Case management in the context of capitation financing: an evaluation of the strengths model

Conclusions

The results of the present evaluation strongly support the essential need for formal case management in providing community support for individuals with serious mental illness. When compared to a control condition in which consumers received CMHC-wide support from therapists, day treatment personnel, and residential staff, the Strengths case management program was considerably more effective in achieving three specific community support goals: increasing consumer personal incomes, providing needed social support, and maintaining consumer physical health. Surprisingly, the case management program was also found to be effective in achieving a goal that is usually not targeted by case management: consumers in the case management group improved in therapist-assessed psychiatric symptomatology more than control group consumers. Since the control and the case management groups had comparable increases in attendance at primary therapy and medication management over the study period, we conclude that the case management program was directly responsible for the improvements in psychiatric symptoms within its caseload. Whether these improvements in mood and cognitive processing are attributable to co-occuring improvements in quality of life variables (i.e., social support or personal income) or whether psychiatric improvement is more directly attributable to case managerin vivo counseling must be decided by future research.

While formal Strengths case management appears to be efficacious as a community support—and perhaps as a psychiatric rehabilitation—intervention, a formal program of case management does not appear to be essential to CMHC preparation for Medicaid capitated financing. The Valley Mental Health case management program significantly increased consumers' residential autonomy and attendance at primary therapy, but improvements on these two Medicaid-related variables were nearly matched within the control group through the efforts of other program staff. Taken as a whole, the study findings demonstrate that a formal case management program can work effectively in league with other CMHC programs to achieve specific managed care-related administrative goals, but that these delineated administrative goals can also be attained through a CMHC-wide mobilization of dedicated front-line staff.