The dissemination of manual-based psychotherapies in managed care: Promises, problems, and prospects.

Manual-based, empirically validated psychotherapies potentially have a very important role to play in building quality managed care delivery systems. Unfortunately, managed care systems have been slow to endorse or implement such models of care on a widespread basis. The essence of the problem is that manual-based procedures have been developed primarily to address the needs of clinical science and little attention has been directed toward the three primary end users in applied settings: the behavioral health program director, the line clinician, and the consumer of behavioral health services. The result is that manual-based therapies are perceived as highly specialized, cumbersome, time consuming, expensive, difficult to train/supervise, and not user friendly to either line clinicians or consumers. Here, the perspectives of the clinical scientist, practitioner, behavioral health program director, and consumer are reviewed to highlight how manual-based procedures could be tailored to fit the demands of all key stakeholders. If these changes are made thoughtfully, manual-based procedures may eventually become a dominant mode of service delivery in managed care.