McMillen J Curtis, Fedoravicius Nicole, Rowe Jill, Zima Bonnie T, Ware Norma
George Warren Brown School of Social Work, Washington University, 1 Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA.
Adm Policy Ment Health. 2007 May;34(3):203-12. doi: 10.1007/s10488-006-0096-5. Epub 2006 Oct 26.
This study examined child welfare and mental health professionals' views of the quality of psychiatric services received by consumers of the child welfare system and explored root causes of perceived quality problems.
One hundred and thirty child welfare, mental health and court professionals participated in qualitative interviews individually or in groups. Data analyses identified perceived problems in quality and perceived causes of quality problems. Participants in member checking groups were then asked to comment on and further clarify the results.
The participants reported concerns related to overuse of psychotropic medication, overmedicated children, short inpatient stays, and continuity of psychiatric care. Overuse of psychotropic medications and overmedication were perceived to be driven by short evaluations, liability concerns, short inpatient stays and a lack of clinical feedback to psychiatrists from child welfare partners. Medicaid reimbursement policies were at the heart of several quality concerns. These problems contributed to a distrust of psychiatric practices among child welfare professionals.
These findings underscore the adverse effects of modern marketplace medicine coupled with low Medicaid reimbursement rates on quality of care for vulnerable groups. Child welfare and mental health professionals and their associated stakeholders may together possess substantial clout to advocate for a reimbursement system and structure that promotes quality service. The findings also point to a crisis of credibility toward psychiatric practice among social service and other non-psychiatrist mental health professionals. Efforts are needed to increase the capacity for psychiatrists and child welfare professionals to communicate effectively with each other and for psychiatrists to receive the information that they need from their child welfare partners to ensure accurate diagnosis and effective treatment.
本研究调查了儿童福利和心理健康专业人员对儿童福利系统服务对象所接受的精神科服务质量的看法，并探讨了感知到的质量问题的根源。
130名儿童福利、心理健康和法院专业人员单独或分组参与了定性访谈。数据分析确定了感知到的质量问题以及质量问题的感知原因。然后要求成员核对小组的参与者对结果发表评论并进一步澄清。
参与者报告了与精神药物过度使用、用药过量的儿童、住院时间短以及精神科护理连续性有关的担忧。精神药物的过度使用和用药过量被认为是由评估时间短、责任担忧、住院时间短以及儿童福利合作伙伴未向精神科医生提供临床反馈所驱动的。医疗补助报销政策是几个质量问题的核心。这些问题导致儿童福利专业人员对精神科医疗实践产生不信任。
这些发现强调了现代市场化医疗以及低医疗补助报销率对弱势群体护理质量的不利影响。儿童福利和心理健康专业人员及其相关利益攸关方可能共同拥有巨大影响力，以倡导建立促进优质服务的报销系统和结构。研究结果还指出了社会服务和其他非精神科心理健康专业人员对精神科医疗实践的信任危机。需要做出努力，以提高精神科医生和儿童福利专业人员相互有效沟通的能力，以及精神科医生从儿童福利合作伙伴那里获得所需信息的能力，以确保准确诊断和有效治疗。
