Abstract:Massachusetts was the first state to introduce a statewide specialty mental health managed care plan for its Medicaid program. This study assesses the impact of this program on expenditures, access, and relative quality. Over a one-year period, expenditures were reduced by 22 percent below predicted levels without managed care, without any overall reduction in access or relative quality. Reduced lengths-of-stay, lower prices, and fewer inpatient admissions were the major factors. However, for one population segment-children and adolescents-readmission rates increased slightly, and providers for this group were less satisfied than they were before managed care was adopted. Less costly types of twenty-four-hour care were substituted for inpatient hospital care. This experience supports the usefulness of a managed care program for mental health and substance abuse services, and the applicability of such a program to high-risk populations.

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In recent years, a general consensus has emerged regarding postvention activities in schools following completed suicides of teenagers. In this case study, standard postvention activities were carried out in a middle school after two youths from the same neighborhood committed suicide 3 months apart. Soon thereafter, a substantial increase in suicidal talk, threats, and attempts took place. Inadvertently, some of the postvention activities appeared to contribute to the romanticization and glorification of the deaths. Changes in postvention practices were made in order to defuse the atmosphere of "romantic tragedy," which in turn led to a decrease in suicidal behavior.

The summer of 2008 in Nassau County, New York, was marked by a historic season of human West Nile virus illness and West Nile virus activity in mosquitoes. The commissioner of Health of the State of New York declared a public health threat, and a decision was made to use adulticide for mosquito control. In contrast to prior years, the Nassau County Department of Health utilized the Incident Command System (ICS) to coordinate a multidisciplinary and multidepartment response to this public health threat. Implementing the ICS ensured coordination and communication between multiple county departments and organizations in the community. The effective response demonstrated that a local health department can mobilize to meet the needs of a public health threat through the use of the ICS. Nassau County Department of Health learned that the ICS is ideal for complex, multidisciplinary operations because of its clear chain of command, transparent organization structure, and flexibility.