An Idiographic Evaluation of an Integrated, Team Case Management Program

Hospitalization, Client Problems and Stages of Change

Abstract

The authors describe the evaluation of an integrated case management and addictions treatment program for individuals who have the dual challenge of coping with both mental illness and substance abuse problems—the dually diagnosed. This program, modeled after the New Hampshire Specialized Services Program, combined assertive case management and a four-stage addictions treatment model in which individuals are conceived as moving through the processes of engagement, persuasion, active group treatment, and relapse prevention. The method consisted of a quasi-experimental A-B design, with an idiographic analysis of patterns of hospitalization across small groups of individuals. Replication of the effect across these groups was accomplished as a natural byproduct of continuous enrollment into the program. Two new measurement devices were developed to assess functioning and to determine the level of change accomplished by the participants: the Client Problems Checklist and the Stages of Change rating scale respectively. Reliability data on each device indicate moderate to good levels of reliability. The results indicate that during its first year the program was successful in reducing hospitalization, increasing commitment to substance abuse treatment, and improving functioning in several life areas. Program participants expressed high levels of satisfaction. Further component analysis research is needed to better define the effects and appropriate targets for treatment.