Critical Ingredients of Intensive Case Management

Abstract

Intensive Case Management (ICM) did not evolve from a single, well-defined model format but from different case management models. As a result, it has been vaguely defined as meaning more "intense" than usual case management, thus highlighting the lack of consensus about ICM's definition and parameters. Despite these differences, ICM programs aspire to a set of common principles and core operational functions derived from the concept of continuity of care. Recent literature reviews have found mixed results regarding studies examining ICM effectiveness ( e.g., psychiatric hospitalizations, etc.). It has been difficult to make comparisons between studies because operational definitions have not been standardized.

This study attempted to construct a program theory that unifies the various ICM practice orientations and specifies its operationalization so that more effective implementation and evaluation can occur. An integrative approach was used that synthesized information from the existing literature and by surveying three distinct stakeholder groups (researchers/ administrators, program managers, case managers) for their perspectives.

Twenty-two researchers/ administrators who were considered experts, 21 ICM program managers and 46 ICMs working in 4 separate programs in New York City rated the importance of 68 program elements. Respondents identified 32 out of 68 program components as critical. A preliminary fidelity index was developed from these results. In addition, empirically derived norms for 12 model specifications were operationalized (e.g. ideal caseload size, etc.). Agreement among all respondents on ratings of importance was high (intraclass r = .92), although there was less agreement for some areas and respondent groups. Consensus was highest among ICMs, followed by program managers and experts.

Significant findings included the perceived importance of a bachelors degree in human services, access to psychiatric consultation, optimum caseload size of 1:11, access to funds for client purchases and 85% of contacts occur in the community. Under treatment foci, a number of practice elements from the Personal Strengths and Rehabilitation perspectives were identified as critical.

Additional suggestions from respondents focused on ICMs participating in the hospitalization/discharge process, how revenues are derived, and the lower success rates ICM has with clients suffering from character disorders and severe substance abuse. Results reinforced the idea that ICM is a "client driven" intervention in contrast to typical case management programs that are "system driven".