Biomedical subjects
Publications and source records attributed to L Bickman.
This article introduces the Fort Bragg managed care experiment. This study was a 5-year, $80 million effort to evaluate the cost-effectiveness of a full continuum of mental health services for children and adolescents. The article describes the development of the Demonstration, the program theory underlying intervention, and how this theory was tested.
The Fort Bragg Demonstration and evaluation was designed to test the cost-effectiveness of a continuum of care model of service delivery for children and adolescents. A crucial aspect of the evaluation was the measurement of the quality of services provided in the Demonstration. Two key service components were examined: intake assessment and case management. It was concluded that these key components of the continuum of care were implemented with sufficient quality to have the theoretically predicted effects on mental health.
This article summarizes the major findings of the Fort Bragg Evaluation and considers alternative explanations for the results. The evaluation found that the continuum of care provided a high-quality system of care but was more expensive and produced no better clinical outcomes than traditional services. The possibility of implementation failure at both the systems and services levels is considered and rejected as an explanation for the results. Support for the validity of the measurement, design, and the analysis is also presented. The implications for research and policy are described.
Explore the source record for details and available documents.
This article describes an $80-million project designed to test whether a continuum of mental health and substance abuse services for children and adolescents is more cost-effective than services delivered in the more typical fragmented system. The study showed that an integrated continuum was successfully implemented that had better access, greater continuity of care, more client satisfaction, and treated children in less restrictive environments. However, the cost was higher, and clinical outcomes were no better than those at the comparison site. The article concludes that reform of mental health systems alone is unlikely to affect clinical outcomes. Cooperation is needed between mental health providers and researchers to better understand how to improve services delivered in the community.
OBJECTIVE: To compare children and adolescents hospitalized under a continuum of care with those hospitalized under traditional insurance coverage. METHOD: With comprehensive data, logistic regressions were used to predict hospitalization and to identify its determinants. RESULTS: As expected, the probability of being hospitalized was much higher under traditional care. In addition, the predictors of hospitalization differed by site. Accuracy of predictions was high. CONCLUSIONS: Different kinds of children were hospitalized under a continuum of care than under a traditional insurance system. Hospitalizations under both systems were highly predictable.
The present review examines the relationship between disaster occurrence and psychopathology outcome for 52 studies that used quantitative measures of such a relationship. Descriptive and inferential techniques were used to examine relationships among four sets of variables: (a) the characteristics of the victim population, (b) the characteristics of the disaster, (c) study methodology, and (d) the type of psychopathology. A small but consistently positive relationship between disasters and psychopathology was found. The distribution of effect-size estimates was significantly heterogeneous, and this heterogeneity was partially accounted for by methodological characteristics of the research. When controlling for methodology, victim and disaster characteristics also contributed variance to the disaster-psychopathology relationship. Implications for future research are outlined in view of these results.
Relative to public services, private sector corporate mental health care has significantly increased since the late 1960s. The many tensions encountered in assigning public and private responsibility for mental health service give rise to significant value-laden questions for psychologists. These questions go to the heart of community mental health, deinstitutionalization, mental health policy development and evaluation, and many other areas in which psychologists are playing major roles. The public-private issue should be understood historically, from the twin vantage points of developments in general medicine and in mental health. Among the many public interest and public policy matters psychologists and others concerned with mental health should address are the emergence of corporate chains; the nature, cost, and quality of private sector services; the compatibility of profit motivation and the motivation to provide care; and patient selection issues (e.g., cream-skimming). Public and private cooperation and planning are certainly in order if the public interest is to be served in addressing the nation's mental health problems.
The utilization of evaluation results continues to be a great concern among professionals in the field. To increase the potential usefulness of evaluation, the feedback research approach is proposed as a method that is especially helpful in studies that fail to find program effectiveness. Going beyond the bounds of the evaluation framework and studying the problem for which the program was designed to ameliorate, evaluations that incorporate a feedback research component can provide clients with valuable information to guide further program development. This paper provides a description of the approach and an illustration of its use in an evaluation of a major international corporation's health improvement/stress management program.
Explore the source record for details and available documents.
Explore the source record for details and available documents.