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CORK Bibliography: Case Management

68 citations. January 2003 to present

Prepared: March 2012

Barnett PG; Masson CL; Sorensen JL; Wong W; Hall S. Linking opioid-dependent hospital patients to drug treatment: Health care use and costs 6 months after randomization. Addiction 101(12): 1797-1804, 2006. (21 refs.)

Aims: To conduct an economic evaluation of the first 6 months' trial of treatment vouchers and case management for opioid-dependent hospital patients. Design: Randomized clinical trial and evaluation of administrative data. Setting: Emergency department, wound clinic, in-patient units and methadone clinic in a large urban public hospital. Participants: The study randomized 126 opioid-dependent drug users seeking medical care. Interventions: Participants were randomized among four groups. These received vouchers for 6 months of methadone treatment, 6 months of case management, both these interventions, or usual care. Findings: During the first 6 months of this study, 90% of those randomized to vouchers alone enrolled in methadone maintenance, significantly more than the 44% enrollment in those randomized to case management without vouchers (P < 0.001). The direct costs of substance abuse treatment, including case management, was $4040 for those who received vouchers, $4177 for those assigned to case management and $5277 for those who received the combination of both interventions. After 3 months, the vouchers alone group used less heroin than the case management alone group. The difference was not significant at 6 months. There were no significant differences in other health care costs in the 6 months following randomization. Conclusion: Vouchers were slightly more effective but no more costly than case management during the initial 6 months of the study. Vouchers were as effective and less costly than the combination of case management and vouchers. The finding that vouchers dominate is tempered by the possibility that case management may lower medical care costs.

Bender K; Kapp S; Hahn SA. Are case management services associated with increased utilization of adolescent mental health treatment? Children and Youth Services Review 33(1): 134-138, 2011. (31 refs.)

Retention in treatment is one of the strongest predictors of positive mental health outcomes. Adolescents, however, are particularly challenging to retain in mental health treatment. Concurrent case management services may offer one strategy for retaining youth in mental health treatment as it aims to reduce barriers to services, coordinate multiple services, and establish a consistent relationship between each client and a single contact person. This study combines three extant data sources from the state of Kansas to examine whether youths' participation in case management is associated with increased utilization of individual and group mental health treatment, controlling for client satisfaction, severity of mental health symptoms, and demographic factors. Linear regression results indicate that participation in case management services predicts increased utilization of both individual and group mental health treatment. Case management may be a useful tool for retaining adolescent clients in mental health services. Practical implications for community mental health service delivery are discussed.

Burnam MA; Watkins KE. Substance abuse with mental disorders: Specialized public systems and integrated care. Health Affairs 25(3): 648-658, 2006. (37 refs.)

Separate public financing and regulation of substance (SA) abuse treatment distinct from mental health (MH) treatment preserves a focus on the special needs of those with substance abuse but creates challenges to providing appropriate care for the large number of people with co-occurring conditions. This paper reviews recent efforts to overcome these challenges through clinical and systems approaches that better integrate care. Although much progress has been made for some subgroups of people with co-occurring disorders, further efforts to develop and sustain clinically integrated service delivery approaches within separate systems, particularly in SA treatment settings, are needed.

Coll KM; Stewart RA; Morse R; Moe A. The value of coordinated services with court-referred clients and their families: An outcome study. Child Welfare 89(1): 61-79, 2010. (23 refs.)

This study assessed the effectiveness of building partnerships with community resources and systems for court-referred clients and their families through a participant outcome evaluation. Specific variables studied included change in substance abuse patterns, family well-being, child safety, and recidivism. Results from pre-post testing revealed that a model with a single case coordinator who collaborated across service providers was particularly effective with court-referred clients and their families for increasing family intimacy and child well-being and for decreasing family danger and conflict. Discussion and recommendations are included.

Cooper RL; MacMaster S; Rasch R. Racial differences in retention in residential substance abuse treatment: The impact on African American men. Research on Social Work Practice 20(2): 183-190, 2010. (57 refs.)

Purpose: This study employed a static group comparison design with 106 men in residential treatment to examine the relationship of race to treatment retention. Methods: A retrospective analysis of retention, by race, including survival analysis, was undertaken. Results: Findings: from the study indicated that (a) Caucasian men complete treatment more frequently than African American men, (b) Race was not predictive of time in treatment, and (c) that race was a factor in the receipt of both criminal justice coercion and case-management both of which were strong predictors of time in treatment. Conclusions: Race serves as a factor in the receipt of services related to retention. Future research should focus on further exploration how race impacts retention, and the interaction of race with coercion and the receipt of case-management.

Coviello DM; Zanis DA; Wesnoski SA; Alterman AI. The effectiveness of outreach case management in re-enrolling discharged methadone patients. Drug and Alcohol Dependence 85(1): 56-65, 2006. (44 refs.)

Background: Heroin dependence is a chronic relapsing disease often requiring multiple treatment experiences. Despite this knowledge, few methadone programs follow-up with discharged patients who frequently continue to engage in risky behaviors. The aim of this project was to evaluate the effectiveness of outreach case management for post-discharged methadone patients. Methods: At 90 days post-discharge 128 active out of treatment heroin users were randomly assigned to receive either a passive referral (PR) for drug treatment (n = 52) or were provided with 6 weeks of outreach case management (OCM), an intervention designed to help motivate and coach patients to re-enter treatment (n = 76). Results: At 6 months post-baseline 29% of the OCM participants had successfully re-enrolled in drug treatment compared to 8% of the PR participants (chi(2) = 7.6, d.f. = 1, p = 0.006). A logistic regression analysis showed that OCM participants were nearly six times more likely than PR participants to re-engage in MMT (OR = 5.8, Cl = 1.6-20.8, p = 0.008). Moreover, OCM subjects had fewer opiate and cocaine positive urines at the 6-month follow-up compared to PR subjects. Conclusions: The findings highlight the importance of engaging former patients in treatment and actively assisting in treatment re-entry. OCM is a simple approach to reduce the number of out-of-treatment drug users, although availability of treatment funding limits enrollment opportunities.

Drake RE. Management of substance use disorder in schizophrenia patients: Current guidelines. CNS Spectrums 12(10, Supplement 17): 27-32, 2007. (33 refs.)

Substance use disorder is the most frequent and clinically significant comorbidity among schizophrenia patients today. All schizophrenia patients should be assessed and monitored carefully regarding their substance use. Those with any regular use of alcohol or other drugs should be considered at risk for multiple adverse effects. As therapies for co-occurring substance use disorders have evolved over the past 20 years, medication management, psychosocial interventions, and rehabilitation models have increasingly emphasized the integration of mental health and substance abuse treatments, attention to group and residential interventions, matching interventions to stage of treatment, comprehensiveness, and long-term perspectives on recovery. Clinicians should understand the implications of each of these principles of care.

Essock SM; Mueser KT; Drake RE; Covell NH; McHugo GJ; Frisman LK et al. Comparison of ACT and standard case management for delivering integrated treatment for co-occurring disorders. Psychiatric Services 57(2): 185-196, 2006. (76 refs.)

Objective: Clients with co-occurring severe mental and substance use disorders are at high risk of institutionalization and other adverse outcomes. Although integrated mental health and substance abuse treatment is becoming a standard clinical approach for such clients, the optimal method for delivering integrated treatment remains unclear. Method: This study compared integrated treatment delivered within two different models of community-based case management (assertive community treatment and standard clinical case management). A total of 198 clients in two urban sites who had co-occurring disorders and were homeless or unstably housed were randomly assigned to one of two treatment conditions and were followed for three years. Results: Participants in both treatment conditions improved over time in multiple outcome domains, and few differences were found between the two models. Decreases in substance use were greater than would be expected given time alone. At the site that had higher rates of institutionalization, clients who received standard case management were more likely to be institutionalized. However, in the site that had lower rates of institutionalization, no differences in the rate of institutionalization were found between the two treatment conditions. Conclusions: Integrated treatment can be successfully delivered either by assertive community treatment or by standard clinical case management.

