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Intensive Case Management: A Critical Re-Appraisal of the Scientific Evidence for Effectiveness

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Administration and Policy in Mental Health and Mental Health Services Research Aims and scope Submit manuscript

Abstract

Intensive Case Management (ICM) is widely claimed to be an evidence-based and cost effective program for people with high levels of disability as a result of mental illness. However, the findings of recent randomized controlled trials comparing ICM with ‘usual services’ suggest that both clinical and cost effectiveness of ICM may be weakening. Possible reasons for this, including fidelity of implementation, researcher allegiance effects and changes in the wider service environment within which ICM is provided, are considered. The implications for service delivery and research are discussed.

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References

  • Abbott, S., Smith, S., Clarke, R., Curson, C., De Souza Gomes, J., Heslop, K., Trainer, E., & Yellowlees, P. (1997). Who is a heavy service user? Preliminary development of a screening instrument for prospective consumers of a mobile intensive treatment team. Australian and New Zealand Journal of Psychiatry, 31, 744–750.

    Article  PubMed  CAS  Google Scholar 

  • Allness, D., & Knoedler, W. (2003). National program standards for ACT teams (2003 revision). NAMI, Arlington, VA, http://www.nami.org/Content/ContentGroups/Programs/PACT1/NationalStandardsforACTeams.pdf, (last accessed 11–16–04).

  • Bond, G. R., & Salyers, M. P. (2004). Prediction of outcome from the Dartmouth ACT Fidelity Scale. CNS Spectrums, 9, 937–942

    PubMed  Google Scholar 

  • Bond, G. R., Drake, R. E., Mueser, K. T., et al. (2001). Assertive community treatment for people with severe mental illness: Critical ingredients and impact on patients. Disease Management & Health Outcomes, 9, 141–159.

    Article  Google Scholar 

  • Burgess, P., & Pirkis, J. (1999). The currency of case management: Benefits and costs. Current Opinion in Psychiatry, 12, 195–199.

    Article  Google Scholar 

  • Burns, T. (2000). Models of community treatments in schizophrenia: do they travel? Acta Psychiatrica Scandinavica Supplementum, 407, 11–14.

    Article  PubMed  Google Scholar 

  • Burns, T., Creed, F., Fahy, T., Thompson, S., Tyrer, T., & White, I. (1999). Intensive versus standard case management for severe psychotic illness trial. UK700 Group. Lancet, 353, 2185–2189.

    Article  PubMed  CAS  Google Scholar 

  • Byford, S., Fiander, M., Torgerson, D., Barber, J, Thompson, S., Van Horn, E., Gilvarry, C., & Creed, F (2000). Cost-effectiveness of intensive v. standard case management for severe psychotic illness: UK700 case management trial. British Journal of Psychiatry, 176, 537–543.

    Article  Google Scholar 

  • Chandler, D., Spicer, G. (2002). Capitated Assertive Community Treatment Program Savings: System Implications. Administration and Policy in Mental Health, 30, 3–19.

    Article  PubMed  Google Scholar 

  • Clarke G. N., Herinckx H. A., Kinney R. F., Paulson, R. I., Cutler, D. L., Lewis, K., & Oxman, E (2000). Psychiatric hospitalizations, arrests, emergency room visits, and homelessness of clients with serious and persistent mental illness: findings from a randomized trial of two ACT programs vs. usual care. Mental Health Services Research, 2, 155–164.

    Article  PubMed  CAS  Google Scholar 

  • Drake R. E., Mueser K. T., Torrey W. C., Miller, A. L, Lehman, A. F, Bond, G. R., Goldman, H. H., & Leff, H. S. (2000). Evidence-based treatment of schizophrenia. Current Psychiatry Reports, 2, 393–397.

    Article  PubMed  CAS  Google Scholar 

  • Dekker, J., Wijdenes, W., Koning, Y. A., Gardien, R., Hermandes-Willenborg, L., & Nusselder, H. (2002). Assertive community treatment in Amsterdam. Community Mental Health Journal, 38, 425–434.

