Marriage and family therapists evaluate managed mental health care
This article presented a study that evaluated the experiences of marriage and family therapists who work in a managed mental healthcare environment. The overall purpose of the qualitative research within this article was to explore the perspectives of 26 MFT therapists involved in managed care, and examine their views on clinical practice, treatment, the therapeutic relationship, as well as the process of diagnosis. The researchers involved in the study included Lisa Christensen who is a Clinical Supervisor at a Family Center in Omaha, Nebraska and Richard Miller is an Associate Professor at the School of Family Life, at Brigham University in Provo, Utah. The affiliations of the researchers did not suggest any positive or negative bias, and because of the two authors being a different sex and holding a different career position, provided a more neutral stance. The researchers did provide some statistics and information regarding the state of the present health care system in the U.S., as well as included information reflecting what a managed health care system would include. Although the authors did provide contrasting systems, they did not include any comments or use language that would reflect personal beliefs, values or boas to either health care system.
The Review of the Literature
The authors of this study did a respectable job disclosing what previous research had been done on the topic of managed healthcare. This article discussed the previous research that had been done with mental health professional including psychologists, psychiatrists, social workers and counselors who work within a managed care environment. Using a quantitative approach as well as surveys to explore the mental health professional's feelings and concerns towards the managed care system has been a main focus of the previous studies. The authors of this article express that the perspective of the Marriage and Family Therapist has not yet been considered in research, nor has a qualitative research design been used. The authors expressed that the use of a qualitative design would create a more in-depth look at the personal experiences of the subjects of the study. This helped the reader understand why the authors wanted to continue investigating the topic using a different approach and.
The Research Question and Hypotheses
The authors defined their purpose for research at the beginning of the article and described why and how their qualitative research would be different and important to consider. The objective of the qualitative research done by Christensen & Miller (2001) is to help Marriage and Family Therapists to become informed of the positive and negative aspects of working with managed care clients. This awareness aims to help the MFT therapists alter their styles of practice to better fit the new structure of health care, with the main goal being to try and “find a balance between cost containment and quality of client care” (Christensen & Miller, 2001, p.510).
Although the authors did explain their objectives and goals for their research study, they did not provide a clear hypothesis or question. The lack of specifying what particular area or question they were going to evaluate, made it difficult for the reader to know what inner experiences the researchers was interested in, thus made it hard to identify what connections or relationships to consider important in the study. The researchers do provide a general objective for the study, but were clear with specific questions, therefore do not create a strong case for what significant research would be revealed.
The authors of the article used a qualitative research design to investigate the feelings of the MFT's working in managed care. The qualitative research design was appropriate because qualitative methods best adhere to exploring more personal and in depth experiences of what it is like to work in managed care, rather than where a quantitative research design would have focused little on experience and more on numbers. The specific qualitative approach used to analyze the data was Grounded-Theory procedures.
The Population and the Sample
A population of 26 marriage and family therapist were used in this particular study. To address this population, a qualitative strategy was employed. The qualitative strategy in this study used questionnaires to collect the data. The participants in the study sample were men and female with an average age of 44 years. A range of 30-60 years was used as the sample population range in the study. The majority of the participants were female (76.9%), who were comprised of European American, and Asian American. The participants held a either a masters degree or doctorate degrees (Christensen & Miller, 2001).
The study goes on to define the credentials of the participants, whereby, the participants were recorded to have triple, dual and general licenses and were certified medical health practitioner. The sample included participants from such medical fields as psychology and social work programs, with a percentile representation of 19.2% and 11.5% respectively. A critical review of the participants/sample presented indicates a bias representation on the sample definition. The study clearly defines part of the participants and leaves the rest undefined. 76.9% of sample representation was female, who were either European American or Asian American; while this sample size is defined, and the percentage representation of male is however not indicated in the study (Christensen & Miller, 2001). Since the objective of this qualitative research is to help marriage and family therapists to become informed of the positive and negative aspects of working with managed care clients; the sample chosen is questionable on the basis that it does not represent or does not cover a wide range of participants (race). This shows biasness in choosing the sample to represent the study; since the study objective and results were not aimed at a particular group (Creswell, 2009).
