Community Mental Health Journal

, Volume 35, Issue 4, pp 325–346 | Cite as

Case Management Models for Persons Who Are Homeless and Mentally Ill: The ACCESS Demonstration Project

  • Matthew Johnsen
  • Laura Samberg
  • Robert Calsyn
  • Margaret Blasinsky
  • Wendy Landow
  • Howard Goldman


Persons who are homeless and mentally illpresent unique challenges to service providers and humanservice systems. In vivo case management approaches suchas assertive community treatment (ACT) have shown promise in engaging this population. This paperexplores case management models employed within theACCESS program, a five year, 18-site demonstrationprogram enriching services for homeless persons with serious mental illness. We describe theimplementation of case management with ACCESS programsand determine the extent of variation across sites usinga measure of fidelity to ACT. While programs reported using four models, much similarity was foundamong programs on multiple dimensions.


Public Health Mental Illness Service Provider Health Psychology Case Management 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Arana, J.D., Hastings, B., & Herron, E. (1991). Continuous care teams in intensive outpatient treatment of chronic mentally ill patients. Hospital and Community Psychiatry 42(5): 503–507.Google Scholar
  2. Bond, G.R., Miller, L.D., Krumwied, R.D., et al. (1988). Assertive case management in three CMHCs: A controlled study. Hospital and Community Psychiatry, 39, 411–418.Google Scholar
  3. Bond, G.R. (1989). Assertive community treatment of the severely ill: Recent research findings. In K.E. Davis, R. Harris, R. Farmer, et al. (Eds.), Strengthening the scientific base of social work education for services for the long-term seriously mentally ill. Richmond, Virginia Commonwealth University.Google Scholar
  4. Burns, B. J., & Santos, A. B. (1995). Assertive community treatment: An update of randomized trials. Psychiatric Services, 46(7), 669–675.Google Scholar
  5. Calsyn, R.J., Goldman, H.H., & Teague, G. (1997, January). Implementation issues concerning the case management comparability study. Presentation at the semiannual ACCESS grantee meeting. Bethesda, MD.Google Scholar
  6. Center for Mental Health Services (1996). Second year interim status report of the evaluation of the ACCESS demonstration program. Rockville, MD: U.S. Department of Health and Human Services.Google Scholar
  7. Deci, P. A., Santos, A. B., Hiott, D. W., Schoenwald, S., & Dias, J. K. (1995). Dissemination of assertive community treatment programs. Psychiatric Services, 46(7), 676–683.Google Scholar
  8. Dincin, J., Wasmer, D., Witheridge, T.F., Sobeck, L., Cook, J., & Razzano, L. (1993). Impact of assertive community treatment on the use of state hospital inpatient bed-days. Hospital and Community Psychiatry, 44(9), 833–838.Google Scholar
  9. Dixon, L., Friedman, N. & Lehman, A. (1993). Compliance of homeless mentally ill persons with assertive community treatment. Hospital and Community Psychiatry, 44(6), 581–583.Google Scholar
  10. Dixon, L.B., Krauss, N., Kernan, E., Lehman, A. F. & DeForge, B.R. (1995). Modifying the PACT model to serve homeless persons with severe mental illness. Psychiatric Services 46(7), 684–688.Google Scholar
  11. Drake, R.E., Antosca, L.M., Noordsy, D.L., Bartels, S.J., & Osher, F. (1991). New Hampshire's specialized services for the dually diagnosed. New Directions for Mental Health Services 50: 57–67.Google Scholar
  12. Ellison, M.L., Rogers, E.S., Sciarappa, K., Cohen, M., & Forbess, R. (1995). Characteristics of mental health case management: Results of a national survey. The Journal of Mental Health Administration, 22(2), 101–112.Google Scholar
  13. Essock, S. M., & Kontos, N. (1995). Implementing assertive community treatment teams. Psychiatric Services, 46(7), 679–688.Google Scholar
  14. First, R.J., Rife, J.C., & Kraus, S. (1990). Case management with people who are homeless and mentally ill: Preliminary findings from an NIMH demonstration project. Psychosocial Rehabilitation Journal, 14(2), 87–91.Google Scholar
  15. Goldman, H.H., Morrissey, J.P., Ridgely, M.S. (1994). Evaluating the Robert Wood Johnson Foundation Program on Chronic Mental Illness. The Millbank Quarterly, 72(1), 37–47.Google Scholar
  16. Jerrell, J. M., & Hu, T. (1989). Cost-effectiveness of intensive clinical and case management compared with an existing system of care. Inquiry, 26, 224–234.Google Scholar
  17. Knoedler, W. (1989). The continuous treatment team model: Role of the psychiatrist. Psychiatric Annals 19(1): 35–40.Google Scholar
  18. LaChance, K.R. and Santos, A. (1995). Modifying the PACT model: Preserving critical elements. Psychiatric Services, 46(6), 601–604.Google Scholar
