Employer provided Qualified Plans ("Qualified Plans") are the most efficient supplement to Social Security savings and benefits. Given the significance of the benefits provided as well as the short-term Revenue constraints upon the Federal government in the form of substantially protracted tax deferrals, Qualified Plan legislation should maintain a conservative disposition. Incremental legislative action in the right direction will steadily graduate ERISA to its intended purpose. Unfortunately ERISA is a convoluted maze of formalities, definitions, and regulation that are only substantially understood by an expert and have yet to be adequately explained to the public at large. Recent publications such as Retirement Heist rouse the public's consciousness of retirement Plans by enumerating perceived abuses by large corporations. These alleged abuses certainly reflect innovative manipulations within the constraints of Qualified Plans. However, my thesis will prove that these "abuses" reflect the United States' disposition toward the rights of proprietorship regarding the Qualified Plan. The intent of the thesis is to illustrate this disposition through a study of the Amara v. Cigna Corp. case as well as a review of an actual LLC's defined benefit plan conversion to a cash balance plan. I will compare and contrast the different approaches taken by these two employers and justify the varied success they each experienced in converting their plans. Through this process, the thesis shall draw conclusions on the United States' dispositions toward ownership of the qualified plan.

Sexual dysfunctions are serious mental health issues that impact an estimated one in three Americans. Due to the complex, relational nature of most sexual dysfunctions, mental health professionals trained to work with couples and their relationship interactions are likely to have better outcomes when treating clients with sexual dysfunction. Data from CIGNA Health Solutions was analyzed to explore differences in therapy outcome for various types of mental health professions when treating clients with sexual dysfunctions. The current research is a retrospective analysis of administrative data that explores whether or not type of profession (i.e. psychologists, Masters of social work, marriage and family therapist, or professional counselor) influences the outcome of mental health treatment. This study also explores whether therapy modality (i.e. individual, conjoint, or mixed mode, a combination of individual and conjoint therapy) influences therapy outcome. Treatment outcome was measured by recidivism rates, client drop out from therapy, the total number of sessions, and cost of treatment. Participants included 230 males and 189 females ages 18 to 101 (M =38.9, SD = 11.4) who received treatment for sexual disorders from 2001 to 2006. Participants were from all regions of the United States. Results indicate that overall, psychotherapeutic treatment for sexual dysfunctions is relatively brief, averaging about seven sessions across all professions. Results suggest that marriage and family therapists treat sexual dysfunctions using a conjoint and mixed mode approach more frequently than therapists with other licenses. Results also suggest that mixed mode therapy has drastically lower dropout rates and longer retention than individual or conjoint therapy. These results suggest that utilizing a combination of relational and individual sessions is beneficial to the treatment of sexual dysfunctions.

Mood disorders are often linked with concurrent partner relational distress. The present study compared the cost effectiveness of treating mood disorder alone versus when the condition is comorbid with partner relational distress. Cigna, a leading health insurance management company in the US, provided outpatient data. Participants included patients with solely a mood disorder diagnosis (n = 72,712) and those with both a mood disorder and a comorbid partner relational distress diagnosis (n = 113, including 69 females and 44 males). These participants were treated in outpatient settings throughout the US. These numbers are surprisingly low considering the extensive literature showing a strong relationship between mood disorder and partner relational distress. A multivariate general linear model and binary logistic regressions were used to analyze the data. Results indicate that having a mood disorder present with a partner relational distress disorder significantly increased the average cost of care by about $471 per person compared to having solely a mood disorder. For mood disorders alone, there were also differences in cost effectiveness and readmission for mood disorders by professional license type, age, and gender with counselors being the most cost effective and medical doctors being the least (60% more costly). The treatment modality used impacted readmission rates, with family therapy having the lowest (8.54%) and mixed therapy having the highest (33.54%). Due to the small sample size, we were unable to determine the significance of subsequent analyses for comorbid disorders. Clinical implications and future directions for research will be discussed.

Generalized anxiety disorder (GAD) is frequently found in primary care settings and is highly prevalent among adolescents. The purpose of this study was to examine the cost effectiveness by provider type and therapy modality in treating adolescents (ages 13-17) with a GAD diagnosis (DSM-IV 300.02). A national insurance company in the United States provided outpatient and unidentifiable data for adolescent GAD cases (n = 2,932). These cases were used to analyze the cost effectiveness, total cost, treatment length, dropout, and readmission rates for the treatment of adolescents with GAD. Descriptive statistics signify that the mean cost of treatment for GAD in the first episode of care across all provider types is $439.28. Results revealed significant differences in cost effectiveness, total cost, treatment length, and readmission rates by provider type and therapy modality. MFTs and counselors were most cost effective, had the lowest total cost and number of sessions, as well as the lowest readmission rate among the provider types. In contrast, MSWs and psychologists were the least cost effective, had the highest number of sessions and the highest readmission rate. Therapy modality comparisons indicated that family therapy is most cost effective followed by individual, then mixed therapy modalities. Significantly fewer sessions were found when conducting family therapy upon treating adolescents with GAD. There were no significant differences in dropout by provider type, therapy modality or age group. The results of total cost by gender were also insignificant. Professional and clinical implications and future directions for research will be discussed.

As many as one in five children and adolescents may suffer from a mental health disorder, yet there are barriers that often prevent children from receiving optimal treatment. The current study explores the influence of practitioner license type, therapy modality, diagnosis, age, and gender on mental health therapy for children and adolescents. Data was provided by Cigna, a leading health care insurance provider in the United States. Participants include 106,374 boys (53.2%) and 93,753 girls (46.8%) ages 3 to 18 (M = 12.1, SD = 3.9) who were treated in outpatient facilities throughout the United States of America. Results indicate that there are differences in dropout, recidivism, cost, and treatment length by provider license, therapy modality, diagnosis, age, and gender. Specifically, results suggest that marriage and family therapists have the lowest percent recidivism and are among the lowest in terms of dropout and cost effectiveness. The results also suggest that family therapy is more cost effective than individual or mixed therapy and that mixed therapy has a much lower percent dropout than individual or family therapy. Analysis by diagnosis suggests a potential severity scale based on dropout, recidivism, and number of sessions. There are also significant differences in dropout and recidivism by age suggesting that younger children are more likely to dropout of treatment. These results provide valuable information about mental health treatment of children and adolescents. Specifically, utilizing a family based approach may help reduce the total length of treatment while utilizing a mixed mode approach to therapy may help reduce the risk of dropout from treatment. Also, some diagnoses appear to be more difficult to treat, with higher percentages of dropout and requiring more time and money for successful treatment. Limitations and future directions are discussed.