The authors used Grounded-Theory procedures and techniques to analyze the data. To establish codes, theme precision and specificity, the authors used the constant-comparative analysis method. In this method, to establish the data codes, every questionnaire was read at least two times; this was aimed at establishing identifying the codes that were important to the study question. A table representing the varying quote contents was developed; the table was used for verbatim documentation of the answers established (Gall, Borg & Gall, 2007). To establish the data depth and scope, the study used theoretical memos. Theoretical memos gave a description of the codes and a provision on how such codes could be used to establish a theme for a possible analysis (Creswell, 2009).
The coding procedures and possibility of major theme inductive emergence were ultimately verified (validity and reliability procedures) by other researchers. This practice was aimed at enhancement of codes and themes. The authors however fail to give raw data collected and the way such data was analyzed (Christensen & Miller, 2001). What the authors provide as data analysis is just a descriptive of the method used to come up to the results. Unavailability of the data incapacitates the reader to practically test on the methods used to analyze the data.
From the data analysis procedures, four themes were established. These included the following:
Clinical practice adaptations
Treatment duration/abandonment issues
Managed care effects
The authors categorized the research findings in terms of themes. This refers to the number of times a particular issue reoccurred. Any issue was considered to be a major theme depending on the frequency of occurrence. It is recorded that adaptation numbers varied with each participant. The response of each participant was compared with the standard procedures used to operate managed health care. In this case, some respondent's practices met the standards set for the managed care units (Christensen & Miller, 2001).
There are also classification and comparison made in response to medical practitioner paperwork and clinical practices. To describe these results, the authors have given examples in form of direct quotes from the questionnaires. In their presentation of the findings, the authors describe the experience of medical practitioners to managed health care. The authors successfully describe all the themes identified after data coding and theme definition. This is by carrying out a comparison of the different views from respondents and giving examples to clarify on the themes (Christensen & Miller, 2001).
Summary and Discussion
The authors summarize the MFTs experience with managed care clients in two ways. First the authors argue that managed care clients brought issues in the clinical practice such that the therapist had to find a way of accommodating them at the work place. Such issues brought more paperwork, rules and regulations for the therapist to observe. At this point, the authors conclude that working environment for the MFTs became more difficult. In the second issue recorded in their summary, medical practitioners were faced with philosophical and ethical issues.
In describing this problematic issue, the authors note that other medical practitioners, apart from MFTs are faced with such ethical issues (Keefe & Hall, 1999; Small & Barnhill, 1998). In conclusion, the authors note that it's the responsibility of the managed care companies to provide the fundamental rules and regulations that govern the number of sessions that are approved by the management on each case. Policies that reduce the health care quality and diminish therapist boundaries need also needed to be modified. The treatment of couples was identified to be a major dilemma facing many therapists. This is because; their treatment has not been approved by many managed care companies. Although this issue emerged as a major theme in the study, the authors concluded that it has been identified as an issue affecting health care. This is because; problems related to relationships have for a long time left uncovered by major insurance companies. This was therefore identified as a major issue that needed to be identified in the marriage and family therapy.
In making these conclusions, it is however important to note that the study was faced by a major limitation in that the data was only collected from one state. This means that the findings cannot be generalized for they practically represent responses from a small sample or a group of people. The results therefore need to be verified by other or further studies on these issues to generalize the conclusions.
Keefe, R. H., & Hall, M. L. (1999). Private practitioners' documentation of outpatient psychiatric treatment: Questioning managed care. Journal of Behavioral Health Services Research, 26, 151-170.
Small, R. R, & Barnhill, L. R. (1998). Practicing in the new mental health marketplace: Ethical, legal, and moral issues. Washington, DC: American Psychological Association.
Christensen, L. L. & Miller, R.B. (2001). Marriage and family therapists evaluate managed mental health care: A qualitative inquiry. Journal of Marital and Family Therapy, 27(4), 509-514.
Creswell, J. (2009). Research design: Qualitative, quantitative, and mixed methods approach. Thousand Oaks, CA: Sage Publications.
Gall, M., Borg, W. & Gall, J. (2007). Educational research: An introduction. New York, NY: Addison Wesley Longman.