Case management and outreach: similarities and differences in worker tasks.

Case management and outreach are two important services provided to many individuals, particularly people with multiple problems. Unfortunately, no taxonomy or measuring instrument has been developed that captures the many dimensions of the jobs performed by both case managers and outreach workers. This study conducted a job analysis that led to the development of an instrument that has a variety of potential uses.

Evaluation of treatment programs for dual disorder individuals: modeling longitudinal and mediation effects.

This study evaluated the effectiveness of the three approaches for treating dual disorder clients who were homeless at intake: integrated assertive community treatment (IACT), assertive community treatment only (ACTO), and standard care (SC). Multilevel Random Coefficient Modeling (MRCM) was used to analyze longitudinal effects and to identify mediators of significant treatment effects. The outcome variables were consumer satisfaction, stable housing, psychiatric symptoms, and substance abuse.

Client outcomes and the working alliance in the client-case manager relationship: a causal analysis.

This study investigated the causal relationship between the working alliance and client outcomes in the client-case manager relationship. All 162 study participants received services fiom a case manager who worked as a member of an assertive community treatment team. All participants had both a substance use disorder and a diagnosis of severe mental illness and were homeless at baseline.

Treating homeless clients with severe mental illness and substance use disorders: costs and outcomes.

This study compared the costs and outcomes associated with three treatment programs that served 149 individuals with dual disorders (i.e., individuals with co-occurring severe mental illness and substance use disorders) who were homeless at baseline.

Impact of assertive community treatment and client characteristics on criminal justice outcomes in dual disorder homeless individuals.

Background: People with severe mental illness and substance use disorders (dual disorder) often have considerable contact with the criminal justice system.

Aims: To test the effects of client characteristics on six criminal justice outcomes among homeless (at intake) people with mental illness and substance misuse disorders.

Methods: The sample was of participants in a randomized controlled trial comparing standard treatment, assertive community treatment (ACT) and integrated treatment (IT).

Predictors of the working alliance in assertive community treatment.

Past research has found that a positive working alliance between clients and their case managers is modestly correlated with client outcomes. The current study tried to identify the predictors of the working alliance in a sample of 115 clients who were receiving services from Assertive Community Treatment (ACT) teams. All of the clients suffered from severe mental illness, had a substance use disorder and were homeless at baseline.

Client outcomes and the working alliance in assertive community treatment programs.

This study examined the relationship between outcomes and the working alliance in clients who were receiving assertive community treatment only or integrated assertive community treatment (assertive community treatment plus substance abuse treatment). All 98 participants had a severe mental illness and a substance use disorder. The Working Alliance Inventory assessed the alliance from the perspective of both the client and the case manager at 3 and 15 months into treatment.

Generalizability of brief psychiatric rating scale prototypical profiles and their use in evaluating treatment outcomes.

The generalizability of previously isolated prototypical profiles of the Brief Psychiatric Rating Scale (BPRS) was examined in a sample of homeless individuals with both severe mental illness and substance-use problems who were part of a 24-month study that evaluated the effectiveness of various treatment interventions. These prototypical profiles (depressed, actively psychotic, and withdrawn) did generalize to the new sample, with a 59.4% coverage rate.

The relationship between social anxiety and social support in adolescents: a test of competing causal models.

This study compared the strength of competing causal models in explaining the relationship between perceived support, enacted support, and social anxiety in adolescents. The social causation hypothesis postulates that social support causes social anxiety, whereas the social selection hypothesis postulates that social anxiety causes social support. The reciprocal model combines the two hypotheses by arguing that the causal relationship between social support and social anxiety is largely reciprocal.

Recruitment, engagement, and retention of people living with HIV and co-occurring mental health and substance use disorders.

People living with HIV/AIDS who have both a co-occurring mental health diagnosis and a substance use disorder (individuals with triple diagnoses) frequently do not receive adequate treatment for one or more of their illnesses. Poverty, risky behaviours, vacillating motivation, and cognitive impairments are additional problems facing many individuals with triple diagnoses. In many communities the service system is inadequately prepared to serve this population.

Utility of the behavioral model in predicting service utilization by individuals suffering from severe mental illness and homelessness.

This study compared the effectiveness of the behavioral model to predict two service utilization variables: case manager visits and total services used. Nearly 4000 individuals who were homeless and suffered from severe mental illness provided data for the study. Enabling variables explained more variance of both service utilization variables than predisposing or need variables.

Evaluation of treatment programs for persons with severe mental illness: moderator and mediator effects.

This study evaluated several statistical models for estimating treatment effects in a randomized, longitudinal experiment comparing assertive community treatment (ACT) versus brokered case management (BCM). In addition, mediator and moderator analyses were conducted. The ACT clients had improved outcomes in terms of housing and psychiatric symptoms than BCM clients.

A modified ESID approach to studying mental illness and homelessness.

This paper describes 15 years of research on homelessness using a modified ESID approach. The article summarizes the results of several needs assessment studies; describes the development and evolution of alternative treatment models to assist homeless individuals with severe mental illness; summarizes results of three outcome evaluation studies; and discusses issues of treatment implementation, treatment diffusion, and dissemination.