Foster S; LeFauve C; Kresky-Wolff M; Rickards LD. Services and supports for individuals with co-occurring disorders and long-term homelessness. Journal of Behavioral Health Services & Research 37(2): 239-251, 2010. (37 refs.)

Co-occurring mental health and substance use disorders are highly prevalent among individuals experiencing long-term homelessness. This paper describes strategies used by 11 projects funded by the Federal Collaborative Initiative to Help End Chronic Homelessness (CICH) to serve individuals with co-occurring disorders (COD) as they transition from homelessness to permanent-supported housing. Findings are based on the observations of clients, program team members, and administrators. This paper presents findings organized around three themes: characteristics and needs of CICH clients with COD, strategies employed to respond to those needs, and challenges associated with implementing an integrated approach to COD. Client characteristics include histories of untreated or intermittently treated mental health and substance use disorders, often further complicated by trauma and chronic illness. Project teams endorsed a variety of services and supports such as engagement, stabilization, motivational techniques, groups, and trauma-informed interventions as useful for their clients with COD. Challenges identified include difficult client behavior, the extended time required for change to occur within this population, inadequate staffing and community resources, and system barriers. The paper concludes with recommendations for further research into the effectiveness of various combinations of service strategies for this population in non-traditional settings during the earliest stage of recovery, along with a call for overcoming workforce and system-level barriers to providing integrated care.

Friedmann PD; Hendrickson JC; Gerstein DR; Zhang Z. Designated case managers as facilitators of medical and psychosocial service delivery in addiction treatment programs. Journal of Behavioral Health Services & Research 31(1): 86-97, 2004. (55 refs.)

This study examines whether having designated case management staff facilitates delivery of comprehensive medical and psychosocial services in substance abuse treatment programs. A multilevel, prospective cohort study of 2829 clients admitted to selected substance abuse treatment programs was used to study clients from long-term residential, outpatient, and methadone treatment modalities. Program directors reported whether the program had staff designated as case managers. After treatment discharge, clients reported their receipt of 9 supplemental services during the treatment episode. In multivariate models controlling for multiple program-level and client-level factors, program-level availability of designated case managers increased client-level receipt of only 2 of 9 services, and exerted no effect on service comprehensiveness, compared to programs that did not have designated case managers. These findings do not support the common practice of designating case management staff as a means to facilitate comprehensive services delivery in addiction treatment programs.

Guydish J; Chan M; Bostrom A; Jessup MA; Davis TB; Marsh C. A randomized trial of probation case management for drug-involved women offenders. Crime & Delinquency 57(2): 167-198, 2011. (100 refs.)

This article reports findings from a clinical trial of a probation case management (PCM) intervention for drug-involved women offenders. Participants were randomly assigned to PCM (n = 92) or standard probation (n = 91) and followed for 12 months using measures of substance abuse, psychiatric symptoms, social support, and service utilization. Arrest data were collected from administrative data sets. The sample included mostly African American and White women (age M = 34.7, education M = 11.6 years). Cocaine and heroin were the most frequently reported drugs of abuse, 86% reported history of incarceration, and 74% had children. Women assigned to both PCM and standard probation showed clinical improvement change over time on 7 of 10 measured outcomes. However, PCM group changes were no different than those observed for the standard probation group. Higher levels of case management, drug abuse treatment, and probationary supervision may be required to achieve improved outcomes in this population.

Havens JR; Cornelius LJ; Ricketts EP; Latkin CA; Bishai D; Lloyd JJ et al. The effect of a case management intervention on drug treatment entry among treatment-seeking injection drug users with and without comorbid antisocial personality disorder. Journal of Urban Health 84(2): 267-271, 2007. (16 refs.)

We examined the effect of a case management intervention on drug treatment entry among injection drug users (IDUs) with and without comorbid antisocial personality disorder (ASPD). Injection drug users attending the Baltimore Needle Exchange Program who sought and were granted referrals to opioid agonist treatment were randomized to receive a strengths-based case management intervention or passive referral. Of 162 IDUs, 22.8% met the DSM-IV criteria for ASPD. Compared to those without ASPD, IDUs with comorbid ASPD who spent 25 or more minutes with their case manager prior to their treatment entry date were 3.51 times more likely to enter treatment than those receiving less than 5 min, adjusting for intervention status, race, and treatment site (95% confidence interval 1.04-11.89). Providing case management services to IDUs with comorbid ASPD may facilitate treatment entry and reduce the negative consequences of drug abuse.

Heinemann AW; Corrigan JD; Moore D. Case management for traumatic brain injury survivors with alcohol problems. Rehabilitation Psychology 49(2): 156-166, 2004. (40 refs.)

Objective: To evaluate a community-based approach to substance abuse using comprehensive case management for persons with traumatic brain injury (TBI). Setting: Two programs that provide case management services (n = 217); a comparison group was recruited that did not receive case management (n = 102). Intervention: Comprehensive case management. Main Outcome Measures: Self-reported substance use, community integration, employment status, health-related quality of life. Results: For those receiving case management, employment at recruitment and early referral were associated with employment 9 months later. Community integration and physical well-being increased for both groups. Earlier program referral was associated with larger gains in physical well-being, employment, and community integration. Conclusions: Case management appears to have beneficial effects for adults with TBI and substance abuse problems in terms of life and family satisfaction as well as to have potential cost savings.

Henskens R; Garretsen H; Mulder CL; Bongers I; Kroon H. Fidelity of an outreach treatment program for chronic crack abusers in the Netherlands to the ACT model. Psychiatric Services 56(11): 1451-1454, 2005. (9 refs.)

This study evaluated an effective outreach treatment program in the Netherlands for chronic, high-risk crack abusers on its adherence to the assertive community treatment model. Fidelity was tested on 25 criteria of the Dartmouth Assertive Community Treatment Scale. Adherence was high on several factors: a small caseload, staff capacity, a nurse and a substance abuse specialist on staff, explicit admission criteria, low intake rate, and intensity of service. Future programs that focus on treating crack addiction should implement these components. The outreach treatment program showed low adherence to the assertive community treatment model for including a psychiatrist and a vocational specialist, both of which are important factors that should be implemented in future programs. Other factors were observed to be important for treating this population: a strong focus on the client-therapist relationship, stagewise substance abuse treatment, and on-the-spot incentives to keep this population involved in treatment.

Hickie IB; Groom GL; McGorry PD; Davenport TA; Luscombe GM. Australian mental health reform: Time for real outcomes. Medical Journal of Australia 182(8): 401-406, 2005. (57 refs.)

After 12 years of national mental health reform, major service gaps and poor experiences of care are common. The mental health community reports little progress in implementing its key priorities, such as expanded early intervention programs, comanagement of people with mental health problems and related alcohol or substance misuse, and widening of the spectrum of acute care settings. We propose new national targets for reducing the social and economic costs of poor mental health; these include increased access to effective care, reduced suicide rates and improved rates of return to full social and economic participation. We detail specific service reforms designed to maximise the chance of achieving these targets, and prioritise youth health and integrated primary care programs. New independent and national reporting systems on the progress of mental health reform are urgently required.

