Assessing the effectiveness of a case management program

Health care for the homeless: what we have learned in the past 30 years and what's next

In the 1980s, the combined effects of deinstitutionalization from state mental hospitals and the economic recession increased the number and transformed the demographic profile of people experiencing homelessness in the United States. Specialized health care for the homeless (HCH) services were developed when it became clear that the mainstream health care system could not sufficiently address their health needs. The HCH program has grown consistently during that period; currently, 208 HCH sites are operating, and the program has become embedded in the federal health care system. We reflect on lessons learned from the HCH model and its applicability to the changing landscape of US health care.

Professionally Speaking

The nurse needs to have a working knowledge of the needs of the seriously mentally ill and their families and effective treatment modalities, including therapeutic use of self, networking and social systems, crisis intervention, pharmacology, physical and psychosocial assessment skills, psychosocial rehabilitation, collaborative skills, teaching skills, psychoeducation, management and leadership skills, research, group skills, psychopathology, relevant legislation, biological psychiatry, and community resources. The ANA Standards of Psychiatric and Mental Health Nursing Practice (1982) provides a broad framework for the nurse case manager.

Opportunities and risks in Philadelphia's capitation financing of public psychiatric services

The city of Philadelphia was one of nine sites selected by the Robert Wood Johnson (RWJ) Foundation and the U.S. Department of Housing and Urban Development (HUD) to receive five-year funding to improve the delivery, quality and cost efficiency of public mental health services to its chronically mentally ill population. As part of the RWJ project, the city plans to restructure its delivery and reimbursement system, creating a not-for-profit central authority which will function as a health insurance organization (HIO) responsible for coordinating and managing psychiatric care to Medicaid clients. Operating under a model of capitation, the central authority will employ diverse funding mechanisms to finance and manage service delivery. This paper examines the benefits and risks inherent in the reorganization of Philadelphia's mental health service system under a capitation financing model. Issues considered include cost and utilization patterns, treatment outcomes, providers and their staffing patterns, service mix and the overall impact of capitation on clients.