The Impact of Health Care Reform: A Survey of Victim and Offender Treatment Providers

Abstract

Health care reform and, especially, managed care may have important consequences for providers of mental health treatment to sexual assault victims and sexual offenders. This study is an initial effort to identify the impact of changes in health care delivery systems on specialist providers. A survey was mailed to 380 therapists in Washington state who were identified as having specialized expertise in either victim or offender treatment. Of the total sample, 39% (N = 135) responded, including 64 providers of treatment to sexual offenders and 86 providers of treatment to victims of sexual abuse. A substantial minority of subjects (46%) reported having made changes in the type of client or treatment approach or seeing fewer clients (43%). A majority (68%) stated that requirements for documentation or reports had increased. Overall, three-quarters of respondents reported that managed care had at least a moderate level of impact on their practice. Differences between providers of treatment to victims and providers to offenders emerged only in the perceived degree of impact on practice, with therapists who work with victims reporting significantly greater impact. Comments from providers revealed that reductions in the number of sessions, increases in administrative expectations, and compromised confidentiality were considered significant threats to the delivery of effective services. It is suggested that the impact of health care reform is more likely to be experienced by victim treatment providers. Offender evaluation and treatment have rarely been covered by commercial insurance and are often sought because of external pressure. As a result, managed care will have less effect on current offender treatment practice.

Cognitive-Behavioral Group Treatment for a Sexually Abused Child and a Nonoffending Caregiver

“…Furthermore, the group treatment modality is a less costly format than traditional individual outpatient services and therefore may present fewer financial constraints (Sanchez & Turner, 2003). In addition, the pretreatment, midtreatment, and posttreatment assessments built into the protocol could prove helpful for clinicians required to document achievement of treatment goals (Berliner & New, 1999).…”

“…As was true in Amanda's case, many parents of children who have been sexually abused seek services for their children due to the disclosure of abuse and not because their children are experiencing symptoms of a specific psychological disorder. This can cause difficulties for clinicians who apply for reimbursement to managed care companies for services rendered, as documentation of a psychiatric diagnosis is usually required to justify service delivery (Berliner & New, 1999). Furthermore, if managed care restrictions required that only children diagnosed with a psychiatric disorder were allowed to attend group treatment, the inclusive and broad nature of Project SAFE would be affected.…”