    Article  PubMed  CAS  Google Scholar 

  • Duan, N., Braslow, J., Weisz, J., & Wells, K. (2001). Fidelity, adherence, and robustness of interventions. Psychiatric Services, 52, 413.

    Article  PubMed  CAS  Google Scholar 

  • Fiander, M., Burns, T., McHugo, G. J., & Drake, R. E. (2003). Assertive community treatment across the Atlantic: comparison of model fidelity in the UK and USA. British Journal of Psychiatry, 182, 248–254.

    Article  PubMed  Google Scholar 

  • Ford, R., Barnes, A., Davies, R., Chalmers, C., Hardy, P., & Muijen, M. (2001). Maintaining contact with people with severe mental illness: 5-year follow-up of assertive outreach. Social Psychiatry & Psychiatric Epidemiology, 36, 444–447.

    Article  CAS  Google Scholar 

  • Harrison-Read, P., Lucas, B., Tyrer, P., Ray, J., Shipley, K., Simmonds S., Knapp, M., Lowin, A., Patel, A., & Hickman M. (2002). Heavy users of acute psychiatric beds: randomized controlled trial of enhanced community management in an outer London borough. Psychological Medicine, 32, 403–416.

    Article  PubMed  CAS  Google Scholar 

  • Harvey, K., Burns, T., Fiander, M., Huxley, P., Manley, C., & Fahy, T. (2002). The effect of intensive case management on the relatives of patients with severe mental illness. Psychiatric Services, 53, 1580–1585.

    Article  PubMed  Google Scholar 

  • Herdelin, A. C., & Scott, D. L. (1999). Experimental studies of the Program of Assertive Community Treatment (PACT). Journal of Disability Policy Studies, 10, 53–89.

    Google Scholar 

  • Issakidis, C., Sanderson, K., Teesson, M., Johnston, S., & Buhrich, N. (1999). Intensive case management in Australia: a randomized controlled trial. Acta Psychiatrica Scandinavica, 99, 360–367.

    Article  PubMed  CAS  Google Scholar 

  • Johnston, S., Salkeld, G., Sanderson, K., Issakidis, C., Teesson, M., & Buhrich, N. (1998). Intensive case management: a cost-effectiveness analysis. Australian and New Zealand Journal of Psychiatry, 32, 551–559.

    PubMed  CAS  Google Scholar 

  • Latimer, E. A. (1999). Economic impacts of assertive community treatment: a review of the literature. Canadian Journal of Psychiatry, 44, 443–454.

    CAS  Google Scholar 

  • Lehman, A. F., Dixon, L., Hoch, J. S., DeForge, B., Kernan, E., & Frank, R. (1999). Cost-effectiveness of assertive community treatment for homeless persons with severe mental illness. British Journal of Psychiatry, 174, 346–352.

    Article  PubMed  CAS  Google Scholar 

  • Littell, J. H., Popa, M., & Forsythe, B. (2005). Multisystemic therapy for social, emotional, and behavioral problems in youth aged 10–17. Cochrane Database of Systematic Reviews, 19, CD004797.

    Google Scholar 

  • Luborsky, L., Diguer, L., Seligman, D.A., Rosenthal, R., Krause, E.D., Johnson, S., Halperin, G., Bishop, M. Berman, J., & Schweitzer, E. (1999). The researcher’s own therapy allegiances: A “wild card” in comparisons of treatment efficacy. Clinical Psychology: Science & Practice, 6, 95–106.

    Article  Google Scholar 

  • Marshall, M., & Lockwood, A. (1998). Assertive Community Treatment for People With Severe Mental Disorders (a Cochrane review). Oxford, England: Update Software (for the Cochrane Library).

    Google Scholar 

  • Marshall, M., & Creed, F. (2000). Assertive community treatment—is it the future of community care in the UK? International Review of Psychiatry, 12, 191–196.