A confirmatory factor analysis of the Brief Psychiatric Rating Scale in a homeless sample.

This study used a confirmatory factor analysis procedure, the Oblique Multiple Group Method (OMG), with the Brief Psychiatric Rating Scale (BPRS) on a sample of homeless individuals who had both a severe mental illness and a substance use disorder. The hypothesized five-factor model of Guy (1976) accounted for 93% of the possible variance, and all the appropriate scales had their highest loading on their respective hypothesized factor. In addition, the Guy model accounted for more variance than did an alternative model.

The case manager's view of the helping alliance.

Although the helping alliance has been a topic of investigation in psychotherapy research for decades, few studies have examined the role of the helping alliance in assertive community treatment programs serving people with severe mental illness. In this article, we describe a series of analyses focused on the case manager's view of the helping alliance. The study addressed two primary questions: What factors facilitate a positive helping alliance in case management? What is the relationship of the helping alliance to client outcomes? Results indicated that few client variables predicted the helping alliance.

Moderators and mediators of client satisfaction in case management programs for clients with severe mental illness.

This randomized experiment first determined that clients with severe mental illness who received Assertive Community Treatment (ACT) were more satisfied with their treatment program than were clients in a brokered case management program (BCM). Eight demographic and diagnostic variables were examined as potential moderators of the treatment effect. Only one of the eight varables, diagnosis of depression, interacted with treatment condition to effect client satisfaction.

Reducing overclaiming in needs assessment studies. An experimental comparison.

A randomized experiment investigated the effect of various instructional sets on reducing agency awareness overclaiming, that is, claiming knowledge of fictitious agencies. As predicted, respondents who were warned that the list contained fake agencies exhibited less agency awareness overclaiming than respondents who were not warned. However, providing respondents a memory retrieval strategy had no effect on agency awareness overclaiming.

Should disability items in the census be used for planning services for elders?

Purpose: The main goal of this study was to determine how well the disability questions of both the 1990 and 2000 Census correlated with a standard measure of disability. If the census questions were to correlate moderately well with a standard measure of disability, then Area Agencies on Aging (AAA) and other organizations would be able to use census information in estimating service needs for their catchment (service) area.

Design And Methods: Questionnaires containing both the census disability questions and a standard measure of disability were mailed to 4,508 older adults; 1,514 completed surveys were returned.

A checklist for critiquing treatment fidelity studies.

My assignment was to critique and integrate the previous papers. I have organized this paper as follows: (1) a description and rationale for a checklist which can be used in judging the quality of a fidelity measure; (2) a critique of the Schaedle and Epstein paper; (4) a critique of the Lucca paper; and (4) a review of the paper by Bond, Evans, Salyers, Williams, and Kim.

Prototypical profiles of the Brief Psychiatric Rating Scale.

Three prototypical profiles of the Brief Psychiatric Rating Scale (BPRS; Overall & Gorham, 1962) were isolated using a Q-type factor-analytic strategy with a sample of homeless men with mental illness (N=165). The 3 profiles--depressed, actively psychotic, and withdrawn--were used to study changes in BPRS profiles over time in a control group and a group that received assertive community treatment (ACT). Over2 time periods (inception to 12 months and 12-24 months), the 2 groups did not differ in terms of changes in profile shape, but they did differ in terms of changes in profile elevation.

The Dartmouth Assertive Community Treatment Scale (DACTS). A generalizability study.

Generalizability theory was used to assess the reliability of the Dartmouth Assertive Community Treatment Scale (DACTS), which was developed to assess treatment reliability to assertive community treatment (ACT). Program staff and local evaluators who were participating in a national demonstration program to serve homeless mentally ill clients provided data. The total scale score for the DACTS demonstrated acceptable internal consistency and interrater reliability.

Do consumers who have a choice of treatment have better outcomes?

This study used a non-equivalent control group design to investigate the effect of consumer choice of treatment on both process and outcome variables. All study participants suffered from severe mental illness, were homeless at baseline, and were enrolled in a modified Assertive Community Treatment (ACT) program. Consumers in the choice condition had selected the ACT program from a menu of five treatment programs; clients in the no-choice condition were simply assigned to the ACT program by an intake worker.

Predictors of psychiatric hospitalization: a multivariate analysis.

Inpatient treatment continues to be the most expensive form of mental health service. This study sought to improve the methodological weaknesses, e.g.

Understanding and controlling response bias in needs assessment studies.

This study demonstrated that estimates of agency awareness in the typical needs assessment study are probably inflated by a response bias labeled "agency awareness overclaming." Overclaimers (respondents who reported being aware of fictitious agencies) reported being aware of more real agencies than other respondents. Estimates of agency awareness may also be biased, because certain segments of the population were more likely to exhibit agency awareness overclaiming.

Case management models for persons who are homeless and mentally ill: the ACCESS demonstration project. Access to Community Care and Effective Services and Supports.

Persons who are homeless and mentally ill present unique challenges to service providers and human service systems. In vivo case management approaches such as assertive community treatment (ACT) have shown promise in engaging this population. This paper explores case management models employed within the ACCESS program, a five year, 18-site demonstration program enriching services for homeless persons with serious mental illness.