Ashley’s Blog

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Care Coordination (It is Often Anything but Coordinated)

In recent years, our health and behavioral healthcare systems have begun to embrace alternative provider payment models designed to enhance the value of the services they deliver.  That such an approach is considered an “alternative” (or even innovative by some standards) is truly remarkable.  Imagine purchasing a car, dishwasher or gym membership without any consideration of their value (i.e., the benefits they confer relative to the resources expended to acquire them).  In no other domain would we commit our capital to goods or services with such little regard for their utility or impact on our welfare. So why has this peculiar exception prevailed within the healthcare industry for so long?  One could easily fill an ocean liner with actuaries, economists, policy specialists, industry insiders (and
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The Media Exposes Neglect of Adults with Mental Illness…Again

The New York Times and ProPublica recently published articles that exposed some of the failures of our supportive housing and community-based systems of care for individuals with serious behavioral health conditions.  These articles detailed the plight of some who have “slipped through the cracks,” so to speak.  Although most occupants of Office of Mental Health (OMH)-funded supportive housing programs manage their health conditions with relative success and enjoy a greater quality of life than would be available to them within institutions, there are surely some who are unable to secure the services needed to survive, much less thrive, in independent settings.  In recent decades the locus of care for our most vulnerable citizens has moved to the community, and alternatives to institutionalization in all its
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So what, exactly, is behavioral health “treatment?”

This question might seem disingenuous, or simply rhetorical, to anyone who is employed in the behavioral healthcare or social services fields.  I posit it is anything but. My agency is one of many that serves individuals with mental illness, substance use disorders and other special needs, and our workforce is comprised of paraprofessionals who possess training and experience in the provision of rehabilitative services to our clients.  They do not hold professional licenses (excepting those in supervisory capacities) nor do they deliver or receive reimbursement for behavioral health “treatment.”  In fact, they are continually reminded of this and advised to redirect any treatment-related issues to properly qualified personnel within our local clinics, hospitals, Assertive Community Treatment (ACT) programs and other “professional” settings.  In other words,