Huckans MS; Blackwell AD; Harms TA; Indest D; Hauser P. Integrated hepatitis C virus treatment: Addressing comorbid substance use disorders and HIV infection. AIDS 19(Supplement 3): S106-S115, 2005. (26 refs.)

Objectives: To examine hepatitis C virus (HCV) and HIV testing patterns within the Northwest Veterans Integrated Service Network (VISN 20). Methods: Using a comprehensive VISN 20 database, we retrospectively reviewed medical records of 293 445 veterans. Results: 32.8% of patients were tested for HCV, 5.5% were tested for HIV, and 4.3% were co-tested. Of those tested, 12.3% were HCV positive, 5.4% were HIV positive, and 1.6% were co-infected. 79.1 % of HIV-positive patients were tested for HCV, 29.2% of whom tested positive. 34.8% of HCV-positive patients were tested for HIV, 4.9% of whom tested positive. Of those tested, HCV-positive patients were significantly more likely than HCV-negative patients to test positive for HIV; HIV-positive patients were no more likely to test positive for HCV than HIV-negative patients. HIV-positive patients with substance use disorders (SUD) were significantly more likely to test HCV positive than those without. Within the total sample, veterans with SUD were significantly more likely to be tested for both diseases and to test positive for HCV but not HIV. After controlling for other categories of SUD, veterans with a history of cocaine abuse compared with those without were at an increased risk of HIV infection and co-infection. Conclusion: 79.1 % of HIV-positive but only 34.8% of HCV-positive veterans were cotested, suggesting barriers to HIV testing may exist in VISN 20. Results also indicate that HCV-positive patients are at increased risk for HIV infection and that HIV-positive patients with SUD are at increased risk of HCV infection; routine co-testing for these patients is therefore warranted. Given significant co-infection rates, HCV and HIV screening and testing should be increasingly integrated. Increased infection rates among patients with SUD also warrant integration of HCV and HIV screening and testing into mental health and addiction programmes.

Hwang SW; Tolomiczenko G; Kouyoumdjian FG; Garner RE. Interventions to improve the health of the homeless: A systematic review. (review). American Journal of Preventive Medicine 29(4): 311-319, 2005. (84 refs.)

Background: Homelessness is a widespread problem in the United States. The primary goal of this systematic review is to provide guidance in the development and organization of programs to improve the health of homeless people. Methods: MEDLINE, CINAHL, HealthStar, PsycINFO, Sociologyogical Abstracts, and Social Services Abstracts databases were searched from their inception through July 2004 using the following terms: homeless, homeless persons, and homelessness. References of key articles were also searched. 4564 abstracts were screened, and 258 articles underwent full review. Seventy-three studies conducted from 1988 to 2004 met inclusion criteria (use of an intervention, use of a comparison group, and the reporting of health-related outcomes). Two authors independently abstracted data from studies and assigned quality ratings using explicit criteria. Results: Forty-five studies were rated good or fair quality. For homeless people with mental illness, case management linked to other services was effective in improving psychiatric symptoms, and assertive case management was effective in decreasing psychiatric hospitalizations and increasing outpatient contacts. For homeless people with substance abuse problems, case management resulted in greater decreases in substance use than did usual care. For homeless people with latent tuberculosis, monetary incentives improved adherence rates. Although a number of studies comparing an intervention to usual care were positive, studies comparing two interventions frequently found no significant difference in outcomes. Conclusions: Coordinated treatment programs for homeless adults with mental illness or substance abuse usually result in better health outcomes than usual care. Health care for homeless people should be provided through such programs whenever possible. Research is lacking on interventions for youths, families, and conditions other than mental illness or substance abuse.

Jones HE; Svikis D; Rosado J; Tuten M; Kulstad JL. What if they do not want treatment?: Lessons learned from intervention studies of non-treatment-seeking, drug-using pregnant women. American Journal on Addictions 13(4): 342-357, 2004. (32 refs.)

Despite specialized drug treatment, many pregnant drug-using women do not seek admission to such programs. This study examined two types of brief drug use intervention models for attracting and retaining pregnant women in drug abuse treatment. Both models offered motivational interviewing (MI) + behavioral incentives (BI) for drug abstinence. One model had an additional case management (CM) component. The addition of CM resulted in less drug use and fewer psychosocial needs, but similar levels of poor participation in the intervention was observed with both models. The intensity of effort expended to retain participants is discussed.

Karow A; Reimer J; Schafer I; Krausz M; Haasen C; Verthein U. Quality of life under maintenance treatment with heroin versus methadone in patients with opioid dependence. Drug and Alcohol Dependence 112(3): 209-215, 2010. (46 refs.)

Background: There is increasing evidence that health-related quality of life (HRQOL) is associated with a successful treatment and better outcome in opioid addiction. The aim of the present study was the longitudinal investigation of HRQOL in patients with severe dependence who were randomly assigned to four groups of medical and psychosocial treatment heroin (diacetylmorphine) versus methadone and case management (CM) versus psychoeducation (PSE) respectively. Methods: HRQOL (MSQoL) and physical health (OTI) were Investigated in 938 subjects who participated in the German multi-centre study examining the effects of heroin-assisted treatment in patients with severe opioid dependence. Data for the present analysis were taken from baseline and 12-month follow up. Results: Under both forms of maintenance and psychosocial treatment HRQOL improved significantly during the observation period. HRQOL improvement under maintenance with heroin exceeded improvement under methadone especially with regard to subjective physical health HRQOL improvement was significantly associated with better expert-rated physical health. Further analyses showed significant better improvement of HRQOL in subjects treated with PSE compared with CM. Conclusions: The advantage of heroin with regard to the improvement of HRQOL may be partially explained by a better Improvement of physical health under maintenance with heroin compared with methadone which highlights the importance of a comprehensive model of health care for patients with severe opioid dependence. Future studies need to investigate the benefits of PSE for patients in maintenance therapy.

Karper L; Kaufmann M; Millspaugh G; Vega E; Stern G; Stern G et al. Coordination of care for homeless individuals with comorbid severe mental disorders and substance-related disorders. Journal of Dual Diagnosis 4(2): 142-157, 2008

Psychiatric symptoms and alcohol and drug use disorders are often diagnosed in individuals who frequent shelters and programs for homelessness. Services are often provided in a fragmented, uncoordinated manner. This study evaluates a care coordination program in dual-diagnosis patients by comparing data on 50 patients treated with standard methods and 50 patients enrolled in the care coordination program. Clinical outcomes were measured with the Hamilton Depression Scale, Positive and Negative Syndrome scale, BASIS-32, service utilization, and alcohol use. We found that care coordination is a relatively low intensity but promising intervention that may improve clinical outcomes of homeless dual-diagnosis patients.

Kilbride HW; Castor CA; Fuger KL. School-age outcome of children with prenatal cocaine exposure following early case management. Journal of Developmental and Behavioral Pediatrics 27(3): 181-187, 2006. (32 refs.)

