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CORK Bibliography: Case Management

54 citations. January 2003 to present

Prepared: March 2008

Arfken CL; Klein S; Agius EJ; di Menza S. Implementation of selected Target Cities components: Analysis of matching, case management and linkages. IN: Stephens RC; Scott CK; Muck RD, eds. Clinical Assessment and Substance Abuse Treatment: The Target Cities Experience. Albany NY: State University of New York Press, 2003. pp. 103-128. (156 book refs.)

This chapter examines the implementation of elements of the Target Cities Program: treatment matching, case management, and linkages to services. The matching was based upon the ASAM (American Society of Addiction Medicine) levels of care, as well as specific client needs, such as for employment counseling, and their availablity withing a single agency or provision to a specific program for a defined clinical problem. Different models for providing case management were present across sites. Linkage was promoted by agreements between agencies, and referral mechanisms. Also discussed is the nature of agency leadership.

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.

Broner N; Nguyen H; Swern A; Goldfinger S. Adapting a substance abuse court diversion model for felony offenders with co-occurring disorders: Initial implementation. Psychiatric Quarterly 74(4): 361-385, 2003. (52 refs.)

Treatment Alternatives for Dually Diagnosed (TADD) was developed to address the need for criminal justice diversion of seriously mentally ill substance-using felons and persistent misdemeanants. The population served by the TADD program and key elements of the program are described, including identification, screening and assessment, specialized court processing and judicial oversight, case management monitoring, joint case conferencing between community and monitoring staff, enforcement, and key stakeholder collaboration. One hundred and thirteen clients diverted by the TADD program were followed for six months. A description is provided of these clients, the community services accessed, as well as the monitoring of clients drug use. During six months of program involvement 87% remained connected to the diversion team, 80% remained in community treatment and the majority took advantage of the rich service environment created through TADD's case management linkage services. The majority of these clients tested drug-free during this six-month period.

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.

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.

Cretzmeyer M; Sarrazin MV; Huber DL; Block RI; Hall JA. Treatment of methamphetamine abuse: Research findings and clinical directions. (review article). Journal of Substance Abuse Treatment 24(3): 267-277, 2003. (36 refs.)

Over the past few years, methamphetamine has appeared in mass quantities, in part, because of the ease and cost efficiency of manufacturing. With this increase in availability, the use of methamphetamine has increased significantly. The purpose of this article is to describe the existing treatment options for methamphetamine abuse and provide recommendations for practitioners and researchers. Methamphetamine abuse adversely impacts physical functioning, brain functioning and cognition, social support and social networks, and behavioral functioning. Negative consequences have also been documented to the environment and communities. In the studies reviewed on effective treatments, interventions consisted of aversion therapy, medication, psychosocial treatment, and case management. Each specific treatment is described as connected with an overall drug treatment program. If methamphetamine abuse continues to increase and the consequences continue to be so devastating, researchers and clinicians could advance the field by particular focus on the treatment of this type of drug use.

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.

Dumaine ML. Meta-analysis of interventions with co-occurring disorders of severe mental illness and substance abuse: Implications for social work practice. Research on Social Work Practice 13(2): 142-165, 2003

A quantitative analysis of 15 empirical studies is conducted to determine effective interventions with the dually diagnosed. Client and practitioner characteristics, types of interventions, and treatment effectiveness are examined through meta-analytic techniques. Age of client was positively correlated with effect size. There were no statistically significant correlations between practitioner training or practitioner-to-client ratio and effect size. Intensive case management was associated with the greatest effect size, and a small positive effect size was found for standard aftercare with outpatient psychoeducational treatment groups. Social work practice implications, based on the results of the quantitative analysis and trends identified in the studies, are that there is a unique role for practitioners in advocating for linkage of resources, additional supports for clients, and the dismantling of barriers that impede resource access.

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.

