The sentinel effect in an outpatient managed care setting

Psychologists who provide services under managed care must typically cope with session restrictions and time-consuming paperwork to justify session use. This process has been broadly challenged by critics of managed care. This study investigated the effect of allocating sessions in outpatient treatment on session use. Providers were authorized either 6, 10, or 19 sessions (benefit maximum), with additional sessions given without restriction. Results showed that doctoral-level psychologists in the 6-session, 10-session, and 19-session groups used up to 2.5 sessions more than the control group, whereas master's-level providers used up to 5.5 sessions more. Master's-level providers also had an 18% treatment dropout rate, compared with 7% for psychologists. On the basis of cost analysis, session management is financially warranted for master's-level providers bur not for doctoral-level psychologists.