Academic journal article
By Anderson, Christopher E.
Roeper Review , Vol. 24, No. 1
This study examined the role of managed mental health care regarding counseling gifted children and their families. Frequently, gifted children and their families seek counseling because of a child's giftedness. Common examples include a child having social problems with peers, parents feeling ill equipped to raise a gifted child, and concerns with sibling relationships. There is evidence to suggest that some gifted children and families require counseling because of the issues that emerge from the child's giftedness (Colangelo, 1997; Moon, Kelly, & Feldhusen, 1997). Some suggest that counseling gifted children be mandatory within gifted curriculum as a preventive measure (Farrell, 1989). One of the major barriers to seeking counseling is the prohibitive cost, especially if a private provider is used. Although insurance benefits may be used to offset the cost, most insurance plans have a managed care component that can present an obstacle.
A criticism of managed care is its perceived reliance on a medical model. In other words, people who use their mental health insurance benefits must have an identified mental illness diagnosis to receive insurance reimbursement. This is referred to as medical necessity. A certification request for a gifted child or family with a gifted child falls into a gray area where medical necessity is difficult to determine. Fortunately, case managers who make certification decisions have some latitude to use their clinical skills and judgment to arrive at certification decisions when considering these types of requests.
The purpose of this study is to gain information and insight into how managed care reviewers respond to requests for services based on a child's giftedness. Managed care personnel who review treatment plans and treatment options with providers were surveyed to determine their qualifications and if they had any specialized knowledge of gifted children and families. This study examined how managed care personnel handled requests for reimbursement of counseling for a gifted child or family. The goal was to determine the number of requests these professionals receive for counseling because of a child's giftedness, the information required from the provider to authorize such services, and to find out if there is a distinct process that managed care personnel use when considering these requests. For the purpose of this study, gifted children are identified as those children who score in the top 5-10% in intellectual ability on standardized tests.
Fifty managed care personnel participated from two large, national managed care companies in a large Midwest urban area. To be considered, they had to be involved in the clinical work of managed care such as performing reviews of clinical information submitted by outpatient providers and inpatient facilities as well as case management. In other words, when a request for counseling for a gifted child or family with a gifted child is made, these are the professionals responsible for making the reimbursement decision. Completed surveys were received from 40 participants (80%). Eleven of the participants (27.5%) were male and 29 participants (72.5%) were female.
The study was divided into two parts. The first part was a survey designed to determine the clinical backgrounds and qualifications of managed care personnel and to provide insights into how they handled requests for certification of counseling for a gifted child or family. The survey also had a set of questions regarding the number of requests for counseling gifted children and families, questions concerning their attitudes towards counseling gifted children and families and questions concerning how much they knew about giftedness. Since the term giftedness was not defined on the survey, the participants answered the survey based on their personal impression of what giftedness means.
To expand the information from the survey, the second part of the study consisted of individual interviews with participants who agreed to be interviewed. …