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; Stephens RC; Muck RD. Lessons learned from the National Target Cities Initiative to improve publicly funded substance abuse treatment systems. IN: Stephens RC; Scott CK; Muck RD, eds. Clinical Assessment and Substance Abuse Treatment: The Target Cities Experience. Albany NY: State University of New York Press, 2003. pp. 179-200. (156 book refs.)

At the start of the Target Cities Program, there was an effort to address problems common in substance abuse treatment in the public sector: weak infrastructure, inconsistent quality of services, limited access to treatment, inadequate coordination and continuity of services. This chapter reviews the goals of the Program and summarizes the extent to which these were addressed. The first goal, improvement of staff training was not examined. The second goal was to create a centralized intake system with standardized instruments and physical exam and psychological evaluation and protocol to matching clients with treatment programs. It was found that the least successful components were case management, and mechanisms for treatment matching. Goal 3 was to enhance clients access to social services, such as AFDC, food stamps, SSI, a goal was met. Goal 4 addressed increased access to preventive and primary care health services, there was no data collected which allowed assessment of this feature. Goal 5 was to provide case management for clients in the criminal justice system. Programs adopted different methods to accomplish this. Goal 6 focused upon the creation of a management information system to track intake, assessment, referral and outcome data, as well as charges and costs of treatment. These systems are now being created by CSAT (Center for Substance Abuse Treatment) with the hope that they will become available to public programs generally. Goal 8 addressed quality assurance systems, which were not included as part of this formal evaluation. Each of these domains is briefly discussed.

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.

Jansson LM; Svikis DS; Beilenson P. Effectiveness of child case management services for offspring of drug-dependent women. Substance Use & Misuse 38(14): 1933-1952, 2003. (34 refs.)

Female drug users and their children have many medical and psychosocial problems, yet they often fail to follow through with prescribed treatments. The present study describes a specialized, case management program for children, birth through age 2, exposed to drugs in utero. Evaluation of program efficacy was examined by comparing 2-year outcomes for women who received different intensities of these child case management services. Mothers who received higher intensity care were more likely to be abstinent from illicit drugs and to have retained custody of their child(ren) at 2-year follow-up than those with lower intensity services. Study findings support clinical and economic efficacy of this model of care.

Johnson RL; Botwinick G; Sell RL; Martinez J; Siciliano C; Friedman LB et al. The utilization of treatment and case management services by HIV-infected youth. Journal of Adolescent Health 33(2 Supplement): 31-38, 2003. (4 refs.)

PURPOSE: This article describes the essential components for effective and comprehensive HIV care for youth who have tested positive and have been linked to HIV treatment. Descriptive profile data are also presented that detail the demographics, risk behaviors and health care barriers of youth served in the five Special Projects of National Significance (SPNS), which focused on adolescents and young adults. METHODS: Data presented are from the core multi-site data set, which was standardized across the five youth-oriented SPNS projects. Substance use and mental health symptoms were gathered using the Personal Problem Questionnaire (PPQ) screener, which was an adaptation of the PRIME-MD. In-depth qualitative interviews with enrolled HIV-positive youth were also conducted by several Projects. RESULTS AND CONCLUSIONS: Medical care alone is not enough and cannot be effective without supportive program components such as flexible scheduling, and a multi-disciplinary team approach that includes assertive case management. Case Managers help enrolled youth with concrete service needs such as housing, emergency financial assistance for food/utilities, transportation, child care, coverage for prescriptions, and public entitlements. They also help isolated youth to connect with a personal support system. Addressing those needs helps to facilitate and reinforce treatment adherence and retention. In addition to other identified needs such as stable housing and transportation, a significant number of enrolled youth self-reported having experienced physical, sexual, and/or emotional abuse in their lives and articulated a need for mental health services. Therefore, effective HIV care for youth must be multi-faceted; it must consist of more than a medical component.

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.

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.

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.

Negrete JC. Clinical aspects of substance abuse in persons with schizophrenia. (review). Canadian Journal of Psychiatry 48(1): 14-21, 2003. (58 refs.)