The impact of prenatal cocaine exposure on neurodevelopmental outcome in childhood continues to be in question. Objectives of this study were to determine if there are differences in growth, behavioral, cognitive or verbal functioning or caregiver-child dyad interactions for inner-city, school-aged children with and without prenatal cocaine exposure, and if these measures would be affected by early family case management. From an initial sample of 118 cocaine-exposed children who were evaluated to 36 months of age, 47 were able to be contacted and 39 (83%) completed a follow-up evaluation at 84 +/- 11 months of age. Subjects had been assigned at birth to early case management (CM, 24) and routine care (RC, 15). Eighteen children from the initial non-cocaine-exposed comparison sample of 41 children were able to be contacted and 12 (67%) were evaluated at 85 +/- 16 months of age. Evaluation included growth measurements, Stanford-Binet IQ, receptive and expressive language quotients, parent-reported Child Behavior Checklists (CBCL), and assessment of caregiver-child interactions by scored videotaped free-play sessions. No differences were found in growth, mean IQ, language quotients, CBCL scores or videotaped caregiver-child play interactions as a function of cocaine exposure. Within the cocaine-exposed group, there were no outcome differences between CM and RC children. However, during the play sessions, CM caregivers had more positive affect in interactions with the child than RC. Within the RC dyads, birthmothers had significantly more positive interactions than non-birthmothers. In summary, no differences in growth, behavioral, cognitive, or language function were evident for inner-city, school-aged children related to prenatal cocaine exposure or early case management. CM caregivers demonstrated more positive interactions during a play session than RC; within the RC group, non birthmothers had the least positive affective interactions. Further study of influences on caregiver-child interactions may lead to effective intervention strategies for drug-exposed infants.

Kreindler SA; Coodin S. Housing histories of assertive community treatment clients: Program impacts and factors associated with residential stability. Canadian Journal of Psychiatry 55(3): 150-156, 2010. (19 refs.)

Objective: Although housing is widely recognized as a crucial issue for people with severe and persistent mental illness, there is much to learn about the ongoing housing experiences of this group of people. Using secondary data, this study examined the housing histories of 65 assertive community treatment (ACT) clients from 2 years prior until up to 7 years after intake, totalling 407 addresses. Method: We used statistical process control to assess the significance and longevity of pre- and post-ACT changes in residential tenure and independent living. We used multivariate survival analysis to explore participant and residence characteristics associated with residential stability. Results: After 6 months in ACT, the client population showed a significant, sustained improvement in housing stability. Similarly, shortly after ACT entry, there was a marked increase in the proportion of participants living independently. At the participant level, substance abuse was the strongest predictor of residential instability; other predictors included age (30 years or younger) and sex (female). Residence characteristics also proved important; independent housing, neighbourhood income (a proxy for housing quality), and receipt of a rental subsidy were associated with significantly longer tenure, controlling for client characteristics. Conclusions: The timing and magnitude of the observed changes imply that ACT was effective in helping clients to achieve stable housing and to live independently. The results also underscore the importance of high-quality housing in promoting residential stability.

Kuerbis AN; Neighbors CJ; Morgenstern J. Depression's moderation of the effectiveness of intensive case management with substance-dependent women on Temporary Assistance for Needy Families: Outpatient substance use disorder treatment utilization and outcomes. Journal of Studies on Alcohol and Drugs 72(2): 297-307, 2011. (61 refs.)

Objective: Intensive case management (ICM) is effective for facilitating entry into and retention in outpatient substance use disorder treatment (OSUDT) for low-income substance-dependent women; however, no studies have specifically examined the moderating impact of depressive symptoms on ICM. The purpose of this study was to investigate whether depressive symptoms moderated ICM's effect on OSUDT engagement, attendance, and outcomes for substance-dependent women on Temporary Assistance for Needy Families (TANF). It was hypothesized that highly depressed women would demonstrate worse outcomes on all indicators. Method: Logistic regression and generalized estimating equations were used to determine depression's moderating impact on ICM in a secondary analysis of data from a randomized controlled trial comparing the effectiveness of ICM to usual care provided by local public assistance offices in Essex County, NJ. Substance-dependent women (N = 294) were recruited while being screened for TANF eligibility and were followed for 24 months. Results: Findings revealed that high levels of depressive symptoms moderated the effectiveness of ICM in unexpected directions for two outcome variables. Subjects with high levels of depressive symptoms in ICM were (a) significantly more likely to engage in at least one treatment program than those in usual care and (b) associated with the fewest mean drinks per drinking day across the 24-month follow-up period. Independent effects for high levels of depressive symptoms and ICM were also found to positively influence engagement, attendance, and percentage days abstinent. Conclusions: ICM is effective for substance-dependent women with a broad spectrum of depressive symptoms in enhancing OSUDT utilization and outcomes.

Libby AM; Riggs PD. Integrated substance use and mental health treatment for adolescents: Aligning organizational and financial incentives. Journal of Child & Adolescent Psychopharmacology 15(5): 826-834, 2005. (44 refs.)

The high prevalence of the dual diagnosis of mental and substance use disorders (SUD) has been increasingly documented for both adolescents and adults. For more than a decade, the National Institute of Drug Abuse (NIDA) has included integrated treatment of comorbid psychiatric disorders as one of nine core treatment principles (National Institute on Drug Abuse 1999). Despite empirically supported practice guidelines, implementation of integrated treatment has been slow. In response to the growing call for integrated treatments and systems of care, this paper: (1) identifies systemic and economic barriers that have impeded widespread implementation of integrated care for adolescents with co-occurring SUD, specifically the supply of treatment providers, shifting priorities of gatekeepers to specialty care, and financing streams; and (2) describes possibilities for aligning economic incentives in order to facilitate the dissemination and implementation of integrated care for adolescents with co-occurring SUD.

May PA; Miller JH; Gossage JP. Enhanced case management to prevent fetal alcohol syndrome. (meeting abstract). Alcoholism: Clinical and Experimental Research 28(5 Supplement): 125A-125A, 2004. (0 refs.)

McLellan AT; Weinstein RL; Shen QS; Kendig C; Levine M. Improving continuity of care in a public addiction treatment system with clinical case management. American Journal on Addictions 14(5): 426-440, 2005. (19 refs.)

Philadelphia attempted to expand the access to and continuity of addiction treatment by focusing on the 15% of patients who received multiple, detoxification-only (MDO) treatments each year. Clinical Case Managers at five detoxification centers encouraged MDO patients to continue care following detoxification in methadone, residential, or outpatient rehabilitation, and sustain improvements, and they recommended opening detoxificafion access for additional patients as well. System administrative information was available for one year prior and three years during the intervention. Counts of unduplicated patients within each year and measures of the length and type of treatment episodes determined the intervention effects. Records from a changes sub-sample of 100 MDO patients were examined to assess sin gstem utilization. Over three years, 890 MDO patients were case managed and bad received assessment, referral, and transort to health care and sober living. The sub-sample of case-managed MDO patients showed a 55% reduction in detoxification-only admissions, a 70% increase in use of rehabilitation, and a twenty-day increase in the average length of stay per episode. Though there are noted limitations in the evaluation design, the findings are consistent with the view that individual case management of MDO patients may improve the clinical appropriateness and administrative efficiency of public addiction treatment.

Morgan BD; Rossi AP. Difficult-to-manage HIV/AIDS clients with psychiatric illness and substance abuse problems: A collaborative practice with psychiatric advanced practice nurses. Journal of the Association of Nurses in AIDS Care 18(6): 77-84, 2007. (10 refs.)

Complex clients with comorbid HIV disease, other medical illness, psychiatric illness, and substance abuse problems present tremendous challenges to providers. Medication adherence and case management become vital issues in providing comprehensive care to this population. This report describes the practice of two advanced practice psychiatric registered nurses who worked collaboratively with each other and with nurse practitioners to provide care to such complex clients. Description of collaborative practices and the model of collaboration used by the two practitioners are highlighted through three case studies. Conclusions about the practice and its use with complex clients are provided.

Morgenstern J; Blanchard KA; McCrady BS; McVeigh KH; Morgan TJ; Pandina RJ. Effectiveness of intensive case management for substance-dependent women receiving temporary assistance for needy families. American Journal of Public Health 96(11): 2016-2023, 2006. (34 refs.)

