[Child and Adolescent Psychiatry: Acceptance of a New Ambulatory Care System]. / Kinder- und jugendpsychiatrische Versorgung: Akzeptanz eines neuen ambulanten Versorgungsmodells.

OBJECTIVE: To evaluate a new ambulatory care system in outpatient child and adolescent psychiatry based on the web-based Development and Well-Being Assessment (DAWBA). METHODS: We analyzed patient paths (flows), acceptance, satisfaction, and staff costs in the newly implemented care model. RESULTS: The new model was very well accepted by the respondents (DAWBA response rate: 92 %). A third of the patients registered with the psychiatric service in 2012 were not in need of psychiatric treatment and were therefore referred to other psycho-social services. The additional staff costs of $ 200 per case might be low compared to the saved costs due to the avoidance of inappropriate medical care. CONCLUSION: The new ambulatory care model proved to be effective, efficient and broadly accepted when resources are strictly limited.

[Concept of budget-based remuneration system for the fields of psychiatry and psychotherapy, psychosomatic medicine and psychotherapy, child and adolescent psychiatry and psychotherapy]. / Konzept eines budgetbasierten Entgeltsystems für die Fachgebiete Psychiatrie und Psychotherapie, Psychosomatische Medizin und Psychotherapie, Kinder- und Jugendpsychiatrie und -psychotherapie.

A new remuneration system is currently being developed for the hospital care of people with mental disorders. Last year, because of sharp criticism the option phase of the planned Flat-rate Charges in Psychiatry and Psychosomatics (Pauschalierende Entgelte Psychiatrie und Psychosomatik, PEPP) was extended by 2 years. During this time the Federal Ministry of Health wants to look for alternatives and possible starting points for the further development of care. Now, 16 scientific professional associations and organisations have presented a joint concept for a sustainable solution: the budget-based remuneration system. The system is suitable for ensuring that people with mental disorders are treated according to their particular needs and for promoting the appropriate further development of regional care in all treatment settings. It corresponds with the objectives as formulated in Section 17d of the Hospital Finance Act (Krankenhausfinanzierungsgesetz, KHG) and translates the PEPP system, which is currently being developed and focusses on average prices, into a performance-oriented, transparent budgetary system. The fundamental principle is the separation of the individual hospitals' budgeting on the basis of evidence-based, feature- and performance-related modules and billing in the form of advance payments from the agreed budget.

[Nonnative guidelines for allocating human resources in child and adolescent psychiatry using average values under convergence conditions instead of price determination - analysis of the data of university hospitals in Germany concerning the costs of calculating day and minute values according to Psych-PV and PEPP-System]. / Normative Vorgaben zum Personaleinsatz in der Kinder- und Jugendpsychiatrie statt Preisfindung anhand von Mittelwerten unter Konvergenzbedingungen.

OBJECTIVE: Despite substantial opposition in the practical field, based on an amendment to the Hospital Financing Act (KHG). the so-called PEPP-System was introduced in child and adolescent psychiatry as a new calculation model. The 2-year moratorium, combined with the rescheduling of the repeal of the psychiatry personnel regulation (Psych-PV) and a convergence phase, provided the German Federal Ministry of Health with additional time to enter a structured dialogue with professional associations. Especially the perspective concerning the regulatory framework is presently unclear. METHOD: In light of this debate, this article provides calculations to illustrate the transformation of the previous personnel regulation into the PEPP-System by means of the data of §21 KHEntgG stemming from the 22 university hospitals of child and adolescent psychiatry and psychotherapy in Germany. In 2013 there was a total of 7,712 cases and 263,694 calculation days. In order to identify a necessary basic reimbursement value th1\t would guarantee a constant quality of patient care, the authors utilize outcomes, cost structures, calculation days, and minute values for individual professional groups according to both systems (Psych-PV and PEPP) based on data from 2013 and the InEK' s analysis of the calculation datasets. CONCLUSIONS: The authors propose a normative agreement on the basic reimbursement value between 270 and 285 EUR. This takes into account the concentration phenomenon and the expansion of services that has occurred since the introduction of the Psych-PV system. Such a normative agreement on structural quality could provide a verifiable framework for the allocation of human resources corresponding to the previous regulations of Psych-PV.

[Hometreatment- an effective alternative to inpatient treatment in child and adolescent psychiatry?]. / Hometreatment -Eine effektive Alternative zu konventionellen Behandlungsformen? .

In many countries hometreatment (HT) offers a cost-effective alternative to hospitalization for children and adolescents with mental health problems requiring intensive mental healthcare. However, the database on HT varies as HT may refer to different models and settings of intensive outpatient treatment. In Germany HT is not used routinely in mental healthcare in child and adolescent psychiatry, therefore the data on HT in Germany, especially in child and adolescent psychiatry, are scarce although funding for studies investigating the effectiveness of HT is available. This review represents a comprehensive search in electronic databases (1980-2014) of literature on HT. It provides as well an overview of the underlying concepts of and the present evidence for HT. In addition, the evidence base on HT for specific child and adolescent mental health disorders is reviewed. Future prospects for the development of HT in Germany facing the upcoming change in health service commissioning (PEPP = «pauschalierendes Entgeltsystem in Psychiatric und Psychosomatik>>) are discussed, as HT in child and adolescent psychiatry, when accurately indicated, can be a valid alternative to inpatient treatment.

