Impact of Case Management on Use of Health Services by Rural Clients in Substance Abuse Treatment
Vaughan-Sarrazin, Mary S., Hall, James A., Rick, Gary S., Journal of Drug Issues
This research evaluates the effect of case management on the utilization of substance abuse, medical, and mental health services by substance abuse treatment clients subsequent to initiating residential treatment. The study also evaluates whether the proximity of the case manager to the treatment facility and use of a telecommunication system are related to case management effectiveness. Clients were randomly assigned to one of four conditions. Three conditions received case management according to the Iowa Case Management model and differed according to the location of the case manager and use of a telecommunication system. A fourth condition received standard treatment services. Clients provided feedback regarding service use for 12 months. Results indicated that when case managers were located at the treatment facility, they had an impact on clients' use of substance abuse treatment and medical services. Clients who were assigned to case managers located at the treatment facility used more treatment aftercare and medical services after admission to residential treatment than clients who received standard treatment. These effects were not found for clients assigned to case managers not located at the facility. Case management was not related to the use of mental health services subsequent to treatment.
Interest in case management for substance abuse has grown in the past decade with the development of managed care in the substance abuse treatment field. Case management offers continuity of services, linkage to necessary collateral services, and coordination of services that cannot be met by a single agency. Most experts agree that case management should be complementary to traditional treatment services (Holloway, McLean, and Robertson 1991; Sullivan, Wolk, and Hartmann 1992). Nevertheless, in most settings primary drug counselors or other agency staff members are expected to provide case management as part of the overall substance abuse treatment. These personnel often have little time beyond direct substance abuse counseling responsibilities to provide case management (Thilges et al. 1996). The purpose of this research is to evaluate the effect of case management provided by dedicated full-time case managers on the utilization of health services subsequent to initiating substance abuse treatment in a residential program.
The Iowa Case Management Project (ICMP) for Rural Drug Abuse was funded by the National Institute of Drug Abuse (NIDA) to develop a model of case management appropriate for drug abuse treatment clients from rural areas and to evaluate this model for improving treatment effectiveness. The ICMP was also designed to determine whether the proximity of the case manager to the substance abuse treatment facility is related to case management effectiveness and whether use of a telecommunication system can enhance case management effectiveness. Clients who were admitted to intensive outpatient or residential substance abuse treatment at a local facility were invited to participate in the ICMP. Those who agreed to participate were randomly assigned to one of four case management conditions. Clients received case management through (I) an ICMP case manager located at the substance abuse treatment facility, (2) an ICMP case manager located at another facility independent of the substance abuse agency, (3) an ICMP case manager who provided case management through a computer-based telecommunication system, or (4) standard substance abuse treatment. Regarding the last condition, we note that substance abuse treatment counselors provided some case management services during a client's treatment episode, but this task was secondary to their primary responsibility as treatment counselor. Clients provided feedback about their status and use of health services for a period of 12 months after recruitment. This paper investigates the use of treatment, medical, and mental health services over the follow-up period, the impact of case management on the use of those services, and the relationship between case manager location and health services utilization for ICMP participants recruited from the residential treatment program. …