Objective. We tested the effectiveness of along-term coordinated care strategy-intensive case management (ICM)-compared with usual care (UC) among a group of substance-dependent women receiving Temporary Assistance for Needy Families (TANF). Methods. Substance-dependent women on TANF (N=302) were recruited from welfare offices. They were assessed and randomly assigned to ICM or UC; follow-up was at 3, 9, and 15 months. UC consisted of a health assessment at the welfare office and a referral to substance abuse treatment and TANF services. ICM clients received ICM services in addition to UC services. Results. ICM clients had significantly higher levels of substance abuse treatment initiation, engagement, and retention compared with UC clients. In some cases, ICM treatment attendance rates were double those of UC rates. Additionally, almost twice as many ICM clients were abstinent at the 15 month follow-up compared with UC clients (P <.0025). Conclusions. ICM is a promising intervention for managing the chronic nature of substance dependence among women receiving TANF. Future research should refine long-term care strategies-such as ICM-that address the chronic nature of substance dependence among low-income populations.

Mueser KT. Integrated Treatment for Dual Disorders. A Guide to Effective Practice. New York: Guilford Press, 2003. (Chapter refs.)

This handbook covers the essential elements of caring for those with coexisting substance abuse disorders and psychiatric illness. It describes the epidemiology of these comorbidities, with special attention to severe mental illness. It discusses integrated treatment and the underlying principles, as well as organizational factors critical to this approach. Attention is then directed to the assessment process: detection, classification, functional assessment, and treatment planning. A variety of treatment modalities are considered. Individual approaches and case management and related skills, such as motivational interviewing; cognitive-behavioral therapy are discussed. This is followed by consideration of group interventions: persuasion groups, active treatment groups, social skills training groups, and self-help groups. Involvement of family is central and chapters are devoted to behavioral family therapy and multiple-family groups. Other clinical issues addressed include: other treatment approaches; residential care; housing options; and vocational rehabilitation, as well as involuntary and coerced interventions. Pharmacological treatment is also discussed.

Nalpas B; Matelak F; Martin S; Boulze O; Balmes JL; Crouzet C. Clinical management methods for out-patients with alcohol dependence. Substance Abuse Treatment, Prevention, and Policy 1: article 5, 2006. (9 refs.)

Background: In France outpatient centres for the care of alcoholics are healthcare establishments providing medical, psychological and social support. Although they meet the practical needs of these patients, their degree of use in each of these domains and the respective mobilisation of different skills by the care team are not well understood. Our aim was therefore to determine in detail the management involved as a function of the severity of alcohol dependence. For this purpose, all the procedures involved were compiled in a thesaurus describing its type (psychological, medical, social, reception), its scheduled or unscheduled nature, its method (face-to-face, telephone, letter) and its duration. The severity of dependence was evaluated using the Addiction Severity Index (ASI). Results: 45 patients were included and followed-up during 291 � 114 days. The mean initial ASI scores (� SD) were: medical (M) = 0.39 � 0.3, working-income (ER) = 0.5 � 0.3, alcohol (A) = 0.51 � 0.2, illicit drugs (D) = 0.07 � 0.08, legal (L) = 0.06 � 0.13, familial and social environment (FS) = 0.34 � 0.26, psychological (P) = 0.39 � 0.22. The total number of procedures was 1341 (29.8 per patient) corresponding to 754.4 hours (16.7 per patient). The intensity of management peaked during the first month of treatment, and then declined rapidly; the maximum incidence of abstinence was observed during the 3rd month of management. Interviews with patients, group therapy and staff meetings represented 68.7%, 9.9% and 13.9% of all procedures, respectively. In patients with severe dependence, as compared to moderate, management was twice as intense in the psychological and social domains, but not in the medical domain. The ASI questionnaire was completed a second time by 24 patients, after an average of 3.2 months. The improvement was significant in the M, A, D and P domains only. Conclusion: This study provided an overview of the methods employed in managing a sample of patients consulting an alcoholism centre in line with standards for medical, psychological and social establishments. The predominance of the social and psychological domains over the medical domain was clearly established. Relapses were common after the third month of treatment, but a remobilisation of teams made it possible to contain them. These results provide a framework for discussions on the organisation of healthcare systems and highly suggest that staff need to maintain a constant level of care throughout the treatment process.

Needels K; Jarnes-Burdurny S; Burghardt J. Community case management for former jail inmates: Its impacts on rearrest, drug use, and HIV risk. Journal of Urban Health 82(3): 420-433, 2005. (19 refs.)

Dramatically increasing incarceration rates in the United States have led to large concentrations of formerly imprisoned people in poverty-stricken urban areas. Therefore, identifying ways to help inmates who exhibit multiple, serious problems and who are at great risk of experiencing poor postrelease outcomes is especially important to urban communities, as well as to service providers and policymakers concerned about these communities. Our research provides evidence about the effectiveness of one strategy, called Health Link, which recruited adult women and adolescent men while they were incarcerated in a New York City jail and offered case management services during the especially challenging first year after release. About 1,400 participants who enrolled during a 3-year period were randomly assigned either to a group that was eligible for intensive discharge planning services and community-based case management services or to a group eligible for less-intensive discharge planning and no community-based services. We investigated whether the availability of these services reduced rates of drug use, HIV risk, and rearrest. Using data from interviews and hair analysis to measure impacts during a 1-year follow-up period after clients? release from jail, we detected increased participation in drug treatment programs and weak evidence for reduced drug use. However, we did not observe reductions in rearrest rates or in activities with high risk of HIV infection. We conclude that a well-executed case management program can make modest differences in a few short-term outcomes of former inmates. However, the intervention did not lead to the hoped-for changes across a range of outcomes that would clearly indicate greater success in community reintegration or improved health.

Noel PE. The impact of therapeutic case management on participation in adolescent substance abuse treatment. American Journal of Drug and Alcohol Abuse 32(3): 311-327, 2006. (34 refs.)

Establishing the efficacy of case management in substance abuse treatment has been confounded by the lack of attention given to assessing the fidelity of case management implementation. The current study measured the fidelity of case management implementation and used fidelity information to examine the impact of therapeutic case management on attrition in an adolescent, outpatient, group, substance abuse treatment program. Ninety adolescent women enrolled in substance abuse treatment were randomly assigned to receive or to not receive case management. Treatment fidelity was measured using the Case Management Quality Inventory. Cox regression analyses revealed that higher fidelity of case management implementation predicted a decreased risk of dropping out of the substance abuse treatment program (RR = -11.21, p < 0.02). Higher proportions of total case management time spent on case management core functions predicted a decreased risk of dropping out of treatment ( RR = 4.32, p < 0.03). This study confirms that programs need to first demonstrate that the case management model has been implemented faithfully before its efficacy in reducing attrition in the substance abuse treatment program can be fairly evaluated. It also suggests that core case management functions may have a greater influence on attrition in substance abuse treatment than does intensity.

O'Connell JJ; Mattison S; Judge CM; Allen HJS; Koh HK. A public health approach to reducing morbidity and mortality among homeless people in Boston. Journal of Public Health Management and Practice 11(4): 311-316, 2005. (8 refs.)

Urban homeless populations suffer disproportionately high rates of premature death. In response to a wave of highly publicized deaths on the streets of Boston during the winter of 1998-1999, the Massachusetts Department of Public Health (MDPH) convened a task force to investigate these deaths and implement an integrated response to this public health crisis. Comprised of a broad coalition of public and private agencies as well as homeless persons and advocacy groups, the MDPH Task Force reviewed the circumstances surrounding the 13 deaths, monitored subsequent deaths among homeless persons in Boston, and implemented a comprehensive plan to address critical needs and prevent further deaths. Contrary to the task force's initial assumption, the 13 decedents had multiple recent contacts with the medical, psychiatric, and substance abuse systems. In response to this finding, the MDPH Task Force sought to improve continuity of care and prevent future deaths among Boston's street population. Coordination of needed services was achieved through the creation of new, and often unconventional, partnerships. This case study exemplifies a public health practice response to the vexing health care challenges confronting homeless people who must struggle to survive on the streets and in shelters.

