Week 8 Term Paper

Introduction

Louisiana Medicaid has provided health care to its members for quite some time now. Mostly, the behavioral health system has incorporated the consumers, the community and other health care providers in the process of giving efficient services to the members (Ortenberg & Roth, 2013). Their focus has been to improve access to the treatment services that have become vital to people. Additionally, the system ought to expand the services that are being provided by the Louisiana Medicaid health behavior systems. The demand for that service has grown, and it’s the duty of the system to expand the services to meet the request. Finally, it’s also the goal of the health behavior system to provide care that is accessible to all at ease.

Description of Behavioral Health Services

The following are some of the services provided at the Louisiana Medicaid behavior care

Addiction services- This includes the individual-centered outpatient services. The health care provider provides rehabilitation and recovery process to the patients. The health care provider will help in the promotion of skills that are responsible for coping with the current lifestyle. The department will assist in the elimination of substance use symptoms and behaviors that may prevent recovery.

Crisis intervention- The department is responsible for the individuals experiencing a psychiatric crisis. When a disaster occurs, victims may be affected by such occurrences may cause psychological problems. Therefore, the crisis intervention program will do a preliminary assessment then followed by a crisis resolution. After that, the medical professional will then do referral and linkage to the relevant community service for further treatment processes.

Group psychotherapy- in this section, a group of individuals with similar behavior challenges will have to sit together and share their experiences. Apparently, they share personal coping skills and practices. Typically, the session will help the patient to identify which method works for them and open up to help in the recovery process.

Psychosocial rehabilitation- The section mainly helps in the elimination of behaviors or barriers that may prevent the healing of the mental Illness. Such behaviors may be to stay away from friends who smoke if the patient if fighting an addiction of smoking.

Care conference- It involves a group of medical practitioners meeting to discuss the treatment of a crisis.

Care Advocacy

The care advocacy in this field is very active and mainly focusses of the various activities that promote all the Medicaid’s members full stabilization after an illness or the whole recovery process of the member. Apparently, the care advocacy unit is concerned with ensuring that the members fully participate in their care. Mostly, various integrated intervention methods have been created that have been fully operational in the member's services, evaluating the members who are at risk and the assisting and delivery of the required care (Griffin, Gooch, Beltrán, Sutherland, & Barsley, 2000). Some of the services that they fully participate in include;

· Ensuring that the medical and behavioral care system is incorporated. This is done through open communication between all the parties that are involved.

· The care advocacy also reaches to members and educates, assess the available risk and also provide care whenever it may be needed.

· They also do medical consultations with the medical staff to ensure that everything is up to date with the current healthcare standards.

· The care advocacy supports members who seek treatment and make a follow up for quality assurance.

Its availability

The service is available for business operations as from Monday to Friday for 8 hours. However, they have increased their staff, and the service is now available on a 24-hour basis including the weekends, they are available to handle any emergency situations, manage the crisis that may erupt from the members and finally, they actively answer questions concerning the care advocacy process.

Home and community-based service

The service is available to adolescents, the aged and other members that may have a severe mental illness. They assist in the recovery process by trying to bring back the quality of life that they once enjoyed. The service uses network providers to instill back several skills that may help the affected members increase their capacity to thrive at home, or their work places, the skills targeted are normally the ones that were lost when the member was in that severe condition.

Peer services and support

The care advocacy has a department that supports community service. In this unit, the various specialist uses their skills, expertise, and training helping the community in achieving recovery and prevention programs. Interestingly, these certified specialist are not limited to the members only but also to the members of the family or the member's guardians. Apparently, their major role includes providing information on health care and facilitation of access to medical services and resources. Over the years, the department has achieved greatly as it makes the society to be more connected and increase the people’s engagement in search of better health care.

Assessment

Every member must be assessed of his or her behavior health. The Louisiana Medicaid under behavior health ensures that all members have their clinical records updated from time to time. The clinical assessment has proved to be useful as the record of members can be traced whether they seek the medical services elsewhere. Typically, the records contain bio-psychosocial history that contains all the information of the member (Ruble, Heflinger, Renfrew, & Saunders, 2005). It included their previous and current providers listing all the diagnosis that the patient had to undergo. Additionally, the record will have the development history, the education history, the cultural background and the community resource that the member can access. Mostly, the records have simplified the providence of better health care as the specialist can know what diagnostic method would work on a certain member depending on the experience that they had with the other members.