    Article  Google Scholar 

  • McGrew, J. H., Bond, G. R., Dietzen, L. L., & Salyers, M. (1994). Measuring the fidelity of implementation of a mental health program model. Journal of Consulting and Clinical Psychology, 62, 670–678.

    Article  PubMed  CAS  Google Scholar 

  • McGrew, J. H., & Bond, G. R. (1995). Critical ingredients of assertive community treatment: Judgements of the experts. The Journal of Mental Health Administration, 22, 113–125.

    Article  CAS  Google Scholar 

  • McHugo, G. J., Drake, R. E., Teague, G. B. & Xie, H. (1999). Fidelity to assertive community treatment and client outcomes in the New Hampshire dual disorders study. Psychiatric Services, 50, 818–824.

    PubMed  CAS  Google Scholar 

  • Mowbray, C., Collins, M., Plum, T., Masterton, T., & Mulder R. (1997). Harbinger I: the development and evaluation of the first pact replication. Administration and Policy in Mental Health, 25,105–123.

    Article  PubMed  CAS  Google Scholar 

  • 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, 37–74.

    PubMed  CAS  Google Scholar 

  • Rotheram-Borus. M. J., & Duan, N. J. (2003) Next generation of preventive interventions. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 518–526.

    Article  PubMed  Google Scholar 

  • Salkever, D., Domino, M. E., Burns B. J., Santos, A. B., Deci, P. A., Wagner, H. R., Faldowski, R. A., & Paolone, J. (1999). Assertive community treatment for people with severe mental illness: The effect on hospital use and costs. Health Services Research, 34, 577–601.

    PubMed  CAS  Google Scholar 

  • Salyers, M. P., Bond, G. R., Teague, G. B., Cox, J. F., Smith, M. E., Hicks, M. L., & Koop, J. I. (2003). Is it ACT yet? Real-world examples of evaluating the degree of implementation for assertive community treatment. Journal of Behavioral Health Services Research, 30, 304–320.

    Article  PubMed  Google Scholar 

  • Teague, G. B., Bond, G. R., & Drake, R. E. (1998). Program fidelity in assertive community treatment: development and use of a measure. American Journal of Orthopsychiatry, 68, 216–232.

    Article  PubMed  CAS  Google Scholar 

  • Stovall, J. (2001) Is Assertive Community Treatment ethical care? Harvard Review of Psychiatry, 9, 139–143.

    PubMed  CAS  Google Scholar 

  • Thase, M. (1999). What is the investigator allegiance effect and what should we do about it? Clinical Psychology: Science & Practice, 6, 113–115.

    Article  Google Scholar 

  • Watson, J. C., Gordon, L. B., Stermac, L., Kalogerakos, F., & Steckley, P. (2003). Comparing the effectiveness of process-experiential with cognitive-behavioral psychotherapy in the treatment of depression. Journal of Consulting and Clinical Psychology, 71, 773–781.

    Article  PubMed  Google Scholar 

  • Ziguras, S., & Stuart, G. (2000). A meta-analysis of the effectiveness of mental health case management over 20 years. Psychiatric Services, 51, 1410–1421.

    Article  PubMed  CAS  Google Scholar 

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Part of the research for this paper was undertaken while a visiting scholar at the Center for Mental Health Evaluation, University of Massachusetts Medical School. The paper also benefited from generous advice provided by Gary Bond.

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Authors and Affiliations

  1. School of Medicine, The University of Queensland, Herston, QLD, Australia

    Robert King

  2. School of Mental Health, The Park Centre for Mental Health, The University of Queensland, Herston, QLD, Australia

    Robert King

  3. Kids in Mind Research Centre, Mater Child and Youth Mental Health Service, Mater Health Services, Brisbane, QLD, 4101, Australia

    Robert King

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Correspondence to Robert King.

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King, R. Intensive Case Management: A Critical Re-Appraisal of the Scientific Evidence for Effectiveness. Adm Policy Ment Health 33, 529–535 (2006). https://doi.org/10.1007/s10488-006-0051-5

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