Provision of Mental Health Counseling Services Under TRICARE (2010) / Chapter Skim
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6 Findings, Conclusions, and Recommendations
6 Findings, Conclusions, and Recommendations
Pages 205-214
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From page 205... ...
The statement of task also asked for conclusions and recommendations regarding the independent practice of licensed mental health counselors under the TRICARE program, including recommendations for modifications of TRICARE policy on and limitations of independent practice. It asked the committee to pay particular attention to the preparedness of licensed mental health counselors to diagnose, treat, and appropriately refer persons with a set of illnesses and disorders that service members could be at special risk for.
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From page 206... ...
Despite an extensive search, the committee identified no literature bearing directly on the comparative quality and effectiveness of care provided by licensed mental health counselors. A review of research related to more general characteristics of mental health practitioners and the care that they deliver found that assertions of differential effectiveness among types of mental health providers are generally not based on empirical evidence.
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From page 207... ...
RECOMMENDATIONS The committee was tasked to offer: conclusions and recommendations for permitting licensed mental health counselors to practice independently under the TRICARE program, including recommendation regarding modifications of current policy for the TRICARE program with respect to allowing licensed mental health counselors to practice independently in the TRICARE program, paying particular attention to the prepared ness of licensed mental health counselors to diagnose, treat and appropriately refer persons with disorders of particular importance to TRICARE beneficiaries. In light of the information that it gathered and reviewed, it recommends that TRICARE replace its current quality management system for oversight of the practice of counselors through physician referral and supervision1 with a mental health quality monitoring and management system that incorporates the following two primary elements: [1]
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From page 208... ...
. The committee believes that a parallel requirement for counselors is appropriate.2 CACREP accreditation in clinical mental health counseling requires programs to provide evidence that student learning has occurred in a number of knowledge, skills, and practice categories that are desirable for an independent practitioner in TRICARE, including (CACREP, 2009)
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From page 209... ...
research relevant to the practice of clinical mental health counseling. A student must also demonstrate "the ability to recognize his or her own limitations as a clinical mental health counselor and to seek supervision or refer clients when appropriate." As the committee's research has documented, there is considerable variability in the examination requirements and numbers of hours of supervised clinical experience needed for state licensure as a mental health counselor.
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From page 210... ...
The committee believes that the requirements listed above, in concert with a comprehensive quality-management system, address the concerns expressed by DOD regarding the independent practice of mental health counselors and would help to ensure that TRICARE beneficiaries who seek counselors' services would receive high-quality care, including, as appropriate, referral to other professionals. The committee believes that it is important to maintain continuity of care for TRICARE beneficiaries who are receiving services from counselors under the current system.
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From page 211... ...
The committee notes that the recommendations regarding evidencebased practices, training and education, quality measures, and monitoring echo the observations offered by the mental health task force convened by DOD (DOD Task Force on Mental Health, 2007)
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From page 212... ...
As a step toward achieving the comprehensive system recommended here, the TRICARE Management Activity should consider requiring that organizations demonstrate that they have mechanisms in place to promote the delivery of evidence-based care, to apply quality measures to assess the performance of providers, to monitor outcomes, and to implement improvement strategies as a condition of their provider contracts. The committee observes that the barriers to establishing a robust quality infrastructure for mental health care are common to all providers and suggests that TRICARE may benefit by working with other government organizations -- such as the Department of Veterans Affairs and the Department of Health and Human Services' Agency for Healthcare Research and Quality, the Centers for Medicare & Medicaid Services, the National Institutes of Health, and the Substance Abuse and Mental Health Services Administration -- to conduct or support research to overcome the barriers.
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From page 213... ...
DOD Task Force on Mental Health.
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