Assisting with recovery

All the medical practitioners within the system are required to help the members in all of their recovery process. Apparently, they are supposed to give them all the information that requires that may help in the decision-making process of the member. The members always have the right to any information regarding the health care provided to them. The information can be useful as it helps in promoting participation of the member in the whole recovery process. Additionally, the practitioners are allowed to discuss all the possible treatment options with the member. Besides that, they are required to outline potential risks and benefits of a chosen recovery plan.

Coordination of Care

The coordination of care involves the communication between the primary physicians and other professionals on the same field related to the care of the member. The process was not easy first, but with the help of the network providers, the process has overwhelmingly been simplified. Firstly, the member has to give written consent to the current physician allowing them to exchange relevant information with other professionals being involved. The process has made it easy for the coordination and the management of care of the member. Communication regarding the time of admission, during the treatment process and at the end of the care must be provided as a member is transferring to another professional.

The coordination of care accrues some various benefits to both the member and the health care providers. Firstly, it helps in the creation of a very comprehensive care plan that could be used for a long time. Future health care providers would have smooth time in determining the cause of a problem or a diagnostic approach that would be required for a specific member. Secondly, providing a clinical record to the inheriting medical professional ensures that there are no adverse medical interactions. It happens mainly on the psychotropic and the non-psychotropic patients. Without a proper record, poor diagnosis can be made on those patients. On the third point, coordination of care provides for better and managed treatment, which will then be supplemented with a follow-up. Finally, it helps with the safe transition of the patients.

The communication process may sometimes be affected by various challenges like when a member is not ready to give consent of the exchange of these personal records. In such an occurrence, the health care professional will have to record it in the clinical registry, which will then be transferred to the next physician. However, the network providers have devised some means that will ensure the process of coordination of the members care if effective and efficient (Gagnon, et al., 2009). Essentially, there is the written consent of the member to exchange relevant information as discussed earlier. Then, the network providers have devised two critical standards that would be followed to increase efficiency. First, the diagnosis process must be put into the clinical records in case the patient gets another physician. In the Louisiana behavior health, if a patient had been to any physician, he would not be admitted to the medical facility without the previous clinical records. Secondly, an assessment should be made which will include the member’s evaluation, the diagnosis itself and the recommended treatment plan. Apparently, the many steps in the coordination of care are to ensure that the member gets the best medical attention for the behavior complications.

Sentinel Events

In some instances in the process of providing health care to the members, a medical practitioner may make a grave or unexpected mistake that may harm the patient seriously. They may sometimes die or suffer serious injuries. In such a scenario, the system has outlined procedures such as the formation of an investigative committee that would conduct and investigate to determine the cause of the problem. A member is supposed to honor the investigations and wait for compensation by the system. Sentinel occurrences ate considered accidental, in fact, they rarely occur.

Provider Satisfaction Surveys

The behavioral health care system takes a sample of the members to survey different satisfaction levels. The members are required to answer some questions regarding the service provided and on the areas that they would require an improvement. Quality health care has been the primary goals of Louisiana Medicaid; therefore, the surveys have been helpful in improving health care providence. Additionally, the clinicians responsible for taking the survey are supposed to be truthful and professional in their duties.

Conclusion

In conclusion, the Louisiana Medicaid behavior health system has some departments that have enabled it to be effective and efficient. The care advocacy department, for instance, has been making follow up to the patients to ensure that a full recovery process is put in place. Apparently, much effort has been put in ensuring that the health care is accessible to all people. Additionally, the system has been improving the providing of the services depending on the survey reports that are provided by the clinicians.

References

Gagnon, M. P., Légaré, F., Labrecque, M., Frémont, P., Pluye, P., Gagnon, J., & Gravel, K. (2009). Interventions for promoting information and communication technologies adoption in healthcare professionals. The Cochrane Library.

Griffin, S. O., Gooch, B. F., Beltrán, E., Sutherland, J. N., & Barsley, R. (2000). Dental services, costs, and factors associated with hospitalization for Medicaid‐eligible children, Louisiana 1996–97 . Journal of public health dentistry, 60(1), 21-27.

Ortenberg, J., & Roth, C. C. (2013). Projected financial impact of noncoverage of elective circumcision by Louisiana medicaid in boys 0 to 5 years old . The Journal of urology, 190(4), 1540-1544.

Ruble, L. A., Heflinger, C. A., Renfrew, J. W., & Saunders, R. C. (2005). Access and service use by children with autism spectrum disorders in Medicaid managed care. Journal of autism and developmental disorders, 35(1), 3-13.