Objective: To review the current knowledge on the problem of psychoactive substance abuse by persons with schizophrenia, with particular attention to issues of direct relevance to clinical practice. Method: The author examined the literature from the last 2 decades and data from studies in which he was involved. Results: Schizophrenia sufferers show an elevated liability for substance abused. Such comorbidity may derive from self-medication attempts, a common neuropathology for addiction and schizophrenia, the psychotogenic properties of certain drugs, or the influence of environmental factors. Among schizophrenia patients receiving treatment, substance misuse is associated with more severe symptoms and poorer therapeutic response. The presence of a chronic psychosis impedes treatment of the substance problem in traditional, nonpsychiatric addiction programs. Better outcomes are observed in integrated therapy services, where patients receive appropriate care for both conditions. Conclusion: Dual-pathology patients need comprehensive care with appropriate pharmacotherapy and psychosocial interventions. This treatment can be best provided within the context of a continuing care psychiatric service.

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.

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.

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.

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; Hall J; Levey S; Fuortes L; Uden-Holmen T. The effect of case management in substance abuse on health services use. Care Management Journals 4(2): 82-87, 2003

This study evaluated the effect of case management, as a supplement to traditional substance abuse treatment, on health services utilization. Data for the study were taken from the Iowa Case Management Project (ICMP). The ICMP evaluated case management using a randomized research design. Residential clients who agreed to participate were randomly assigned to one of four case management conditions. The first three conditions were variations of the Iowa Case Management (ICM) model: (a) Inside Case Management, (b) Outside Case Management, and (c) Telecommunications. Case management clients in these three conditions were eligible for 12 months of case management. The fourth condition, the control condition, received no additional case management through ICMP. The study results show that the use of case management decreased the use of mental health services while increasing clients' use of inpatient care, access to physician, and the emergency room. It was expected that case management would increase, in the short run, the substance abuser's use of health services due to staying longer in treatment and seeking medical care that would be otherwise neglected. However, in the long run such early use of necessary health services might reduce the clients' use of avoidable, more costly care. Case management should be looked at as an investment with long-term payoffs.

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.

Seal DW; Margolis AD; Sosman J; Kacanek D; Binson D; Project START Study Group. HIV and STD risk behavior among 18- to 25-year-old men released from U.S. prisons: provider perspectives. AIDS & Behavior 7(2): 131-141, 2003. (27 refs.)

Ninety-seven service providers, representing 83 agencies, were interviewed about sexual and drug use HIV/STD risk behaviors and their determinants among young men who have been released from prison. Providers believed that men frequently practiced sexual risk behavior, often in conjunction with substance use. Individual determinants of risk behavior primarily focused on "making up for lost time," being a man, degree of HIV/STD knowledge and vulnerability, desire to escape, and future orientation. Peers, partners, and family were portrayed as strong interpersonal influences on risk behavior, both positively and negatively. The dominant contextual determinant of risk behavior was the co-occurrence of sex and drug use. Structural determinants of reduced risk included stable housing, economic sufficiency, and positive community support for safer behavior (e.g., drug treatment access, needle exchange). The findings highlight the need for comprehensive, transitional case management for young men as they reintegrate into the community, including HIV/STD prevention.

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.

Sims J; Iphofen R; Payne K. Triangular treatment paradigm in dual-diagnosis clients with a mental illness. Journal of Substance Use 8(2): 112-118, 2003. (23 refs.)

Research evidence suggests that a large number of individuals with substance abuse problems also have accompanying psychopathology. Previous research has also highlighted the shortfall in appropriate clinical response to these individuals. Some individuals diagnosed with schizophrenia may warrant a dual diagnosis. The clinical area of psychiatric dual diagnosis, i.e., serious mental illness associated with substance abuse, is often linked to the "revolving door" admissions of individuals with this complex comorbidity picture. Often there is limited information sharing and cooperation between statutory agencies that deal with this highly vulnerable client group. This article looks at the role of the specialist dual-diagnosis worker in North Wales and how the appointee to this role has been able to facilitate the seamless transition of these clients through the mental health care system. This process has been facilitated by the authors' development of an integrated pathway of care called the Triangular Treatment Paradigm.

