An Action Research Project

“Where is the evidence?”

Methodology Questions

 

1. Where is the evidence showing that the current quality of treatment is inadequate?

2. Does this mean that the licensing and professional boards are all failing to do their jobs?

3. Has BCBSMA addressed them and how?

4. Where is the evidence showing efficacy and usefulness of the TOP?

5. Where and how have clients or providers been helped by 600,000 TOP tests taken?

6. What is the evidence that TOP questions are more useful than therapist questions?

7. What does the TOP assume about client trust in providing data?

8. How does the TOP account for clients who minimize or overstate their symptoms?

9. How does the TOP account for clients who lie because they mistrust insurance companies?

10. Where is the account of iatrogenic effects of the TOP (experienced by this author)?

11. How are the outside influences (Case Mix) factored into the results for each client?

12. What is the validity of the results data base if it does not reflect Case Mix?

13. If BCBS gets a score of 1-5 for each client, how will that number reflect Case Mix?

14. If it does not, how can BCBS use the data to justify unequal compensation?

15. Where is validation of scale of 1-5?

16. What are known problems with the accuracy of the 600,000 test results data base?

17. How do the problems affect validity of the scales?

18. Why does the TOP report lose so much of the detail of the TOP form?

19. Can’t therapists get more information by simply reading the actual TOP form themselves?

20. If so, (this therapist’s experience), then how does BCBS justify the expense of BHL processing?

21. How often does the TOP fail to generate a diagnosis?

22. Why does this happen and what does it tell us about the usefulness of the instrument?

23. Might BCBS use the lack of TOP diagnosis to declare treatment not “medically necessary” or to limit number of sessions?

24. Is there a scientific justification for the TOP that is not self-referential (i.e. a system that defines “depression” and then uses the same language to identify it and to label a client)?

25. Doesn’t the TOP contribute to the labeling of people?

26. Doesn’t the TOP fail to understand clients as the unique individuals they are?

27. Is BCBS attempting to impose a Cognitive Behavioral Therapy (CBT) methodology on clients and therapists?

28. Does BCBS know that most therapists disagree with the methodology implicit in the TOP?

29. Does BCBS value the views of academicians over therapists actually seeing clients?

30. Does BCBS know about the many ways that companies improve quality by actually talking to their customers and service providers?