Academic journal article Care Management Journals

Iowa Case Management for Rural Drug Abuse: Preliminary Results

Academic journal article Care Management Journals

Iowa Case Management for Rural Drug Abuse: Preliminary Results

Article excerpt

The Iowa Case Management Project (ICMP) was developed to evaluate the effectiveness of a comprehensive, solution-focused model of case management with rural clients in drug abuse treatment. For this preliminary report, 483 clients who were admitted to residential or outpatient treatment at a local facility volunteered to participate and were randomly assigned to one of four research conditions. Clients in three of the conditions received Iowa Case Management (ICM), while clients in the fourth condition received standard treatment services and served as the control group. Clients were assessed regarding psychosocial characteristics at intake and three additional times during the subsequent 12 months.

Results indicate that Iowa Case Management (ICM) significantly impacted psychological and employment status. Residential clients receiving ICM reported fewer days of psychological distress and more days paid for working at follow-up sessions than clients in the control condition. These results, however, were not found for clients admitted to the outpatient program. Clients in all conditions, including those in the control, experienced significant reductions in drug and alcohol use during the 12 months following treatment.

These results provide initial support for the effectiveness of Iowa Case Management with drug abuse clients. Suggestions for additional research are discussed.

Case management for drug abuse clients has been espoused as a viable model for providing continual contact and improving outcomes. Most experts agree that case management should be complementary to traditional treatment services (Holloway, McLean, & Robertson, 1991; Sullivan, Wolk, & Hartmann, 1992). Nevertheless, in most drug abuse treatment settings, case management has been the responsibility of the primary addiction counselor. In actual practice, however, these drug counselors have little time beyond their primary drug counseling responsibilities to provide case management services (Thilges, Carswell, Vaughan, & Hall, 1996). Thus, the purpose of this research was to evaluate the effect of case management provided by dedicated fall-time case managers on outcomes of substance abuse treatment. By determining if case management helps drug abuse clients to maintain drug-free lifestyles, drug agencies can determine whether resources should be given to this type of intervention.

Case management was delivered according to the Iowa Case Management model, a comprehensive model developed by the Iowa Case Management Project (ICMP) for Rural Drug Abuse through a grant from the National Institute of Drug Abuse (NIDA). Rural clients who were admitted to intensive outpatient or residential substance abuse treatment at a local facility were invited to participate in the ICMP. Participants were randomly assigned to one of four treatment conditions, which were designed to evaluate the impact of case management on outcomes as well as determine whether the proximity of the case manager to the substance abuse treatment facility and use of a telecommunication system enhances case management effectiveness. We hypothesized that clients in the conditions that received Iowa Case Management would have better outcomes than clients who received standard treatment services. Furthermore, we hypothesized that the actual minutes of case management received by clients would be related to outcomes.

BACKGROUND

Models of Case Management

Ross (1980) distinguishes case management models based on levels of comprehensiveness?minimal, coordinated (i.e., brokerage), and comprehensive?while others, such as strengths-based case management (Fast & Chapin, 1996; Rapp, 1992), have been classified by their method or philosophy. Comprehensive models of case management, such as Iowa Case Management, are characterized by the greater intensity of services and lower caseloads than brokerage or minimal models.

Comprehensive models of case management have been shown to be an effective intervention with several vulnerable client populations:

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