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Special Report:
Preventive Interventions
Under Managed Care: Mental Health
and Substance Abuse Services
Executive Summary
Programs and services that prevent substance abuse and mental
health disorders have the potential to lessen an enormous
burden of suffering and to reduce both the cost of future
treatment and lost productivity at work and home. The availability and
accessibility of these interventions to the millions of Americans whose
health care is provided by managed care organizations depend upon the
services’ status as covered benefits. At a time when cost containment is
a driving force in decisions about benefits, the ability to persuade managed
care enrollees to demand coverage for these preventive interventions
and to encourage managed care organizations to provide them may
be enhanced with evidence of their effectiveness and their positive impact
on cost.
To compile and disseminate that evidence,
the Offices of Managed Care in both the
Center for Mental Health Services and the
Center for Substance Abuse Prevention,
Substance Abuse and Mental Health Services
Administration, jointly supported this review
of the literature on preventive interventions
to promote mental health and the use of
tobacco, alcohol, and the misuse of licit and
illicit drugs. After an extensive search of
peer-reviewed journals, 54 articles from 1964
to 1999 that demonstrate positive outcomes
from preventive substance abuse and mental
health interventions are summarized in this
document. The following six preventive services
are recommended for consideration by
managed care organizations:
1. Prenatal and infancy home visits.
2. Targeted cessation education and counseling
for smokers, especially those who are
pregnant.
3. Targeted short-term mental health
therapy.
4. Self-care education for adults.
5. Presurgical educational intervention
with adults.
6. Brief counseling and advice to reduce
alcohol use.
While the documented state of the art is
in an early stage of development, intervention
research has produced solid evidence
that selected preventive programs and services
are associated with positive outcomes
and that the cost of providing them may be
offset by savings elsewhere in the health care
system. As efforts to expand this knowledge
base move forward, managed care stakeholders
can utilize available research results
to inform their decisions about coverage for
and provision of interventions with the
potential to prevent substance abuse and
mental health disorders.
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