Continuous care teams in intensive outpatient treatment of chronic mentally ill patients

Case management models for persons who are homeless and mentally ill: the ACCESS demonstration project. Access to Community Care and Effective Services and Supports

Persons who are homeless and mentally ill present unique challenges to service providers and human service systems. In vivo case management approaches such as assertive community treatment (ACT) have shown promise in engaging this population. This paper explores case management models employed within the ACCESS program, a five year, 18-site demonstration program enriching services for homeless persons with serious mental illness. We describe the implementation of case management with ACCESS programs and determine the extent of variation across sites using a measure of fidelity to ACT. While programs reported using four models, much similarity was found among programs on multiple dimensions.

Expertise in Caring: A Source of Power

1. Caring generates power in relationships with patients and helps them to evolve. 2. Caring is more than an emotional response. It is acting in ways that demonstrate that people, relationships, and issues are important. 3. Continuity of care providers across settings help yield positive outcomes for patients.

Effectiveness of case management with severely and persistently mentally ill people

This meta-analytic review synthesizes the findings of 24 published studies dealing with the effectiveness of case management with the severely and persistently mentally ill. Summative findings were: (1) Overall, case management interventions are effective--75% of the clients who participate in them do better than the average client who does not; (2) The estimated preventive fraction (e.g., prevention of re-hospitalization) among clients who experience relatively intense case management service (case loads of 15 or less, 89%) is nearly 30% greater than that estimated among similar clients receiving less intensive service; and (3) Various case management practice models did not differ significantly on estimated effectiveness. Important questions concerning the differential effectiveness of case management by specific program, worker, client, and client-worker relationship characteristics remain to be answered.