[The new hospital reimbursement system: a chance and a challenge to child and adolescent psychiatry or «much ado about nothing¼?]. / Das neue Entgeltsystem.

New legislation in the financing of psychiatric hospitals in Germany stipulates the introduction of a new reimbursement system for psychiatric child and adolescent psychiatric and psychosomatic hospitals in Germany by 2013. In several steps norms are to be empirically defined and services to be documented, and the current per diem system of hospital charges has to be replaced by a more specific system reflecting differences in the level of distinct patient groups. This discussion paper gives an overview of the legal framework as well as the risks and chances of the new system. An increased effort in documentation will be one of the clear consequences of the new system («much ado¼ ...). Psychiatric inpatient treatment will be much more transparent in detail, though it is not yet clear whether there will be a real improvement for patients (... «about nothing¼). The new system also offers the chance to introduce modern treatment concepts like home treatment. Such chances for innovation should be implemented to the benefit of patients.

Revenue: understanding insurance reimbursement and CPT coding in child and adolescent psychiatry.

Since the early 1990s, Current Procedure Terminology (CPT) has been the gold standard for billing for medical services. After reviewing the historical context of CPT coding, this article presents the coding methodology, discussion of specialty codes (psychiatric and other specialty codes of potential use to child and adolescent psychiatrists), and the evaluation and management (E/M) codes. Various coding options for common clinical encounters are also presented.

Implementation of MET/CBT 5 for adolescents.

Implementation of effective substance abuse treatment programs in community settings is a high priority. The selection of a proven cost-effective model is a first step; however, difficulty arises when the model is imported into a community setting. The Center on Substance Abuse Treatment selected a brief substance abuse treatment program for adolescents, the MET/CBT-5 program, determined to be the most cost-effective protocol in the Cannabis Youth Treatment trial, for implementation in two cohorts of Effective Adolescent Treatment grantees. A qualitative investigation of the protocol implementation with nine sites in the second cohort chronicled adaptations made by grantees and prospects for sustainability. The study found that agencies introduced adaptations without seeming to be aware of potential effects on validity. In most sites, sessions were lengthened or added to accommodate individual client needs, address barriers to client participation, and provide consistency with current norms of treatment. Implications for fidelity of future implementation projects are addressed.

A doubtful guest: managed care and mental health.

This article examines the ways in which mental health services have been affected by managed care and describes how to address some of the ethical conflicts that have always existed, but have been transformed immeasurably. It outlines the ethical dilemmas between the competing values of mental health providers and managed care, as well as the practical ethical considerations related to confidentiality, billing, and coding. It suggests that there can be no real improvement for mental health providers in the ethical minefield of managed care until they stop focusing on how distressed they are about it and start dealing with the larger, systemic issues in psychiatry and American health care. The article concludes by noting that the only way to effect meaningful change in the health care system is to combine knowledge with advocacy and to proactively define the standards needed to make the necessary choices.

Inpatient treatment in child and adolescent psychiatry--a prospective study of health gain and costs.

BACKGROUND: Inpatient treatment is a complex intervention for the most serious mental health disorders in child and adolescent psychiatry. This is the first large-scale study into its effectiveness and costs. Previous studies have been criticised for methodological weaknesses. METHODS: A prospective cohort study, including economic evaluation, conducted in 8 UK units (total n = 150) with one year follow-up after discharge. Patients acted as their own controls. Outcome measurement was the clinician-rated Childhood Global Assessment Scale (CGAS); researcher-rated health needs assessment; parent- and teacher-rated symptomatology. RESULTS: We found a significant (p < .001) and clinically meaningful 12-point improvement in CGAS following mean 16.6 week admission (effect size .92); this improvement was sustained at 1 year follow-up. Comparatively, during the mean 16.4 week pre-admission period there was a 3.7-point improvement (effect size .27). Health needs assessment showed similar gain (p < .001, effect size 1.25), as did teacher- and parent-rated symptoms. Improvement was found across all diagnoses. Longer stays, positive therapeutic alliance and better premorbid family functioning independently predicted better outcome. Mean cost of admission was pound 24,100; pre-admission and post-discharge support costs were similar. CONCLUSIONS: Inpatient treatment is associated with substantive sustained health gain across a range of diagnoses. Lack of intensive outpatient-treatment alternatives limits any unqualified inference about causal effects, but the rigour of measurement here gives the strongest indication to date of the positive impact of admission for complex mental health problems in young people.

Mental health provision for young offenders: service use and cost.

BACKGROUND: The full costs of accommodating and supporting young people in the criminal justice system are unknown. There is also concern about the level of mental health needs among young offenders and the provision of appropriate mental health services. AIMS: To estimate the full cost of supporting young people in the criminal justice system in England and Wales and to examine the relationship between needs, service use and cost. METHOD: Cross-sectional survey of 301 young offenders, 151 in custody and 150 in the community, conducted in six geographically representative areas of England and Wales. RESULTS: Mental health service use was low despite high levels of need, particularly in the community. Monthly costs were significantly higher among young people interviewed in secure facilities than in the community (pound 4645 v. pound 1863; P<0.001). Younger age and a depressed mood were associated with greater costs. CONCLUSIONS: Young people in the criminal justice system are a significant financial burden not only on that system but also on social services, health and education. The relationship between cost and depressed mood indicates a role for mental health services in supporting young offenders, particularly those in the community.