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Trauma therapists are increasingly concerned about trauma survivors having adequate access to therapy services. The imperative to staunch spiraling health-care expenditures in the United States has produced a massive shift from fee-for-service to managed health care. Patients in managed-care systems are often restricted in the choice of provider, and the length and type of treatment must be approved. A substantial percentage of therapists treating sexual assault victims reports that managed care has had an adverse impact on their practice (Berliner & New, in press).

In addition to cost containment, a stated objective of health care reform is to ensure that services are effective. Fortunately, there is a treatment outcome literature that documents the effectiveness of psychotherapy. The trauma outcome literature is not as well developed, but it is growing. There are now scientifically sound studies demonstrating that psychosocial and pharmacological treatments are effective in treating posttraumatic stress symptomatology.

What can trauma specialists do? For one thing, they should strive to deliver proven treatments to trauma survivors. For example, ISTSS members can rely on the guidelines for treatment of PTSD that will soon be available. Therapists can also take a leading role in educating health-care systems about the current state of knowledge.

A particular area where trauma specialists can make a difference is with crime victim compensation programs. Each state has a fund for crime victims who report to law enforcement. The mental-health benefits usually have capped monetary or session limits, but in many cases, they exceed those of commercial insurance or can be extended when medical necessity is shown (NACVCB, 1997). CVC programs are focusing attention on mental-health benefits because they consume a substantial percentage of all moneys paid to crime victims. The programs want to be sure that therapy is actually addressing crime-related psychological impacts and is effective.

This emphasis has resulted in a variety of efforts. Two states (Washington and California) have established treatment guidelines task forces, and others are considering forming their own. Many states use mental-health professionals on advisory committees, peer or utilization review boards, or as independent mental-health examiners.

This situation creates a real opportunity for ISTSS members to influence practice. Members can become proactively involved in their respective states by developing relationships with CVC programs; offering to serve as consultants, utilization reviewers, or independent examiners; and providing training on trauma impact and treatment to claims managers. By sharing our expertise through collaboration, we can enhance the quality, and perhaps availability, of services for trauma victims.


Berliner, L. & New, M. (in press) The impact of health care reform: A survey of victim and offender treatment providers. Sexual Abuse: A Journal of Research and Treatment.

NACVCB (1997) National Association of Crime Victim Compensation Boards Annual Program Survey. WA: DC; Author

For more information, contact: Dan Eddy, executive director, National Association of Crime Victims Compensation Boards, 703/370-2996, e-mail: nacvcb@aol.com.