This study evaluated the efficacy of an intensive-case management program in extending
community tenure and reducing rates of rehospitalization for mentally ill outpatients. The study
group was composed of 196 individuals with a history of state psychiatric hospitalization. One
subgroup of subjects was composed of all clients currently receiving intensive case management
(ICM) services (n = 108). A second subgroup, the control group, was made up of randomly
selected clients (n = 88) eligible for intensive case management services. Survival analysis
models were tested to derive a model that contained the maximum number of significant
covariates predictive of community tenure (survival) until rehospitalization. After statistically
controlling for these covanates, clients in the control group were 41.2% less likely to be
rehospitalized (survival). Clients most at risk of rehospitalization were ICM clients who received
shorter intervals of intensive case management; higher levels of services per month; and had
experienced brief, frequent prior hospitalizations.
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References
1.
Allison, P.D. (1984). Event history analysis: Regression for longitudinal event dataLondon: Sage.
2.
American Psychiatric Association (APA). (1994 ). Diagnostic and statistical manual of mental disorders [DSM] (4th ed.). Washington, DC : Author.
3.
Barton, T.R., & Pillai, V.K. (1995). Using an event history analysis to evaluate social welfare programsResearch on Social Work Practice , 5, 176-192.
4.
Brennan, J.P., & Kaplan, C. (1993). Setting new standards for social work case management , Hospital and Community Psychiatry, 44, 219-222.
5.
Chamberlain, R., & Rapp, C.A. (1991). A decade of case management: A methodological review of outcome researchCommunity Mental Health Journal , 27, 171-188.
6.
Curtis, J.L., Millman, E.J., Struening, E., & D'Ercole, A. (1992). Effect of case management on rehospitalization and utilization of ambulatory care servicesHospital and Community Psychiatry, 43, 895-899.
7.
Fellin, P. (1996). Mental health and mental illness: Policies, programs and servicesItasca, IL: F. E. Peacock.
8.
Franklin, J.L., Solovitz, B., Mason, M., Clemons, J.R., & Miller, G.E. (1987). An evaluation of case managementAmerican Journal of Public Health, 77, 674-678.
9.
Fraser, M.W., Pecora, P.J., Popuang, C., & Haapala, D.A. (1992). Event history analysis: A proportional hazards perspective on modeling outcomes in intensive family preservation services In D. F. Gillespie & C. Glisson (Eds.), Quantitative methods in social work: State of the art (pp. 123-158). New York: Haworth.
10.
Goering, P.N., Farkas, M., Wasylenki, D.A., Lancee, W.J., & Balliantyne, R. (1988). Improved functioning for case management clientsPsychosocial Rehabilitation Journal , 12, 3-17.
11.
Goldman, H.H., Skodol, A.E., & Lave, T.R. (1992). Revising axis V for DSM-IV: A review of measures of social functioningAmerican Journal of Psychiatry , 149, 1148-1156.
12.
Hornstra, R.K., Bruce-Wolfe, V., Sagduyu, K., & Riffle, D.W. (1993). The effect of intensive case management on hospitalization of patients with schizophreniaHospital and Community Psychiatry , 44, 844-847.
13.
Jerrell, J.M., & Hu, T.W. (1989). Cost-effectiveness of intensive clinical and case management compared with an existing system of careInquiry , 26, 224-234.
14.
Korr, W.S., & Cloninger, L. (1991). Assessing models of case management: An empirical approachJournal of Social Service Review, 14, 129-146.
15.
Langenbucher, J.W., & Chung, T. (1995). Onset and stage of DSM-IV alcohol dependence using mean age and survival-hazard methodsJournal of Abnormal Psychology, 104, 346-354.
16.
Luke, D.A. ( 1993). Charting the progress of change: A primer on survival analysisAmerican Journal of Community Psychology , 21, 203-246.
17.
McMurtry, S.L., & Lie, G.Y. (1992). Differential exit rates of minority children in foster careSocial Work Research and Abstracts , 28, 42-48.
18.
Mulder, R. (1985). Evaluation of the Harbinger program, 1982-1985Lansing, MI: Department of Mental Health.
19.
National Association of Social Workers (NASW). ( 1992). Standards for Social Work Case ManagementWashington, DC: Author.
20.
Norusis, M.J. (1993). SPPS for Windows Advanced Statistics Release 6.0Chicago, IL: SPSS.
21.
Patterson, D.A., & Lee, M.S. (1995). A field trial of GAFS-MAmerican Journal of Psychiatry, 152 , 1386-1388.
22.
Ross, H. (1980). Proceedings of the conference on the Evaluation of Case ManagementLos Angeles: Volunteers for Services to Older Persons.
23.
Rossler, W., Loffler, W., Fatkenheuer, B., & Riecher-Rossler, A. (1992). Does case management reduce the rehospitalization rate?Acta Psychiatrica Scandinavia , 86, 445-449.
24.
Rubin, A. (1992). Is case management effective for people with serious mental illness?A research review. Health and Social Work , 17, 138-150.
25.
Sledge, W.H., Astrachan, B., Thompson, K., Rakfeldt, J., & Leaf, P. (1995). Case management in psychiatry: An analysis of tasksAmerican Journal of Psychiatry, 152, 1259-1265.
26.
Spitzer, R.L., Gibbon, M., Skokol, A.E., Williams, J.B.W., & First, M.B. (1989). DSM-III-R casebookWashington, DC: American Psychiatric Association.
27.
Stein, L.I., & Test, M.A. (1980). Alternative to mental hospital treatment, I: Conceptual model, treatment program, and clinical evaluationArchives of General Psychiatry, 37, 392-397.
28.
Strauss, J., & Carpenter, W. (1977). Prediction of outcome in schizophrenia III. Five-year outcome and its predictorsArchives of General Psychiatry , 34, 159-163.
29.
Thornicroft, G. (1991). The concept of case management for long-term mental illnessInternational Review of Psychiatry, 3, 125-132.
30.
Waters, R.M., Womack, P., & Hinton, J. (1991). The Tennessee Case Management Program: Status report on implementation (Report). Nashville, TN: Department of Mental Health and Mental Retardation.
