Managed Care System

Topic 6: In-Service Scenario Analysis Directions: In 750-1,000 words, select one of the scenarios below to write an essay that answers the reflection questions. Use a minimum of three scholarly references to support your analysis. Scenario 1: Marcie is a new client and a 22-year-old female who works as a receptionist in a doctor’s office. She has just revealed to you during the intake session that she has recently lost interest in most activities, has been sleeping a great deal yet feels tired all the time, and sometimes wishes she could cease to exist. She mentioned feeling as though she has been “on an emotional roller coaster” during the past year, throughout her on-again/off-again relationship with a 35-year-old married man. The last breakup with him seemed final, and Marcie has felt herself sinking deeper and deeper into depression ever since. When probed further about suicidal ideations, Marcie admitted that she has considered killing herself, although she is uncertain whether or not she would actually do it. Scenario 2: A managed care clinician completed a utilization review and has just denied authorization for you to continue treating a client. You believe that the client could benefit from four additional sessions. At the same time, you understand that the managed care clinician must apply criteria of medical necessity to justify continued treatment, and you are aware that many of your agency’s clients have problems much more severe than your client’s problems. Reflection Questions: 1.      Does the primary diagnosis via the current DSM play a factor in what you would do as an administrator of the facility? 2.      What steps would ensure the safety of the client within a community/mental health care setting? 3.      Would communication be a concern within the agency? How would you, as the administrator address training to ensure privacy of the client? What could be included within the informed consent process to ensure emergency notification for the client? 4.      Make a list of all of the ways that you could try to ensure that the managed care system does not prevent you from giving your client the type and duration of treatment services that he or she needs. 5.      Categorize each of the items from question 4 into two groups reflecting those that would be considered professionally appropriate and ethical, and those that would be considered a violation of professional ethical standards.

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