Whether or not a provider has entered a case-rate or capitation arrangement, there is still wiggle room on how one approaches behavioral health clinically. Typically, the MCO will have fee ranges for individual and group therapy. The MCO regulates costs by limiting the number of units. It is the provider, though, who best understands the needs of the individual and what will work. Out of habit, and a need to keep their schedules filled, therapists scheduled clients on a weekly, biweekly or other regular basis.
Clients go through growth spurts, then reach plateaus where they consolidate their gains.
That dependence can be very necessary for clients who are highly vulnerable. With a caseload of 35 spread across three counties, and only two days available per week, necessity gave birth to invention. The press of service demand made brief therapy the only possible approach. The author found himself seeing individuals four to six times over an average period of six to eight months. It happened mostly through using prescriptive and cognitive-behavioral therapy.