Ostroff JS; Shuk E; Krebs P; Lu WH; Burkhalter J; Cortez-Weir J et al. Qualitative evaluation of a new tobacco cessation training curriculum for patient navigators. Journal of Cancer Education 26(3): 427-435, 2011. (38 refs.)

Treatments for tobacco dependence exist but are underutilized, particularly among low-income and minority smokers. Patient navigation has been shown to help patients overcome barriers to quality care. In preparation for testing the feasibility of integrating tobacco cessation patient navigation into primary care, this paper describes the development and qualitative evaluation of a new curriculum for training patient navigators to address cessation treatment barriers faced by low-income, minority smokers who are advised to quit by their physicians. Thematic text analysis of transcripts obtained from focus groups with experienced patient navigators (n = 19) was conducted. Participants endorsed patient navigation as a relevant strategy for addressing tobacco cessation treatment barriers and made several recommendations regarding the knowledge, core competencies, and skills needed to conduct tobacco cessation patient navigation. This curriculum could be used by existing patient navigation training centers or made available as a self-guided continuing education program for experienced navigators who wish to expand their navigation interventions to include a tobacco cessation focus. [Note: A "navigator" serves as a coordinator/case manager, a patient advocate, linking clients in primary care with community resources.]

Redko C; Rapp RC; Elms C; Snyder M; Carlson RG. Understanding the working alliance between persons with substance abuse problems and strengths-based case managers. Journal of Psychoactive Drugs 39(3): 241-250, 2007. (48 refs.)

A substantial body of literature has examined the importance of the working alliance in psychotherapy; few works have examined it in the context of case management. Qualitative methods were used to examine how 26 persons with substance abuse problems perceived the working alliance with case managers who practice from the strengths perspective. Clients' narratives emphasized the personal qualities of the case manager and the nature of the client-case manager relationship. Their narratives also reflected two guiding principles of strengths-based case management: personal control over goal-setting, and an emphasis on strengths. Most clients concluded that a positive working alliance helped them to build trust, self-worth, and self-esteem.

Renner JA; Levounis P. Handbook of Office-Based Buprenorphine Treatment of Opioid Dependence. Washington DC: American Psychiatric Association, 2011

This guide is directed to both psychiatrists and other clinicians who wish to incorporate buprenorphine treatment into an existing clinical practices. It highlights the importance of counseling as an essential component of quality buprenorphine treatment and discusses assessment and available treatment options to ensure that patients receive the appropriate intensity of care. It is recommended that clinicians identify therapists trained in cognitive-behavior therapy, motivational enhancement therapy, and 12-step facilitation who can become involved in providing comprehensive care, and stresses the importance of all involved clinicians coordinating care. The book provides a history of opioid abuse, provides assessment criteria, and outlines guides for clinical management. It also discusses psychiatric comorbidity, reviews the pharmacology, efficacy and safety of buprenorphine treatment, and issues related to medical management, as well as special issues related to opioid use by adolescents. Also it provides clinical tools, including a checklist of what is necessary for setting up an office-based treatment program, screening instruments, and a sample informed consent form. Illustrative case vignettes are included.

Ries RK; Short RA; Dyck DG; Srebnik DS. Unlinking disability income, substance use and adverse outcomes in dually diagnosed, severely mentally ill outpatients. American Journal on Addictions 13(4): 390-397, 2004. (24 refs.)

The goals of the current study were to determine whether incorporating disability benefit management into combined outpatient psychiatric/addiction treatment was feasible and clinically useful for managing severely mentally ill, substance-abusing patients over time, and then if patients in this program would demonstrate the first-week-of-the-month increased substance abuse and hospitalizations shown in other studies. Forty-four patients were studied for an average of forty weeks, with little treatment or study dropout. There was no evidence in either the schizophrenic/cocaine abuser or the broader diagnostic sample of the cyclic first-of-the-month pattern of substance use and hospitalizations observed in other studies. Findings suggest that combined treatment/benefit management programs are clinically feasible and effective in stabilizing patients and keeping them in treatment.

Robles RR; Reyes JC; Colon HM; Sahai H; Marrero CA; Matos TD et al. Effects of combined counseling and case management to reduce HIV risk behaviors among Hispanic drug injectors in Puerto Rico: A randomized controlled study. Journal of Substance Abuse Treatment 27(2): 145-152, 2004. (41 refs.)

This study examined the effectiveness of a combined counseling and case management behavioral intervention, using motivational interviewing strategies, in engaging Hispanic injection drug users in treatment and reducing drug use and injection-related HIV risk behaviors. Follow up data are presented on 440 (79.0%) of 557 randomized participants, 6 months after the initial interview. Subjects in the experimental arm were significantly less likely to continue drug injection independent of entering drug treatment, and were also more likely to enter drug treatment. Subjects in both arms who entered drug treatment were less likely to continue drug injection. Among subjects who continued drug injection, those in the experimental arm were significantly less likely to share needles. Confirming the outcomes of this study in other Hispanic sites and populations could be a critical step towards reducing factors that contribute to the self-sustaining HIV/AIDS epidemic in Puerto Rico and communities in the U.S. mainland.

Rosenheck RA; Neale MS; Mohamed S. Transition to low intensity case management in a VA Assertive Community Treatment Model Program. Psychiatric Rehabilitation Journal 33(4, Special Issue): 288-296, 2009. (18 refs.)

Objective: To study transition to lower intensity services in a national VA program modeled on Assertive Community Treatment (ACT). Methods: This study uses national VA administrative data from VA's Mental Health Intensive Case Management (MHICM) program, to compare veteran characteristics, patterns of service use and early clinical changes among veterans who were formally transitioned to lower intensity treatment and veterans who were not. Bivariate comparisons and logistic regression analyses are used to identify factors associated with transition to low intensity treatment and to characterize post-transition service use. Descriptive information on the criteria for termination and subsequent service use are also presented. Results: Among 2,137 veterans in the sample who enrolled in MHICM from FY 2002-2006 and who participated in at least one year of treatment, 196 (9.2%) were transitioned to lower intensity services. These veterans did not differ from others on baseline clinical characteristics but had a smaller number of program contacts during the first 6 months of participation, a higher quality of family relationships and overall quality of life after 6 months of treatment. Only 5.7% were reported to have needed to return to higher service intensity after the transition and they continued to have reduced levels of service use on several measures but no reduction in therapeutic alliance. Conclusion: The VA policy did not result in frequent transition to lower intensity services. Those who did transition had shown greater clinical improvement, used fewer services, had better family relationships, and rarely required a shift back to higher intensity services.

Rosenthal MZ; Lynch TR; Linehan MM. Dialectical behavior therapy for individuals with borderline personality disorder and substance use disorders. IN: Frances RJ; Miller SI; Mack AH, eds. Clinical Textbook of Addictive Disorders, 3rd edition. New York: Guilford Press, 2005. pp. 615-636. (20 refs.)

This is a manual-based treatment for substance abusers for those with Borderline Personality Disorders, which has been recently introduced and early studies indicate promising outcomes. It is a psychosocial treatment which places emphasis on efforts to reduce drug-related behaviors, provide new coping skills, and promote attachment. It uses case management such as providing assistance in housing and other crises via environmental interventions. It also uses drug therapies. Dialectical abstinence refers to having a goal of total abstinence while anticipating and responding to the reality that there may be lapses in abstinence. Thus it draws upon a harm reduction approach to move toward abstinence.

