While the controversy over managed care may be garnering more attention in the public and media, many Boston College faculty - and some students - have already experienced its impact on the health and human services fields.
"A few of our doctoral students have seen the supervisors at their practicum sites laid off due to cutbacks or reorganization," said Prof. Mary Walsh (SOE), chairwoman of the school's Counseling, Developmental Psychology and Research program. "The students were devastated. This was obviously a very compelling example of the changes - both positive and negative - happening in the field because of managed care."
Preparing students for those changes has become a major challenge for Walsh and many of her colleagues, as managed care becomes the prevalent form of health care. With its emphasis on short-term therapy, cost-effectiveness and outcomes, managed care requires an orientation for the next generation of nurses, psychologists, social workers and other professionals which differs from that of their predecessors, faculty say.
Yet, even as these faculty have added new courses or changed existing ones to help students learn the new ways, they stress the importance of retaining traditional professional values.
"Because of Boston College's mission, its focus on ethics and social justice, our graduates stand to play a major role in ensuring that patients are not abandoned," said Asst. Prof. Judith Shindul-Rothschild (SON). "It is critical that we foster and nurture our programs, because those schooled in Jesuit philosophy can ensure the care and concern necessary in a bottom-line era."
Even as this transitional period in health care and social work education takes shape, many current practitioners and their allies strongly criticize managed care as centered more on cost than patients' needs. Faculty, however, believe they must give their students a comprehensive and practical perspective, so they may be successful in dealing with case managers, requesting approvals for treatment, and other facets of managed care.
"Taking a constructive view is important," explained Asst. Prof. Thomas O'Hare (GSSW). "There is little reason to believe resources in these areas will expand any time soon. Managed care has the potential to do good. The question is, given these limited resources, how can we as professionals make decisions ethically and cost-effectively?"
O'Hare recently co-led a workshop for GSSW faculty to discuss how social work educators can deal with managed care issues in curriculums. The group talked about how faculty can help students choose more optimal treatments for their clients and develop greater skills at policy analysis, among other subjects.
"There is no longer a one-size-fits-all approach," O'Hare said. "It is more vital now for social workers to temper their theoretical knowledge with a commitment to outcomes; that is, distinguish between theories about why people have problems and what works best to resolve those problems."
Nursing education, Shindul-Rothschild says, is focusing less on teaching individualized, long-term therapy and more on group or crisis-oriented approaches in which a patient's progress can be measured in quantifiable terms.
Nurses also are assuming new tasks once reserved for other health professionals, which require training. As nurses gain the power to prescribe medication, for example, SON's program in psychopharmacology for advanced practical nurses is gaining popularity, drawing students from other nursing programs, Shindul-Rothschild said.
Often, students also require a grounding in financial, legal and other aspects of managed care, faculty add, especially as more professionals consider forming their own entities to compete in the market instead of joining companies. SON students can pursue a joint master's degree in nursing and business administration, Shindul-Rothschild notes, which will put them in great demand.
Perhaps the most critical test for health and human services education, the faculty say, is to encourage students to be advocates as well as practitioners.
"Now, more than ever, they have to be a voice for those not able to speak," Walsh said. "This is something we emphasize in our discussion of professional ethics. There are some moral issues at stake here, and we want the students to respond effectively at the level of politics and policy, to intervene not just for an individual client but all of them."
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