Sorensen JL; Dilley J; London J; Okin RL; Delucchi KL; Phibbs CS. Case management for substance abusers with HIV/AIDS: A randomized clinical trial. American Journal of Drug and Alcohol Abuse 29(1): 133-150, 2003. (38 refs.)

In a random assignment study, substance-abusing patients with HIV/AIDS in a public general hospital received a brief contact condition (n=98) or received 12 mo of case management (n=92) delivered by paraprofessionals. Patient outcomes included substance use, HIV transmission risk, physical health, psychological status, and quality of living situation. In both conditions, a significant decrease occurred in a range of problems from intake to the 6-mo interview, followed by no significant pattern of change at 12- and 18-mo interviews. On major outcome variables there were no significant differences between the brief contact and case management conditions. Sixteen percent had died by the 18-mo interview. Process data indicated wide variation in the amount of case management received by participants, and the amount of case management was not related to improvement in the outcome measures. The study has limitations yet does not support the hypothesis that case management improves outcomes better than brief contact for this population.

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.

Van de Mheen HD. Demand-driven care: Can it work in the addiction field? Journal of Substance Use 8(2): 119-125, 2003. (23 refs.)

The approach to the client is being discussed in the addiction field because the care that is offered is apparently not fully effective, efficient, or of sufficient quality. The new policy direction of the addiction field in The Netherlands aims at improving the quality and innovation of care and prevention by use of evidence-based research. One of the spearheads is Social Addiction Policy, which focuses on material context (e.g., housing and work) and the social circumstances in which addicts live. This article outlines the concept of demand-driven care and discusses its applicability in the addiction field. Quotations from drug users and clients of various services are used to illustrate the issues and attitudes discussed in the article. The new policy in the addiction field encompasses so-called assertive outreach, which implies that care providers should actively try to reach marginalized groups that do not seek help themselves. Although this seems contrary to the general concept of demand-driven care, it is argued that demand-driven care in the form of assertive outreach is both necessary and possible. Four main characteristics of the addiction field are discussed in relation to the principles of demand-driven care, and are compared with characteristics of the healthcare sector. A demand-driven approach seems worthwhile in the addiction field.

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.

Woods ER; Samples CL; Melchiono MW; Harris SK. Boston HAPPENS Program: HIV-positive, homeless, and at-risk youth can access care through youth-oriented HIV services. Seminars in Pediatric Infectious Diseases 14(1): 45-53, 2003

The Boston HAPPENS Program is a collaborative network of care consisting of multiservice outreach agencies; community health centers; and hospitals for HIV-positive, homeless, and hard-to-reach youth. In four years of data collection, the program served more than 2,000 youth, including 54 HIV-positive youth. The youth were 19.9 +/- 2.9 years old; 64 percent female; 45 percent youth of color; 11 percent gay/lesbian, bisexual, or undecided; and 13 percent homeless or runaway. Homeless youth were much more likely to have been involved with a mental health system (47% vs. 12%, P < 0.001), the criminal justice system (20% vs. 2%, P < 0.001), high-risk sexual behaviors (21% vs. 3%, P < 0.001), and substance abuse (25% vs. 6%, P < 0.001) than were other youth served by the program. Comprehensive networks of care offering a continuum of services and a variety of entry routes and types of care sites are needed to connect under-served youth to health care. Outreach and human immunodeficiency virus (HIV) counseling and testing services can offer important portals of entry into health services for at-risk youth. Support services such as outreach, case management, and mental health services are needed to complement medical services by all youth at-risk for contracting HIV. Support services are neessary for the initiation and retention of youth in care so that early case identification and complex treatment regimens can be initiated and tailored to the individual.