The Impact of Managed Care Organizations on Pennsylvania Certified Addiction Counselors' Global Assessment of Functioning Rating of Substance Dependent Patients

Defense Date


Graduation Date

Spring 1-1-2004


Campus Only

Submission Type


Degree Name



Counselor Education and Supervision (ExCES)


School of Education

Committee Chair

Nicholas J. Hanna

Committee Member

Joseph F. Maola

Committee Member

Michael Crabtree


addiction counselor, GAF, managed care


Managed Care Organizations (MCOs) have been a major contributor to the changes in healthcare services in the United States over the past decade. One requirement they have made of addiction counselors is the use of current Global Assessment of Functioning rating (GAF) of patients (Diagnostic and Statistical Manual of Mental Health Disorders, [DSM-IV-TR], 2000). This research hoped to investigate the influence of MCOs on Pennsylvania Certified Addictions Counselors (CAC) GAF ratings through the use of a thirteen-question survey developed and field-tested by the researcher. One hundred Pennsylvania CACs were chosen at random from the 1,794 currently certified in Pennsylvania. They received a survey and instructions as to its completion. A statement of implied consent was included with the instructions, along with assurance of respondent confidentiality. Seventy-one percent of the surveys were returned, with 66% (n=66) of total surveys deemed valid for this research. Forty-five percent of respondents were male, and 55% female, exactly matching the entire PA CAC population. Sixty-seven percent were masters prepared, and 51% worked in either inpatient or outpatient drug and alcohol treatment settings. Eight and one half percent were African American, and 91.5% were Caucasian. Confidentiality was insured through the absence of name, address, or other information that would identify participants. Respondents were informed of survey results after the completion of the research via mailing. A paired-samples t-test was used to determine the existence of a statistically significant difference between GAF ratings of substance dependent clients with MCOs opposed to those without. The results of the analysis yielded a significant difference beyond .001. Analysis was done within the group between counselors determined as more experienced and counselors determined as less experienced. A significant difference was found between high experienced counselors' ratings of patients with MCO and low experienced counselors with MCO. The implications of this study may be far reaching and prove to impact counselor education, the need for certification in addiction counseling, ethical standards of counseling in a managed care environment, treatment planning, standardization of treatment placement criteria, the use of GAF rating in treatment, and possible legislation around managed care organizations.





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