Can small intensive case management teams be as effective as large teams?

Area of Science:

• Health Services Research
• Mental Health Services
• Rural Health

Background:

• The Veterans Health Administration (VHA) aimed to provide Assertive Community Treatment (ACT) services in low-density areas.
• ACT is an intensive case management approach for individuals with severe mental illness.

Purpose of the Study:

• To compare the effectiveness of small-staffed ACT teams versus large-staffed ACT teams in rural VHA settings.
• To assess the feasibility and clinical outcomes of small ACT teams for veterans.

Main Methods:

• Utilized VHA administrative data to compare veterans served by small ACT teams (2-3 staff) and large ACT teams (10+ staff).
• Compared treatment outcomes, including symptom improvement and suicidality indices, between the two groups.
• Adjusted for baseline differences between veteran cohorts.

Main Results:

• Smaller ACT teams demonstrated statistically significant, though small, effect sizes for less symptom improvement.
• Smaller teams also showed smaller declines in suicidality indices compared to larger teams.
• No significant differences were observed in 11 other outcome measures between small and large ACT teams.

Conclusions:

• Small-staffed ACT teams are clinically needed and practically feasible for delivering intensive case management in rural areas.
• These findings suggest that small teams can be potentially effective, despite minor differences in specific outcomes.
• The study supports the use of small ACT teams to expand access to care in underserved, low-density populations.