Mental health assessment of young children in a managed care environment

Managed behavioral health care is widely perceived as a threat to traditional practice in mental health at the expense of quality care. Although such assertions by mental health providers may prove to be justified in certain circumstances, they should not serve to obscure the quite reasonable public health motives behind managed care and the favorable effect managed care organizations may ultimately have on clinical decision-making and practice. By compelling practitioners to more clearly articulate the basis for their clinical judgments and by increasingly requiring evidence to support such judgments, they discourage the application of ill-considered, sometimes inappropriate, and occasionally iatrogenic evaluation and treatment interventions. In the future, there is significant danger that developmental assessment and treatment procedures for young children will be inappropriately constrained and diminished. This is especially true if those who work with young children fail to use the tools available to them to make the case for the best of current practice, whether a clearly stated clinical rationale, a formal appeal, the advocacy of our health professions, or applied clinical services research. The practices of our health plans need to be understood by providers in the context of managed care values. Primitive systems should not be confused with corrupt systems. Although undoubtedly the latter exist, they do not necessarily predominate. Within a managed care context and with due respect to managed care assumptions, it is possible to bring utilization management and contemporary practices in developmental assessment into closer alignment, ultimately to the benefit of children who need them.