the managed care industry. The issues of concern in managed care include reducing the variation in practice, addressing the need to have effective case-mix adjustment, increasing accountability to the consumer, recognizing that not all care and not all practitioners achieve therapeutic objectives, and responding to accredtrtion initiatives. The implications for training new practitioners are examined.

Geological modelling is widely used to predict resource potential in subsurface reservoirs. However, modelling is often slow, requires use of mathematical methods that are unfamiliar to many geoscientists and is implemented in expert software. We demonstrate here an alternative approach using Sketch-Based Interface and Modelling (SBIM) that allows rapid creation of complex three-dimensional (3D) models from 2D sketches. Sketches, either on vertical cross-sections or in map-view, are converted to 3D surfaces that outline geological interpretations. A suite of geological operators is proposed that handle interactions between the surfaces to form a geologically realistic 3D model. These operators deliver the flexibility to sketch a geological model in any order and provide an intuitive framework for geoscientists to rapidly create 3D models. Two case studies are presented, demonstrating scenarios in which different approaches to model sketching are used depending on the geological setting and available data. These case studies show the strengths of sketching with geological operators. Sketched 3D models can be queried visually or quantitatively to provide insights into heterogeneity distribution, facies connectivity or dynamic model behaviour; this information cannot be obtained by sketching in 2D or on paper.Supplementary material:https://doi.org/10.6084/m9.figshare.c.5303043

Managed behavioral health care is a rapidly growing field that is becoming more complex, resulting in a blum'ng of traditional distinctions between different sectors of the industry. Practice guidelines and outcome research will become critical elements of future managed care approaches, and these elements will be pamt of an overall focus on improvement in the quality of care. Here a model of quality improvement that emphasizes differing levels of organization is proposed, and the role of psychology in the emerging health care system is discussed. The field of psychology has not ascended to a leadership role in the evolving health care system. Suggestions are made to move the field of psychology to assume a more significant role in the managed care system. Key words: managed health care, managed behavioral health care, industry and clinical trends in managed behavioral health care, quality improvement, prychology. [Clin Psycho1 Sci Prac 553-66, 79981Managed behavioral health care is a significant aspect of the evolving system of health care delivery in the United States-managed care. It is difficult to think of a phrase that evokes more varied responses within the health care community than the phrase "managed care." The phrase means different things to different people and unfortunately has taken on an emotive connotation. Despite the differing responses to managed care, the fact remains that the current health care system is becoming, and soon will be completely, organized around managed care principles. Managed behavioral health care will be the dominant organization of the delivery of mental health and substance abuse services by the turn of the century. In this article, we describe the series of activities, structures, and business arrangements that are now known as "managed behavioral health care."The general goal of this article is to provide a backdrop and context in which to read the articles on specific topics that follow. The articles included in this section are an important but small subset of many areas that need to be explored in depth to arrive at an understanding ofthe relationship between health care organizations and the delivery of behavioral health care services. This article is organized into four major sections, each ofwhich identifies key issues within the industry. In the first, we define and &scuss the core structural features of managed behavioral health care. All too ofien, managed care is viewed from a narrow or singular perspective. We attempt to identify the range of activities and processes that are identified with managed care. Second, we provide our own comments on emerging industry trends-both business and clinical. As we will show, there are no shortages of prognostications on this topic; however, we enter the foray and offer our own suggestions in this area. In the third section, we elaborate on one of the trends in our business-the focus on quality management and quality improvement. We provide a fiamework designed to understand quality management and quality improvement that...

The authors examine the use of two sets of criteria, both dealing with substance abuse level‐of‐care determinations, yet having two different functions, and frequently yielding different decisions: The Green Spring Health Services (GSHS) Medical Necessity Criteria for Utilization Management and The American Society of Addiction Medicine (ASAM) Patient Placement Criteria. The GSHS criteria are used for rendering medical‐necessity determinations for individuals covered under a managed care program. These determinations involve assigning the least restrictive and least intensive level of care capable of meeting the patient's needs through the use of the complete continuum of treatment service options, including outpatient detoxification, intensive outpatient programs, partial hospitalization programs, and supervised residential settings. The ASAM criteria are oriented toward treatment planning within substance abuse settings to coordinate patient placement between levels of care within a treatment program.

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