Community Mental Health Journal

, Volume 51, Issue 2, pp 161–164 | Cite as

Can Small Intensive Case Management Teams be as Effective as Large Teams?

  • Somaia MohamedEmail author
Brief Report


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.


Rural mental health Case management Access to care Community psychiatry Veterans issue 


  1. Deci, P. A., Santos, A. B., McLeod-Bryant, S., & Deas-Nesmith, D. (1994). MUSC’s rural mental health services initiatives. The Journal of the South Carolina Medical Association, 90(3), 101–104.PubMedGoogle Scholar
  2. Derogatis, L. R., & Spencer, N. (1992). The brief symptom index; administration, scoring and procedure manual. Baltimore, MD: Johns Hopkins.Google Scholar
  3. Endicott, J., Spitzer, R. L., Fleiss, J. L., & Cohen, J. (1976). The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry, 33(6), 766–771.PubMedCrossRefGoogle Scholar
  4. Horvath, A. O., & Greenberg, L. S. (1989). The development and validation of the Working Alliance Inventory. Journal of Counseling Psychology, 36, 223–233.CrossRefGoogle Scholar
  5. Kessler, R. C., Berglund, P. A., Bruce, M. L., Koch, J. R., Laska, E. M., Leaf, P. J., et al. (2001). The prevalence and correlates of untreated serious mental illness. Health Services Research, 36(6 Pt 1), 987–1007.PubMedCentralPubMedGoogle Scholar
  6. 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
  7. Lehman, A. F. (1996). Measures of quality of life among persons with severe and persistent mental disorders. Social Psychiatry and Psychiatric Epidemiology, 31(2), 78–88.PubMedCrossRefGoogle Scholar
  8. 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/ Scholar
  9. McLellan, A. T., Luborsky, L., Woody, G. E., & O’Brien, C. P. (1980). An improved diagnostic evaluation instrument for substance abuse patients. The Addiction Severity Index. The Journal of Nervous and Mental Disease, 168(1), 26–33.PubMedCrossRefGoogle Scholar
  10. Meyer, P. S., & Morrissey, J. P. (2007). A comparison of assertive community treatment and intensive case management for patients in rural areas. Psychiatric Services, 58(1), 121–127. doi: 10.1176/ Scholar
  11. Mohamed, S., Neale, M., & Rosenheck, R. A. (2009). VA intensive mental health case management in urban and rural areas: Veteran characteristics and service delivery. Psychiatric Services, 60(7), 914–921. doi: 10.1176/ Scholar
  12. Neale, M. S., & Rosenheck, R. A. (1995). Therapeutic alliance and outcome in a VA intensive case management program. Psychiatric Services, 46(7), 719–721.PubMedCrossRefGoogle Scholar
  13. 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
  14. NPFC. (2005). Interim report of the president’s new freedom commission on mental health: 2002.Google Scholar
  15. Overall, J., & Gorham, D. (1962). Brief Psychiatric Rating Scale. Psychological Reports, 10, 799–812.CrossRefGoogle Scholar
  16. Rosenheck, R. A., & Neale, M. S. (1998). Cost-effectiveness of intensive psychiatric community care for high users of inpatient services. Archives of General Psychiatry, 55(5), 459–466.PubMedCrossRefGoogle Scholar
  17. Santos, A. B., Deci, P. A., Lachance, K. R., Dias, J. K., Sloop, T. B., Hiers, T. G., et al. (1993). Providing assertive community treatment for severely mentally ill patients in a rural area. Hospital and Community Psychiatry, 44(1), 34–39.PubMedGoogle Scholar
  18. Stein, L. I., & Test, M. A. (1980). Alternative to mental hospital treatment. I. Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry, 37(4), 392–397.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York (Outside the USA) 2014

Authors and Affiliations

  1. 1.New England Mental Illness, Research, Education and Clinical CenterWest HavenUSA
  2. 2.Department of PsychiatryYale School of MedicineNew HavenUSA
  3. 3.VA Connecticut Health Care SystemWest HavenUSA

Personalised recommendations