Sacks S; Chandler R; Gonzales J. Responding to the challenge of co-occurring disorders: Suggestions for future research. Journal of Substance Abuse Treatment 34(1): 139-146, 2008. (32 refs.)

This special issue consolidates some recent research findings and scientific thought on co-occurring disorders from both the substance abuse and mental health fields. This summary article recaps and synthesizes the main findings and themes, then considers additional issues in the field today to arrive at an agenda for future co-occurring disorders research. Plans must: (1) encourage and assist further development of treatment programs that respond to an array of types and severities of co-occurring disorders while taking into account the limited resources typically available; (2) continue the development and testing of continuing care models by exploring strategies that will sustain the recovery of treated individuals who remain vulnerable to relapse; and (3) contribute to our understanding of the mechanisms and processes that enable new interventions and practices to be adopted, implemented, and sustained. '' Co-occurring disorders '' is a relatively new area of research; this special issue illustrates the productivity of work to date and indicates the potential for advances to come.

Saleh SS; Vaughn T; Levey S; Fuortes L; Uden-Holmen T; Hall JA. Cost-effectiveness of case management in substance abuse treatment. Research on Social Work Practice 16(1): 38-47, 2006. (30 refs.)

Objective: The purpose of this study, which is part of a larger clinical trial, was to examine the cost-effectiveness of case management for individuals treated for substance abuse in a residential setting. Method: Clients who agreed to participate were randomly assigned to one of four study groups. Two groups received face-to-face case management and one telecommunication case management, and the fourth was the control group. Results: Using a ratio of cost to days free from substance abuse, the case management groups were less cost-effective than the control group at 3 months, 6 months, and 12 months. The telecommunication case management was least cost-effective of the three case management conditions. Conclusion: Results from the analysis revealed case management is not cost-effective as a supplement to traditional drug treatment over a 12-month follow-up period.

Shelton RC; Golin CE; Smith SR; Eng E; Kaplan A. Role of the HIV/AIDS case manager: Analysis of a case management adherence training and coordination program in North Carolina. AIDS Patient Care and STDS 20(3): 193-204, 2006. (68 refs.)

Highly active antiretroviral therapy (HAART) adherence rates of 90%-95% or more are required to be effective at treating the virus and preventing drug resistance. From both a medical and public health perspective, it is essential that HIV-positive clients strictly adhere to antiretroviral treatment regimens. One promising approach to promoting optimal adherence rates among HIV-positive individuals is training and reimbursing case managers to provide adherence coordination services to HIV-positive clients. In this study, a sample of 16 HIV/AIDS case managers from agencies across North Carolina participated in a Case Management Adherence Training and Coordination Program for a 3-month period. After case manager training, case managers enrolled 1-4 of their existing clients, who met eligibility criteria, to receive the adherence coordination program. Data were analyzed from focus group interviews and individual interviews conducted with case manager participants; their respective client care plans were also analyzed to identify primary barriers and strategies reported by case managers. Although case managers perceived themselves to be well positioned to provide adherence coordination services for their HIV-positive clients, they also identified barriers that they face in providing these services, including lack of reimbursement for their time, inadequate training, and insufficient knowledge of HIV/AIDS and medications. The findings of this study suggest that, with appropriate training and reimbursement, HIV/AIDS case managers can play a pivotal role in promoting and improving client adherence to antiretroviral medications.

Sorensen JL; Masson CL; Delucchi K; Sporer K; Barnett PG; Mitsuishi F et al. Randomized trial of drug abuse treatment-linkage strategies. Journal of Consulting and Clinical Psychology 73(6): 1026-1035, 2005. (39 refs.)

A clinical trial contrasted 2 interventions designed to link opioid-dependent hospital patients to drug abuse treatment. The 126 out-of-treatment participants were randomly assigned to (a) case management, (b) voucher for free methadone maintenance treatment (MMT), (c) case management plus voucher, or (d) usual care. Services were provided for 6 months. MMT enrollment at 3 months was 47% (case management), 89% (voucher), 93% (case management plus voucher), and 11% (usual care); at 6 months enrollment was 48%, 68%, 79%, and 21%, respectively. Case management and vouchers can be valuable in health settings to link substance abusers with medical problems to drug abuse treatment.

Sosin MR; Durkin E. Perceptions about services and dropout from a substance abuse case management program. Journal of Community Psychology 35(5): 583-602, 2007. (56 refs.)

This article uses event history analysis to examine certain determinants of dropout from a case management program that serves homeless adults with substance abuse problems. The examined determinants are perceptions of conventional treatment services: (a) client perceptions concerning the value of the conventional services that case managers help them to obtain, (b) the views of use services held by social contacts, and (c) client perceptions of the legitimacy of conventional services. The findings, some of which involve statistical interactions, suggest that clients drop out of case management services more slowly (a) when they favor pursuit of particularly efficacious conventional programs, (b) when they find conventional programs to be of low legitimacy; (c) when, under special conditions, they perceive that conventional services are less caring; or (d) when social contracts do not pressure them. These findings generally imply that clients took to case management services when they are more skeptical about conventional services. The variables predicting dropout from case management poorly predict continuation in conventional substance abuse services, indicating that dropout is linked to perceptions of services in context-specific ways.

Strathdee SA; Ricketts EP; Huettner S; Cornelius L; Bishai D; Havens JR et al. Facilitating entry into drug treatment among injection drug users referred from a needle exchange program: Results from a community-based behavioral intervention trial. Drug and Alcohol Dependence 83(3): 225-232, 2006. (32 refs.)

We evaluated a case management intervention to increase treatment entry among injecting drug users referred from a needle exchange program (NEP). A randomized trial of a strengths based case management (intervention) versus passive referral (control) was conducted among NEP attenders requesting and receiving referrals to subsidized, publicly funded opiate agonist treatment programs in Baltimore, MD. Logistic regression identified predictors of treatment entry within 7 days, confirmed through treatment program records. Of 247 potential subjects, 245 (99%) participated. HIV prevalence was 19%. Overall, 34% entered treatment within 7 days (intervention: 40% versus control: 26%, p = 0.03). In a multivariate "intention to treat' model (i.e., ignoring the amount of case management actually received), those randomized to case management were more likely to enter treatment within 7 days. Additional 'as treated' analyses revealed that participants who received 30 min or more of case management within 7 days were 33% more likely to enter treatment and the active ingredient of case management activities was provision of transportation. These findings demonstrate the combined value of offering dedicated treatment referrals from NEP, case management and transportation in facilitating entry into drug abuse treatment. Such initiatives could be implemented at more than 140 needle exchange programs currently operating in the United States. These data also support the need for more accessible programs such as mobile or office-based drug abuse treatment.

Torchalla I; Nosen L; Rostam H; Allen P. Integrated treatment programs for individuals with concurrent substance use disorders and trauma experiences: A systematic review and meta-analysis. Journal of Substance Abuse Treatment 42(1): 65-77, 2012. (70 refs.)

The purpose of this study was to examine the evidence of psychotherapeutic integrated treatment (IT) programs for individuals with concurrent substance use disorders and trauma histories. Electronic searches of Cochrane Central Register of Controlled Trials, MEDLINE, Web of knowledge, PubMed, PsycINFO, CINAHL, PILOTS, and EMBASE identified 17 IT trials (9 controlled trials). Both narrative review and meta-analysis indicate that IT effectively reduces trauma symptoms and substance abuse from pretreatment to longest follow-up. However, IT and nonintegrated programs appear to produce similar declines in symptoms. Methodological issues limiting the current body of work and recommendations for future research are discussed. Well-designed randomized controlled trials are clearly needed, particularly large sample studies evaluating understudied IT programs and exposure-based approaches.