  19. Lehman, A.F. (1989). Strategies for improving services for the chronic mentally ill. Hospital and Community Psychiatry, 40(9): 916–920.Google Scholar
  20. Marx, A. J., Test, M. A., & Stein, L. I. (1973). Extrahospital management of severe mental illness. Archives of General Psychiatry, 29, 505–511.Google Scholar
  21. McGrew, J.H., & Bond, G.R. (1995). Critical ingredients of assertive community treatment: Judgments of the experts. The Journal of Mental Health Administration, 22(2), 113–125.Google Scholar
  22. McGrew, J.H., Bond, G.R., Dietzen, L., McKasson, M., & Miller, L.D. (1995). A multiline study of client outcomes in assertive community treatment. Psychiatric Services, 46(7), 696–701.Google Scholar
  23. McGrew, J. H., Bond, G. R., Dietzen, L., & Salyers, M. (1994). Measuring the fidelity of implementation of a mental health program model. Journal of Consulting and Clinical Psychology, 62, 670–678.Google Scholar
  24. Morse, G. A., Calsyn, R. J., Allen, G., Tempelhoff, B., & Smith, R. (1992). Experimental comparison of the effects of three treatment programs for homeless mentally ill people. Hospital and Community Psychiatry, 43(10), 1005–1010.Google Scholar
  25. Morse, G.A., Calsyn, R.J., Klinkenberg, W.D., Trusty, M.L., Gerber, F., Smith, R., Templehoff, B., & Ahmad, L. (1997). An experimental comparison of three types of case management for homeless mentally ill persons. Psychiatric Services, 48(4), 497–503.Google Scholar
  26. Mulder, R. (1985). Evaluation of the Harbinger Program, 1982_1985. Lansing, Michigan, Department of Mental Health.Google Scholar
  27. Olfson, M. (1990). Assertive community treatment: An evaluation of the experimental evidence. Hospital and Community Psychiatry, 41(6), 634–641.Google Scholar
  28. Orwin, R.G., Sonnefeld, L.J., Garrison-Mogren, R., & Gray Smith, N. (1994). Pitfalls in evaluating the effectiveness of case management programs for homeless persons: Lessons from the NIAAA Community Demonstration Program. Evaluation Review, 18(2), 153–207.Google Scholar
  29. Rapp, C.A. & Chamberlain, R. (1985, September_October). Case management for the chronically mentally ill. Case Management Services, 417-422.Google Scholar
  30. Rosenheck, R., Neale, M., Leaf, P., Milstein, R., & Frisman, L. (1995). Multiline experimental cost study of intensive psychiatric community care. Schizophrenia Bulletin, 21, 129–140.Google Scholar
  31. Scott, J. E., & Dixon, L. B. (1995). Assertive case management and case management for schizophrenia. Schizophrenia Bulletin, 21, 657–668.Google Scholar
  32. Stein, L. I., & Test, M. A. (1980). An alternative to mental hospital treatment. I: Conceptual model, treatment program, and clinical evaluation. Archives of General Psychiatry, 37, 392–397.Google Scholar
  33. Teague, G. (1996, July). Case management comparability study. Presentation at the semiannual ACCESS grantee meeting. Bethesda, MD.Google Scholar
  34. Teague, G. B., Drake, R. E., & Ackerson, T. H. (1995). Evaluating the use of continuous treatment teams for persons with mental illness and substance abuse. Psychiatric Services, 46(7), 689–695.Google Scholar
  35. Test, M.A., Knoedler, W., Allness, D., & Burke, S.S. (1992). Training in community living (TCL) model: Two decades of research. Outlook, 2(2), 5–8. Alexandria, VA: National Association of State Mental Health Program Directors.Google Scholar
  36. Test, M. A. (1992). Training in community living. In R. P. Liberman (Ed.), Handbook of psychiatric rehabilitation (pp. 153–170). New York: Macmillan.Google Scholar
  37. Thompson, K.S., Griffith, E.E.H., & Leaf, P.J. (1990). A historical review of the Madison model of community care. Hospital and Community Psychiatry, 41(6), 625–634.Google Scholar
  38. Torrey, E. F. (1986). Continuous treatment teams in the care of the chronically mentally ill. Hospital and Community Psychiatry, 37, 1243–1247.Google Scholar
  39. Turner, J.E., & Shifren, I. (1979). Community support systems: how comprehensive? In L. Stein (ed.) Community support systems for the long-term patient. New directions for mental health services (2). San Francisco: Jossey-Bass.Google Scholar
  40. Witheridge, T.F. (1991). The “active ingredients” of assertive outreach. In N. Cohen, Psychiatric Outreach to the Mentally Ill. New Directions for Mental Health Services (52). San Francisco: Jossey-Bass.Google Scholar
  41. Wolff, N., Helminiak, T.W., Morse, G.A., Calsyn, R.J., Klinkenberg, W.D., & Trusty, M.L. (1997). Cost-effectiveness evaluation of three approaches to case management for homeless mentally ill clients. American Journal of Psychiatcy, 154, 341–348.Google Scholar

Copyright information

© Human Sciences Press, Inc. 1999

Authors and Affiliations

  • Matthew Johnsen
  • Laura Samberg
  • Robert Calsyn
  • Margaret Blasinsky
  • Wendy Landow
  • Howard Goldman

There are no affiliations available

Personalised recommendations