Evaluating Case Management

Numerous research studies have been carried out to evaluate the effectiveness and efficiency of case management. Partly because of the differences between case management programs, the results of these studies have been mixed and sometimes contradictory. Nevertheless, there is clear consensus that case management is effective for achieving certain results. This research literature answers specific questions about the effectiveness of specific types of case management programs (Bond, McGrew, & Fekete, 1995; Chamberlin & Rapp, 1991; Mueser, Bond, Drake, & Resnick, 1998; Solomon, 1992).

Mueser et al. (1998) identified 75 controlled studies of case management for review. Most of these 75 studies examined ACT programs or intensive case management (ICM) programs because other models of case management were less well represented in the research literature. The ACT and ICM program models are very similar with respect to design (see Table 7.1). The major difference between them is that ACT program staff share caseloads, whereas ICM program staff do not. This review provided clear evidence that these programs were effective at reducing time spent in the hospital and increasing clients' housing stability in the community. They also provided some modest evidence for improvements in quality of life and symptomatology.

Mueser et al. (1998) concluded that when case management services were reduced or withdrawn, for example when programs had a designated length of service, consumers showed reduced levels of functioning. This has very important implications for funding as well as the design of future case management services. Nevertheless, the gradual reduction of ACT services to a lower level of intensity is possible without the loss of the gains of the full model. This is known as a step-down approach and has been found to be successful (Salyers, Masterton, Fekete, Picone, & Bond, 1998).

TABLE 7.I

Features of Different Community Care Models

TABLE 7.I

Features of Different Community Care Models

Community Care Model

Assertive

Intensive

Brokered Case

Clinical Case

Strengths

Rehabilitation

Community

Case

Program Feature

Management

Management

Model

Model

Treatment

Management

Staff : patient ratio

1 : 50?

1 : 30+

1 : 20-30

1 : 20-30

1 : 10

1 : 10

Outreach to patients

Low

Low

Moderate

Moderate

High

High

Shared caseload

No

No

No

No

Yes

No

24-hour coverage

No

No

No

No

Often

Often

Consumer input

No

Low

High

High

Low

Low

Emphasis on skills

No

Low

Moderate

High

Moderate?

Moderate?

training

Frequency of patient

Low

Moderate

Moderate

Moderate

High

High

contacts

Locus of contacts

Clinic

Clinic

Community

Community

Community

Intergration of

Low

Moderate

Low?

Low?

High

High?

treatment

Direct service

Low

Moderate

Moderate

Moderate

High

High

provision

Target population

SMI

SMI

SMI

SMI

SMI high service utilizers

SMI high service utilizers

From Mueser, K. T., Bond, G. R., Drake, R. E., & Resnick, S. G. (1998). Models of community care for severe mental illness: A review of research on case management. Schizophrenia Bulletin, 24(1), 40.

From Mueser, K. T., Bond, G. R., Drake, R. E., & Resnick, S. G. (1998). Models of community care for severe mental illness: A review of research on case management. Schizophrenia Bulletin, 24(1), 40.

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