The effect of case management in substance abuse on health services use.

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.

Effectiveness of case management in substance abuse treatment.

Health officials have promoted case management as a promising intervention in substance abuse treatment (Ridgely & Willenbring, 1992). The relationship between organizational mission combined with case management and different types of outcomes has not been explored in studies, but they are worth noting and exploring further. This study, which is part of a larger clinical trial, examined the 3-, 6-, and 12-month effectiveness of case management in a residential setting for individuals treated for substance abuse. Clients who agreed to participate were randomly assigned to one of four study groups. The groups received face-to-face case management and one telecommunication case management, while the fourth was the control group. Results from the analysis revealed only modest support for the effectiveness of case management as a supplement to traditional treatment. The face-to-face case-managed groups achieved improvements on the legal, employment, and psychiatric domains exceeding that achieved by the control group. Because of the short-term follow-up of the study, conclusive evidence of the effects of case management could not be drawn. This study is a valuable stepping stone, however, to further research in the field and as an aid to policymakers who are interested in knowing more about the effects of case management.