Utilization Management for Residential Programs

Abstract

This paper reviews recent literature on utilization management (UM) in community-based supportive residential programs for people with behavioral disorders. Various approaches for facilitating placement and movement are discussed in the context of an effort to develop a residential UM process in New Haven, Connecticut. Recommendations are made for a residential UM process that may be applied to a range of service systems. It takes into account the methodological difficulties inherent in the development of generalizable decision tools.

The Clinical Relevance of a Socioecological Conceptualization of Self-Worth

“…Among individuals with or at-risk for a variety of psychiatric disorders, low self-worth has been endorsed as a key aspect of suffering and a factor that perpetuates disengagement from self-care behaviors including medication adherence and substance use treatment. For example, in interviews with young people who were homeless and had a history of a suicide attempt, feeling worthless was identified as being a central component of their suicidal ideation (Kidd et al, 2004). More specifically, feelings of worthlessness emerged from the perception that others “looked down on them and thought they were ‘worthless street trash’ and/or that nobody cared about them” and their own belief that their status as “a street youth, drug addict, or prostitute was of no worth” (Kidd et al, 2004, p. 440).…”

“…For example, in interviews with young people who were homeless and had a history of a suicide attempt, feeling worthless was identified as being a central component of their suicidal ideation (Kidd et al, 2004). More specifically, feelings of worthlessness emerged from the perception that others “looked down on them and thought they were ‘worthless street trash’ and/or that nobody cared about them” and their own belief that their status as “a street youth, drug addict, or prostitute was of no worth” (Kidd et al, 2004, p. 440). Studies of women recovering from childhood sexual abuse similarly highlighted shared feelings of insignificance and undeservingness (Saha et al, 2011).…”

“…More specifically, feelings of “worthlessness” or “unworthiness” appear throughout the codification of different psychiatric disorders; it is one of the nine symptoms present in major depressive disorder (“feelings of worthlessness or excessive or inappropriate guilt…”), an aspect of the depressivity personality trait associated with Borderline Personality Disorder, and a functional consequence of developmental coordination disorder (American Psychiatric Association, 2022, p. 183). Additionally, this concept arises as a key feature of suffering in multiple qualitative studies of individuals with substance use and mental health disorders (e.g., Batchelder et al, 2013; Batchelder, Gonzalez et al, 2015; Batchelder, Peyser et al, 2015; Kidd et al, 2004). Despite a few exceptions in early clinical psychology (e.g., Freud in 1917/1993 and famously referenced by Rogers in his “conditions of worth” in 1959), personality, developmental, and social psychologists have, in more recent years, largely and problematically regarded self-worth as synonymous with the construct of self-esteem.…”

Psychometric Properties of an Assessment for Mental Health Recovery Programs

“…Organizations that provide services to persons with severe and persistent mental illness are under increasing pressure to demonstrate that those services are achieving recognizable and measurable outcomes with respect to client functioning. The concept of “recovery” can be operationalized from either the perspective of the consumer of mental health services, or from the perspective of the agency providing those services, and current efforts to measure client outcomes have used both approaches (Kidd et al 2004 ; Test et al 2005 ).…”