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Am J Psychiatry 1997; 154:341-348
Copyright © 1997 by American Psychiatric Association
Cost-effectiveness evaluation of three approaches to case management for homeless mentally ill clients
N Wolff, TW Helminiak, GA Morse, RJ Calsyn, WD Klinkenberg and ML Trusty
Community Support Systems, St. Louis, USA. nwolff@rci.rutgers.edu
OBJECTIVE: In this study the authors compared the cost-effectiveness of
three approaches to case management for individuals with severe mental
illness who were at risk for homelessness: assertive community treatment
alone, assertive community treatment with community workers, and brokered
case management (purchase of services). METHOD: Individuals were randomly
assigned to the three treatment conditions and followed for 18 months.
Eligibility requirements included a severe DSM-III axis I diagnosis, such
as schizophrenia, and either current homelessness or risk for homelessness
based on prior history of homelessness. Participants were recruited from
the emergency rooms and inpatient units of local psychiatric hospitals.
Data on 85 people were available for analyses: 28 in assertive community
treatment alone, 35 in assertive community treatment with community
workers, and 22 receiving brokered case management (purchase of services).
RESULTS: Clients assigned to the two assertive community treatment
conditions had more contact with their treatment programs, experienced
greater reductions in psychiatric symptoms, and were more satisfied with
their treatment than clients in the brokered condition. There was no
statistically significant difference between treatment conditions in terms
of the total costs of treating the participants. However, the assertive
community treatment conditions spent less money on inpatient services than
brokered case management, but more on case management services and
maintenance (i.e., food stamps, housing subsidies, and Supplemental
Security Income payments). CONCLUSIONS: Assertive community treatment has
better client outcomes at no greater cost and is, therefore, more
cost-effective than brokered case management.
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