Intensity and duration of intensive case management services

Area of Science:

• Psychiatry
• Health Services Research

Background:

• Intensive case management (ICM) programs face policy challenges regarding caseload limits and service duration.
• Determining appropriate service intensity and duration is crucial for program efficiency and client outcomes.

Purpose of the Study:

• To examine policy issues of limiting caseload size and providing perpetual intensive services in ICM programs.
• To evaluate the impact of service duration on client decompensation within an ICM program.

Main Methods:

• Utilized the Denver Acuity Scale to assess client service needs and manager efficiency.
• Analyzed acuity ratings, readmission rates post-graduation, and functional trajectories of clients in an ICM program.

Main Results:

• Only 4% of 112 discharged clients were readmitted.
• Over half of clients reaching peak functioning maintained it; some showed temporary dips followed by improvement.
• A significant portion of clients continued to deteriorate despite sustained high-level functioning, though many did not reach lowest function levels.

Conclusions:

• Service intensity in ICM should be individualized based on client functioning levels for optimal efficiency.
• Perpetual intensive case management is generally unnecessary and potentially detrimental to client recovery.
• Providing services longer than needed can be inefficient and hinder consumer progress.