Strengthening Clinical Research in Marriage and Family Therapy: Challenges and Multilevel Solutions.

There is a critical need for high-quality and accessible treatments to improve mental health. Yet, there are indications that the research being conducted by contemporary marriage and family therapy (MFT) scholars focuses less on advancing and disseminating clinical interventions than in previous decades. In this article, we describe challenges to increasing rigorous clinical research in MFT. We use systems mapping and the intervention-level framework to identify strategic goals designed to drive innovation in clinical research in the field. It is our hope this article encourages dialog and action among MFT stakeholder groups to support clinical science that will improve the health and functioning of families.

The Case for Insurance Reimbursement of Couple Therapy.

A case is made for why it may now be in the best interest of insurance companies to reimburse for marital therapy to treat marital distress. Relevant literature is reviewed with a considerable focus on the reasons that insurance companies would benefit from reimbursing marital therapy - the high costs of marital distress, the growing link between marital distress and a host of related physical and mental health problems, as well as the availability of empirically supported treatments for marital distress. This is followed by a focus on the major reasons insurance companies cite for not reimbursing marital therapy, along with a discussion of advances in several growing bodies of research to address these concerns. Main arguments include the direct medical offset costs of couple and family therapy (including for high utilizers of health insurance), and the fact that insurance companies already find it cost effective to reimburse for prevention of other health and psychological problems. This is followed by implications for practitioners and researchers.

Costs of treating depression with individual versus family therapy.

Depression is one of the most common concerns that bring clients to treatment. Although marriage and family therapy has been shown to be an effective treatment, little research exists regarding the cost-effectiveness of related services. In this study, we examined claims data for 164,667 individuals diagnosed with depression to determine (a) differences in the cost of treating depression according to type of therapy and license type, (b) differences in recidivism rates by age, gender, type of therapy, and type of mental health professional, and (c) differences in cost-effectiveness by therapy modality and type of professional. The results showed that services provided by marriage and family therapists resulted in the lowest recidivism rate, and family therapy services were the least expensive.

Preliminary estimates of cost-effectiveness for marital therapy.

Cost-effectiveness of marital therapy was examined beginning with a simple question: If government or health insurers paid for the screening and, where indicated, empirically supported treatment of 100,000 randomly selected married persons (i.e., 50,000 couples) from the general population, would the financial benefits outweigh costs? Two empirically supported forms of marital therapy, behavioral marital therapy and emotionally focused therapy, were considered in aggregate as possible treatments of choice. Marital therapy appears to be cost-effective when paid for by government to reduce public costs of divorce or when paid for by insurers to offset the increased health-care expenses associated with divorce. Implications and specific needs for future research to substantiate these conclusions are discussed.

Assessing the costs, benefits, cost-benefit ratio, and cost-effectiveness of marital and family treatments: why we should and how we can.

The vast majority of outcome studies examining the effects of marital and family treatments focus exclusively on indicators of and changes in familial functioning and individual members' psychosocial adjustment, but fail to measure, report, or analyze treatment costs, benefits, cost-benefit ratio, or cost-effectiveness. Because of growing concerns about spiraling health care costs, clinical and economic outcomes constitute equally important and complementary aspects of any evaluation of marital and family treatments. The twofold purpose of this article is to define different components of cost analyses of health-related interventions, including marital and family treatments, and to describe methods for calculating and integrating clinical and cost outcome information when evaluating marital and family treatments. There are significant opportunities to promote the use of such treatments by conducting and reporting the results of cost analyses.

Estimating the cost of direct reimbursement of marriage and family therapy under Medicare.

In this article, we investigated the estimated cost to the Medicare program for covering psychotherapy services provided by marriage and family therapists (MFTs). Historical trends were identified by using psychotherapy cost and utilization data for the years 1999-2001. Using these trends, projections for the years 2002-2006 were made with MFTs included as providers. Employing this methodology, the 5-year estimated net increase and gross increase in cost due to the provision of psychotherapy services by MFTs was found to be approximately dollar 10.5 million (or dollar 2.1 million per year) and dollar 13.9 million (or dollar 2.8 million per year), respectively. This represents an increase of less than 1/2 of 1% of the Medicare mental health budget, and less than .0015% of Medicare expenditures overall.

