Chapter 15: Employee assistance programs, private practice, coaching, and managed care

What is a health and wellness coach

Examine and develop healthier lifestyles

What is a career coach?

Helps individual/organizations improve their performances

What is a personal/life coach?

Helps people with range of challenging life issues

Tips for success in Private Practice?`

Website Marketing & Professional networking Ongoing training Professional peer-support Return phone calls Pay your bills Collect payments Take a marketing/business class Manage staff/external supports Manage your time/learn to say "NO" Be practical, but willing to take risks Believe in yourself ACA Private Practice Support

Certification of coaches

CCE offers BCC (board certified coach) NBCC affiliate Requirements vary depending on degree attainment. For Master's degreed persons 60 hrs. coaching training 30 hrs. coaching experience 1 professional endorsement Pass the BCC Exam ($279 -$40) 70 hrs. CE every 5 yrs. (4 in ethics)

EAP services

Counseling Consultation (e.g. supervisors, management, policy, unions, work groups) Training Information & educational activities Critical incident management -Traumatic/Crisis events Program implementation and management

Private Practice

Develop Niche Play therapy Trauma (e.g. EMDR) Spiritual-based counseling Opiate Addiction Grief counseling LGBTQQI Supportive Counseling What would be your niche? Other services in private practice: Supervision Consultation Community Service Pro Bono work

Upcoding

ο a practitioner might assign a more serious diagnosis than is warranted to obtain more authorized sessions

Downcoding

ο apply a less serious diagnosis, so that the client is able to receive treatment

Organizations

ο were grouped into nine areas of preventive health, with one of the largest being the alcohol, drug abuse, and mental health block grant (ADAMHA). In 1992, Congress passed the ADAMHA Reorganization Act, which abolished ADAMHA and replaced it with a new federal organization called Substance Abuse and Mental Health Services Administration (SAMHSA), a division of the Department of Health and Human Services (DHHS).

Possible Private Practice Services

ϖ Play therapy ϖ Trauma ϖ Spiritual-based counseling ϖ Opiate Addiction ϖ Grief Counseling ϖ LGBTQQI Supportive Counseling ϖ Supervision* ϖ Consultation* ϖ Community Service* ϖ Pro Bono work*

What are EAP goals?

Promoting healthy, congruent work culture Work with employees -Counseling -Education -Prevention and wellness Career planning Referral to ancillary services

What are the characteristics of EAP interventions?

Short-term Solution-focused Free to employees & families

Utilization review

ο Process by which an MCO reviews the diagnosis, treatment plan, and response to treatment before authorizing the use or extension of the client's benefit plan.

What is coaching?

"partnering with clients in a thought-provoking and creative process that inspires them to maximize their personal and professional potential (ICF, 2016).

What is an executive coach?

(aka. corporate, business, leadership) Help executives perform duties effectively

What are some considerations you should acknowledge in regards to private practice?

Benefits/challenges of working alone Office space Billing Paperwork Professional protection (aka. liability insurance) Attorneys and accountants Emergency contacts and procedures

What was Wickline v. State of California about?

Medical service case Provider held liable for HMO's decision to limit services Why? Court concluded provider failed to adequately protest HMO's decision

Muse v. Charter Hospital of Winston-Salem inc

Mental hospitalization case Provider discharged patient (Joe) when insurance expired Provider made decision based on payment rather than patient care Court concluded MH provider should determine services based on patient care needs not the needs of insurance companies.

Regulation of coaches

None! But....if you are a MCH, you are ethically obligated to provide services for which you are trained.

What is managed care?

a general term used to describe the systems of businesses and organizations that arrange for the financing and delivery of medical and mental health services.

Carve-out

ο The separation, or carving out, of specific types of health care from the overall benefit package. For example, the mental health and substance abuse portion of healthcare benefits may be "carved out" of the overall package and separately contracted with managed behavioral care organizations.

Rationing

ο Time-limited treatment imposed by MCOs also can affect client welfare in that it may compromise quality, providing the client with partial treatment, which may result in early termination. I. J. Miller (1996) refers to this practice as rationing and cautions that it is imperative for counselors to inform clients in advance about the possibility of rationed services.

What is the health maintenance organization act of 1973

designated federal funding for the development of managed care programs and required employers to offer managed care options to employees.

Managed care is a way to...

providing care a philosophy of care finance care control costs

What are employee assistance programs?

work-based programs that address the personal problems of employees and their family members to improve the productivity of the workforce.

case managment

ο A coordinated set of professional activities focused on treatment planning and assurance of treatment delivery that addresses clients' needs while maintaining good quality, cost-effective outcomes.

capiation

ο A form of payment in which the provider is paid on a per-member basis.