DOI
https://doi.org/10.25772/04HV-1T82
Defense Date
2014
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Social Work
First Advisor
Mary Secret
Abstract
Therapeutic Day Treatment (TDT) is a community-based mental health treatment program regulated and funded by the Department of Medical Assistance Services (DMAS) in the Commonwealth of Virginia. This case study sought to understand how DMAS regulatory changes impacted the implementation of the TDT program in the Commonwealth between fiscal years 2004 and 2011. In an effort to respond to this question, sources of qualitative and quantitative data were collected including: TDT fee-for-service data, regulations in the Community Mental Health and Rehabilitative Services manual guiding the implementation of the TDT program, and structured interviews with eight key stakeholders who interface with the TDT program. The fee-for-services analysis found that there was a 269% increase in fee-for-service expenditures between fiscal years 2007 and 2011. The analysis of the regulations found DMAS added language to provide greater clarity to the existing regulators. Some of these changes include the implementation of the PA process with KePRO as well as the VICAP process. Additionally, staff requirements changed and paraprofessionals were no longer able to provide TDT programming. Caseload limits were also set for TDT programming. Four themes emerged through the analysis of the structured interviews. These themes include: 1) fraudulent practices and misuse of TDT services, 2) regulatory oversight, 3) cost containment, and 4) evaluation. Implications focused on the areas of policy, practice, and research by suggesting further research studies focusing on TDT and policy, offering the foundation of a more comprehensive theory focusing on policy implementation, and lastly the researcher provided a logic model for the TDT program in an effort to propel evaluation research forward.
Rights
© The Author
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
8-18-2014