Behavioral couples therapy for male substance-abusing patients: a cost outcomes analysis.

The cost outcomes for married or cohabiting substance-abusing male patients (N = 80) who were randomly assigned to receive either behavioral couples therapy (BCT) or individual-based treatment (IBT) were compared. Social costs incurred by patients in several areas (e.g., cost of substance abuse treatment, support from public assistance) during the year before and the year after treatment were estimated. BCT was more cost-beneficial than IBT; although the monetary outlays for delivering IBT and BCT were not different, the average reduction in aggregate social costs from baseline to follow-up was greater for patients who received BCT (i.e., $6,628) than for patients who received IBT (i.e., $1,904). BCT was also more cost-effective than IBT; for each $100 spent on the treatment, BCT produced greater improvements than IBT on several indicators of treatment outcome (e.g., fewer days of substance use, fewer legal problems).

Cost-benefit and cost-effectiveness analyses of behavioral marital therapy as an addition to outpatient alcoholism treatment.

Thirty-six newly abstinent married male alcoholics, who had recently begun outpatient individual alcoholism counseling, were randomly assigned to a no-marital-therapy control group or to 10 weekly sessions of a behavioral marital therapy (BMT) or an interactional couples group. The cost-benefit analysis of BMT plus individual alcoholism counseling showed (a) decreases in health care and legal costs in the 2 years after as compared to the year before treatment, (b) a positive cost offset, and (c) a benefit-to-cost ratio greater than 1 indicating that health and legal system cost savings (i.e., benefits) exceeded the cost of delivering the BMT treatment. None of the positive cost-benefit results observed for BMT were true for participants given interactional couples therapy plus individual alcoholism counseling for which posttreatment utilization costs increased. Thus, adding BMT to individual alcoholism counseling produced a positive cost benefit, whereas the addition of interactional couples therapy did not. Individual counseling both alone and with BMT added showed substantial and significant cost savings from reduced utilization that substantially and significantly exceeded the cost of delivering the treatment; and the two treatments did not differ significantly on these cost savings and cost offsets. Individual counseling alone did have a significantly more positive benefit-to-cost ratio than BMT plus individual counseling due to the lower cost of delivering the individual counseling which was about half the cost of delivering BMT plus individual counseling. Cost-effectiveness analyses indicated that BMT plus individual counseling was less cost effective than individual counseling alone and modestly more cost effective than interactional therapy in producing abstinence from drinking. When marital adjustment outcomes were considered, the three treatments were equally cost effective except during the active treatment phase when BMT was more cost effective than interactional couples therapy. Study limitations are discussed.

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); coverage of screening mammography and Papanicolaou (PAP) tests, certified marriage and family therapists, and requirements for coverage and reimbursement of services of physicians in teaching settings--Office of the Secretary, DoD. Final rule.

This final rule revises the exclusions and limitations of the CHAMPUS regulation pertaining to preventive care and unnecessary diagnostic tests not related to a specific illness, injury, or definitive set of symptoms, to allow coverage for screening mammography and PAP tests on a preventive basis initially following the recommended guidelines of the American Cancer Society as a basis for coverage. The final rule also removes the requirement for physician supervision and referral for certified marriage and family therapists; requires all certified marriage and family therapists to accept CHAMPUS payment as payment in full; ensures that the relationship of certified marriage and family therapists is consistent with other mental health practitioners with comparable education and training; protects the CHAMPUS beneficiary from incurring added out-of-pocket costs for care rendered that is not part of the current CHAMPUS mental health benefits package; and better defines the specific requirements of existing CHAMPUS policies for coverage and reimbursement of services of teaching physicians and physicians in training. EFFECTIVE DATE: This part is effective February 22, 1994.(ABSTRACT TRUNCATED AT 250 WORDS)