Provision of Mental Health Counseling Services Under TRICARE (2010)

Several terms are used in this report to refer to concepts in the field of mental health care and counseling. The committee’s working definitions of those terms are listed here.

Counseling: An array of noninvasive and nonpharmacologic interventions whose primary focus is on promoting coping and facilitating growth related to life-cycle transitions.

Credentialing: The systematic process of screening and evaluating qualifications and other relevant evidence—such as licensure, education, training, and clinical experience—to ensure that specific requirements are met.

Diagnosis: Comprehensive and systematic assessment of a person presenting for mental health care to gain an understanding of the person’s clinical condition and determine a plan of treatment. Three issues are critical to understanding the nature of this task:

1. The designation of a specific Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) diagnosis is generally considered an essential element of “making a diagnosis.” However, making a DSM or ICD diagnosis is only one element of a comprehensive evaluation. To

formulate an adequate treatment plan, the clinician will invariably require considerable information about the person being evaluated beyond that required for a DSM or ICD diagnosis. Furthermore, these systems are intended to be used by people who have appropriate clinical training and experience in diagnosis and their criteria are meant to serve as guidelines to be informed by clinical judgment, not to be used as a cookbook.

2. Unfortunately, the term mental disorder implies a distinction from physical disorder. This is a reductionistic anachronism of mind–body dualism. A compelling literature documents that there is much “physical” in “mental” and “mental” in “physical.”

3. A diagnostic assessment is not a one-time event that occurs at the initiation of care. Diagnostic assessment is a longitudinal process that requires continuing, systematic data collection and integration of the data into a continually evolving treatment plan.

Licensure: A document—a license, certification, or registration—that grants official or legal permission to practice in a state or other jurisdiction.

Privileging: The process by which the scope and content of patient-care services are defined for an individual provider. Privileging by a healthcare organization is based on an evaluation of a provider’s credentials and performance in delivering services competently, and it authorizes the provider to perform the duties outlined in his or her professional scope of practice.

Psychotherapy: An array of noninvasive and nonpharmacologic clinical interventions whose primary focus is on remedying symptoms, behaviors, and affect associated with psychopathologic conditions; fostering emotional growth; and improving functioning. (Note that most insurance plans do not reimburse for “growth” alone, in that it is not considered to be a so-called medical necessity.)

Quality: The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. Quality incorporates

six aims: safety, timeliness, effectiveness, efficiency, patient-centeredness, and equitableness. Good-quality services are provided in a culturally sensitive and technically competent manner with good communication and shared decision making. Quality is often thought of as containing three main components: structure, process, and outcomes of care (Donabedian, 1998).

Scope of Practice: The range of activities (the ability to perform diagnoses, deliver treatment, or prescribe medications, for example) or procedures that a medical professional is permitted to perform under the law, their license, a regulation, a provider agreement, or other system of conduct. A scope of practice may be defined on the basis of a professional’s level of education, training, or experience, or on the basis of an assessment of the professional’s demonstrated competencies. It may include a list of circumstances under which the activities or procedures must be performed under some form of supervision.

Treatment: An array of procedures and interventions intended to alleviate illness and improve or if possible restore health and improve function in affected people.

Donabedian A. 1998. The quality of health care: How can it be assessed? Journal of the American Medical Association 260(12):1743-1748.

This page intentionally left blank.