Tracy K; Burton M; Nich C; Rounsaville B. Utilizing peer mentorship to engage high recidivism substance-abusing patients in treatment. American Journal of Drug and Alcohol Abuse 37(6): 525-531, 2011. (39 refs.)

Background: Often high recidivism substance-using patients have difficulty connecting to outpatient treatment contributing to greater functioning disturbances. Approaches to address this problem frequently are staff extensive. Objective: This study evaluates the impact of peer mentorship and/or enhanced dual recovery treatment (DRT) on individuals who are inpatients, substance abusing, and have a history of high recidivism. The primary outcome is post-discharge treatment attendance. Methods: In an inpatient Veterans Administration hospital setting, 96 patients with a history of high recidivism and current and/or past diagnosis of substance use disorders were randomized to either (i) Treatment As Usual (TAU), (ii) TAU + DRT + Mentorship for Addictions Problems to Enhance Engagement to Treatment (MAP-Engage), or (iii) TAU + MAP-Engage. Results: Overall MAP-Engage was found to be comparable to the DRT + MAP-Engage and both of these conditions were significantly better than TAU alone at increasing adherence to post-discharge substance abuse, medical, and mental health outpatient appointments. Conclusion/Scientific Significance: MAP-Engage offers an alternative approach to address lack of attendance to outpatient treatment appointments post discharge that is relatively low in staff reliance.

Vanderplasschen W; Rapp RC; Wolf JR; Broekaert E. The development and implementation of case management for substance use disorders in North America and Europe. Psychiatric Services 55(8): 913-922, 2004. (88 refs.)

Because of the multifaceted, chronic, and relapsing nature of substance use disorders, case management has been adapted to work with persons who have these disorders. Deliberate implementation has been identified as a powerful determinant of successful case management. This article focuses on six key questions about implementation of case management services on the basis of a comparison of experiences from the United States, the Netherlands, and Belgium. It was found that case management has been applied in various populations with substance use disorders, and distinct models have been associated with positive effects, such as increased treatment participation and retention, greater use of services, and beneficial drug-related outcomes,. Program fidelity, robust implementation, extensive training and supervision, administrative support, a team approach, integration in a comprehensive network of services, and minimal continuity have all been linked to successful implementation.

Vanderplasschen W; Wolf J; Rapp RC; Broekaert E. Effectiveness of different models of case management for substance-abusing populations. Journal of Psychoactive Drugs 39(1): 81-95, 2007. (85 refs.)

Case management has been implemented in substance abuse treatment to improve (cost-) effectiveness, but controversy exists about its potential to realize this objective. A systematic and comprehensive review of peer-reviewed articles (n=48) published between 1993 and 2003 is presented, focusing on the effects of different models of case management among various substance-abusing populations. Results show that several studies have reported positive effects, but only some randomized and controlled trials have demonstrated the effectiveness of case management compared with other interventions. Longitudinal effects of this intervention remain unclear. Although no compelling evidence was found for the effectiveness of case management, some evidence is available about the (differential) effectiveness of intensive case management and assertive community treatment for homeless and dually-diagnosed substance abusers. Strengths-based and generalist case management have proven to be relatively effective for substance abusers in general. Most positive effects concern reduced use of inpatient services and increased utilization of community-based services, prolonged treatment retention, improved quality of life, and high client satisfaction. Outcomes concerning drug use and psychosocial functioning are less consistent, but seem to be mediated by retention in treatment and case management. Further research is required to learn more about the extent of the effects of this intervention, how long these are sustained and what specific elements cause particular outcomes.

Vanderplasschen W; Wolf J; Rapp RC; Broekaert E. Is case management an effective and evidence based intervention for helping substance abusing populations. IN: Pederson MU; Segraeus V; Hellman M, eds. Evidence Based Practice? Challenges in Substance Abuse Treatment. NAD Monograph No. 47. Helsinki Finland: Nordic Council for Alcohol and Drug Research, 2005. pp. 137-155. (76 refs.)

Case management has been found to be effective with mental health populations in reducing hospitalization rate, increasing utilization of outpatient and community-based services, and increase client satisfaction and quality of life. While applied to substance abuse clients, there is conflicting data on the impact on functioning. The authors review the different models of case management -- broker/generalist model, assertive community treatment, clinical model, and strengths-based approach. The authors conduct a literature review identifying 46 papers meeting the criterion for inclusion in their study. Of note is that the effectiveness of case management is not compelling. Descriptive studies tend to report better outcomes than methodological stronger designs. Comparison of results is made difficult by different outcome measures and contextual differences.

Warhaft N. The Victorian Doctors Health Program: The first 3 years. Medical Journal of Australia 181(7): 376+, 2004. (10 refs.)

The Victorian Doctors Health Program (VDHP) was established in November 2000 to provide a confidential and compassionate service for doctors and medical students with health concerns, including alcohol, other drug and mental health problems. Although funded by the Medical Practitioners Board of Victoria, the VDHP is completely independent of the Board. Its staff include a director with experience of North American Physician Health Programs and a case manager/psychologist. In its first 3 years of operation, the VDHP had 438 contacts: 218 requests for advice and information, and 220 contacts resulting in provision of services (to 92 doctors and students with alcohol or other drug problems, 82 with psychiatric problems, and 40 with stress-related or emotional problems). 99 participants received standard care (assessment, referral and up to two consultations with the program) and 56 extended care (three or more consultations with the program). 65 participants (most with substance use disorder) entered the more intensive Case Management, Aftercare and Monitoring Program (CAMP); 57 of these have had outcomes considered satisfactory, with 50 returned to work.

Willenbring ML. Integrating care for patients with infectious, psychiatric, and substance use disorders: Concepts and approaches. AIDS 19(Supplement 3): S227-S237, 2005. (140 refs.)

Patients with chronic viral infections such as HIV/AIDS or hepatitis C often have multiple co-existing problems such as psychiatric and addictive disorders, as well as social problems such as lack of housing, transportation and income that present challenging obstacles to successful management. Because services for these different problems are usually provided by different disciplines in varying locations, fragmentation of care can lead to treatment dropouts, lack of adherence, and poor outcomes. Integration strategies, ranging from simple efforts to improve communication and coordinate care to fully integrated multidisciplinary teams have been used to improve disease management. Although evidence for effectiveness is comprised primarily of observational studies of demonstration programmes, integration may be desirable on a pragmatic basis alone. Quality improvement strategies are attractive vehicles for implementing care integration and measuring its impact. Careful assessment of the problem to be solved and the development of targeted strategies will maximize chances of a successful outcome.

Womack S; Compton WM; Dennis M; McCormick S; Fraser J; Horton JC et al. Improving treatment services for substance abusers with comorbid depression. American Journal on Addictions 13(3): 295-304, 2004. (49 refs.)

Early identification of patients with comorbid depression and their subsequent enrollment in an enhanced psychiatric case management (PCM) intervention were examined as an effective way to engage depressed substance abuse patients into psychiatric treatment. Depression was screened using the Global Appraisal of Individual Needs (GAIN) and a DMS-IV checklist. Patients positive on both evaluations were assigned to PCM (n = 10) or to no case management,or treatment as usual (TAU) (n = 10). An examination of outcomes at six weeks indicated that PCM services are feasible and appear to be effective in encouraging use of psychiatric referral by depressed substance abusers.