Handbook Of Quality Assurance In Mental Health

professional-standards-review organizations (PSRO) in defining quality of care for the Medicare program; it is a "shared responsibility of health professionals and government to provide a reasonable basis for confidence that action will be taken, both to assess whether services meet professionally recognized standards and to correct any deficiencies that may be found" (p. 14). Similar pronouncements have been made for the quality assurance activities of the Department of Defense's CHAMPUS program and of the 1980s successor to the PSROs, the federally designated peer-review organizations (PROs), established to ensure quality and utilization-efficient care for Medicare. Links between the federal and state gov ernments and between professional associations and private review entities have been developed to make this "shared responsibility" manifest in the delivery and reimbursement of health services. This responsibility is seen in light of both pro fessional and legal accountability, a view noted by Gibson and Singhas (1978) and Alger (1980). Accountability, then, becomes a concentric concept that elaborates on the pure view of quality and reflects the federal government's consumer protection activities during the 1970s. The Joint Commission on Accreditation of Hospitals (JCAH), which has pro vided another primary historical leadership role in defining quality assurance, has promoted the evolution of the concept of resource limitations as a part of the defini tion of quality assurance.

For the first time in history, behavioral health providers are expected to understand and participate in activities intended to access and improve the quality of services they provide. This handbook is designed as a general resource in the field of behavioral health quality management for a very diverse group of readers, including graduate and undergraduate students, payors, purchasers and administrators within managed care organizations, public sector service system planners and managers, applied health services researchers and program evaluators. This volume provides a comprehensive context for the development of quality management (QM) in health services - behavioral health in particular - as well as an overview of tools, techniques, and programs reflecting QM in practice. It also offers perspectives on both internally- and externally-based QM activities.

In keeping with previous editions, this manual incorporates responses to recent significant changes in the field of peer review, quality assurance, and utilization review, including increased involvement of federal and state agencies in quality of care review. Not intended as a standard for psychiatric care, this manual offers useful guidelines to those involved in quality assurance activities within hospitals and other health care organizations.

Clinicians who understand mental health care administration in addition to their clinical fields are likely to be valuable to the organizations in which they work. This handbook is an accessible source of information for professionals coming from either clinical or management backgrounds. Sections offer coverage in: mental health administrative principles, mental health care management, business, finance and funding of care, information technology, human resources and legal issues.

Clinicians who understand mental health care administration in addition to their clinical fields are likely to be valuable to the organizations in which they work. This handbook is an accessible source of information for professionals coming from either clinical or management backgrounds. Sections offer coverage in: mental health administrative principles, mental health care management, business, finance and funding of care, information technology, human resources and legal issues.

For two decades, I have been responding to questions about the nature of health psychology and how it differs from medical psychology, behavioral medicine, and clinical psychology. From the beginning, I have taken the position that any applica tion of psychological theory or practice to problems and issues of the health system is health psychology. I have repeatedly used an analogy to Newell and Simon's "General Problem Solver" program of the late 1950s and early 1960s, which had two major functional parts, in addition to the "executive" component. One was the "problem-solving core" (the procedural competence); the other was the representa tion of the "problem environment. " In the analogy, the concepts, knowledge, and techniques of psychology constitute the core competence; the health system in all its complexity is the problem environment. A health psychologist is one whose basic competence in psychology is augmented by a working knowledge of some aspect of the health system. Quite apparently, there are functionally distinct aspects of health psychology to the degree that there are meaningful subdivisions in psychological competence and significantly different microenvironments within the health system. I hesitate to refer to them as areas of specialization, as the man who gave health psychology its formal definition, Joseph Matarazzo, has said that there are no specialties in psychology (cited in the editors' preface to this book).