Case management within substance abuse treatment programs in Los Angeles County.

Case management has been used to link clients and the service system, but is loosely defined and poorly understood. The aims of this study were to describe the use and purposes of case management within substance abuse treatment programs, and also the structures and processes for providing case management services. A descriptive survey was done, with 50 program directors of 134 treatment programs (with 205 case managers), in Los Angeles County. Results showed that 80% of directors reported they use case management. Half of the programs use case management both before and after discharge, and 72% provide case management to all clients. Case managers' most important roles are to develop treatment plans and prevent relapse during treatment, and 60% of directors indicate the case managers in their programs are also counselors. Case managers perform numerous roles of coordination and advocacy. Eighty percent of case managers follow the care of the client during treatment and 32% of directors reported a case load of 1-10, while 26% reported a case load of 11-20. The professional background of case managers varies from chemical dependence professional to social worker or nurse. Twenty percent of program directors plan to increase case management in the future. The concept of case management is not new, having begun in the 19th century as social case work to link clients and the service system with which they were interacting. Since that time, case management has been performed by social workers, public health nurses, parole officers, child protection workers, and public assistance program employees, among others (Willenbring, Ridgely, Stinchfield, & Rose, 1991). As the health care industry scrambles to survive the move to managed care and decreased revenue, case management has been used to organize care, coordinating and linking services across the continuum of care delivery (Kersbergen, 1996). Case management has particularly been used within hospital settings to coordinate care more effectively and has been shown to improve patient outcomes and reduce costs (Geary & Smeltzer, 1997; Ireson, 1997; Trella, 1993). Protocols, or care paths, may be used to guide care and manage variances (Smith, 1997; Smith & Bezon, 1997). Case managers in all settings are expected to facilitate collaboration and coordination of care among care providers, and the processing and exchange of information to assure necessary services are performed and providers are united (Allred et al., 1995). However, while case management has moved into most arenas in efforts to provide higher quality of care and decreased costs, the term remains loosely defined and poorly understood (Ridgely & Willenbring, 1992). Recent investigations of substance abuse treatment programs in Los Angeles County (Polinsky, Hser, Anglin, & Maglione, 1995) revealed that most programs reported case management services. Ninety-three percent provide monitoring and follow-up, 81% provide advocacy, and 88% provide coordination of services. Because of the recent use of case management to decrease cost and improve outcomes in hospitals and high-risk settings, case management experts and researchers were interested to know the purpose and processes of case management within substance abuse treatment programs. Little was found in the literature about who is case managed and the professional background of case managers. Likewise, sparse information was found about case load, the methods of case management, and future directions. The aims of this study were to describe the use and purposes of case management within substance abuse treatment programs, and also the structures and processes for providing case management services. BACKGROUND OF CASE MANAGEMENT IN MENTAL HEALTH Within mental health services, as early as 1980, Lamb argued that case management functions must be part of the duties of the therapist, and that only in the context of this relationship can client needs be accurately assessed and skillfully facilitated. …