Program Shows Rehabilitation Can Thrive Under Capitation

Excerpted from:MHW,vol.6 #30; 7-29-96

Southern California, and Los Angeles County in particular, has weathered its
share of financial storms over the last year. But despite the setbacks,
innovation on the psychosocial rehabilitation front continues, offering a
model for states seeking to bring alternative mental health services into
their own managed care plans. (NOTE: This seems to be case in many places:
money is avail for 'model' programs that allow people to write papers, but
not for mass implementation of known programs that work.-dj)

Characteristics of large urban health systems create a unique set of
challenges, and if a wide-scale capitated psychosocial rehabilitation program
can succeed in Los Angeles County, it promises to have a strong influence
over similar approaches in other urban areas.

Managed care programs need a single point of accountability for meeting the
needs of persons with serious mental illness, said Martha Long , director of
the Village Integrated Service Agency. I think it needs to be through
psychosocial rehabilitation. The Village is not just running a program
under the managed care label, but is providing services in a rehabilitative
manner, Joseph Ruin, the Villageis associate director told MHW.
The Village provides intensive case management, substance abuse support
groups, money management, social services, recreation, employment services
and medication management.
The program strives to offer its clients isupported integration with a
self-help orientation that varies with level of need. The pilot program does
not discharge members but instead adapts to their level of need. We're in
it for the long haul,Ruiz said.
Some people can go for two or three years before they require
hospitalization or other intensive services. As members of the Village they
get the services.
In terms of reducing hospital costs and improving outcomes, the program has
shown to be effective, but it also spends more on rehabilitation services
than does the traditional system. In addition, many of the Village's clients
previously were receiving few or no services, which accounts for a short term
increase in cost. This program is not in itself cost-effective; it's more
cost efficient, Ruiz said.

[The Village: (310)-437-6717]

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