Cognitive-Behavioral Therapy in Intensive Case Management: A Multimethod Quantitative-Qualitative Study.

Area of Science:

• Psychiatry
• Clinical Psychology
• Mental Health Services Research

Background:

• Cognitive-behavioral therapy (CBT) improves outcomes in schizophrenia and severe mental illness.
• Access to CBT is limited for individuals with severe and persistent mental illness.
• Intensive case management (ICM) teams offer a potential avenue to increase CBT accessibility.

Purpose of the Study:

• To assess the feasibility and effectiveness of implementing CBT within ICM teams.
• To compare patient outcomes between ICM teams delivering CBT and those providing treatment as usual (TAU).

Main Methods:

• A 90-week quality improvement study involving 8 ICM clinicians implementing CBT with 40 patients.
• CBT-trained clinicians received 36 hours of seminars and weekly group supervision.
• Patient outcomes (Clinical Global Impressions, Montreal Life Skill Survey) were compared to a control group (4 TAU clinicians, 49 patients).

Main Results:

• Patients receiving CBT through ICM demonstrated fewer negative symptoms compared to the TAU group after 90 weeks.
• Qualitative data identified patient trajectories in CBT, suggesting factors influencing treatment response.
• Clinician reports provided insights into CBT interventions, session focus, and satisfaction.

Conclusions:

• CBT can be effectively integrated into ICM teams for patients with severe and persistent mental illness.
• This model shows promise for expanding access to evidence-based psychological therapies.
• Further research can explore factors influencing patient response to CBT within ICM settings.