Indiana Consortium For Mental Health Services Research Indiana University

Abstract

Reprint #4: Communities of Care: A Theoretical Perspective on Case Management Models in Mental Health

Bernice A. Pescosolido, Indiana University, Eric R. Wright, Indiana University-Purdue University at Indianapolis, William Patrick Sullivan

With the advent of community-based care as the major direction for treatment, case management has emerged as the linchpin for organizing programs for people with severe mental disorders and other chronic illnesses. A wide variety of models have been implemented and evaluated but few systematic explanations have been offered to understand the underlying differences across models, to provide common ground to compare one to another, or to lay a framework for the empirical examination of when and why models work. In this paper, we briefly review and categorize a number of treatment programs generally agreed to be variations of the case management model, including the broker model, clinical case management, Assertive Community Treatment (ACT) teams, and Family-Aided Assertive Community Treatment. A critical feature of all case management programs lies in the reconstruction and management of community relations for people whose social networks have been damaged, altered, or challenged due to illness. As such, we argue that case management attempts to provide a synthetic, professionally-based social support system in the community for individuals as a by-product of treatment. Variations across case management approaches represent profound differences in the nature of the network support system constructed for individuals. Here, we recast four types of prominent case management programs as social network structures, providing graphical representations of how each model links the client to the case manager and how each anchors clients to the treatment system, the social service system, and the lay community. These representations provide the base for understanding why each model works and for formulating comparative hypotheses for future outcome studies. We end by discussing the implications of this perspective for developing new case management programs, for evaluating differences across programs, and for considering policy and cost issues.