Can Small Intensive Case Management Teams be as Effective as Large Teams?
- 632 Downloads
In 2007, the Veterans Health Administration (VHA) implemented a program to deliver the full array of Assertive Community Treatment services in areas with low population density using teams with small staffs. VHA administrative data were used to compare treatment and outcomes of veterans who received services from teams with only two or three staff (N = 805) and veterans served by teams with ten or more staff (N = 861). After adjusting for baseline difference, smaller teams had statistically significantly less symptom improvement and smaller declines in suicidality indices but effect sizes were small and there were no differences on 11 other outcomes. These data demonstrate the clinical need, practical feasibility and potential effectiveness of providing intensive case management through small teams.
KeywordsRural mental health Case management Access to care Community psychiatry Veterans issue
- Derogatis, L. R., & Spencer, N. (1992). The brief symptom index; administration, scoring and procedure manual. Baltimore, MD: Johns Hopkins.Google Scholar
- Kulka, R. A., Schlenger, W. E., & Fairbank, J. A. (1989). Trauma and the Vietnam war generation: Report of findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel.Google Scholar
- McCarthy, J. F., Valenstein, M., Dixon, L., Visnic, S., Blow, F. C., & Slade, E. (2009). Initiation of assertive community treatment among veterans with serious mental illness: Client and program factors. Psychiatric Services, 60(2), 196–201. doi: 10.1176/appi.ps.60.2.196.PubMedCrossRefGoogle Scholar
- Neale, M., Rosenheck, R., Castrodonatti, J., Martin, A., Morrissey, J., & D’amico, M. (2007). Mental Health Intensive Case Management (MHICM): The Tenth National Performance Monitoring Report: FY 2006. West Haven, CT: Northeast Program Evaluation Center.Google Scholar
- NPFC. (2005). Interim report of the president’s new freedom commission on mental health: 2002.Google Scholar