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Social workers are a dominant presence in public mental health, and many serve as intensive case managers. This critical review of randomized field trials of intensive case management for individuals with serious and persistent mental illness finds only qualified support for the efficacy of intensive case management. This article reviews published trials since the inception of the CSS initiative. Inadequate sample sizes by design and attrition, vaguely delimited conceptual frameworks, and inconclusive analysis strategies are faulted for the inconclusiveness of the research to date. Directions for correcting these weaknesses in case management research and in random trials of social work practice research in general are discussed.

AbstractIssues that arise in employing consumers as providers in psychiatric rehabilation programs include readiness of the sponsoring agency, consumer disclosure, and adjustments in employment practices. Psychiatric rehabilitation agencies are obligated to seriously consider employing consumers, since they fequently ask the same of other organizations.

This analysis sought to determine whether a team of mental health service consumers delivered intensive case management services differently than a team of nonconsumer case managers. Ninety-six seriously mentally ill clients were randomly assigned to consumer and nonconsumer teams of case managers. Service documentation for each client's first year of service was analyzed by condition using t-tests, discriminant function, and multiple regression. Consumer case managers delivered more services face-to-face with the client and fewer services in the office and in interactions with family members or other mental health service providers. If current trends continue, social workers in mental health will be delivering more services with consumers as peer service providers or supervisees.

It was hypothesized that clients receiving case management services will improve to a moderate extent in terms of a variety of psychosocial and clinical outcomes compared with clients served by the usual system of care. It was further hypothesized that clients served by an Assertive Community Treatment (ACT) team will have significantly greater improvement than clients served by forensic case managers working individually. Two hundred seriously mentally ill inmates leaving jail were assigned to three conditions, and 94 remained in the study at 1 year. One-year outcomes were analyzed by service condition, using a hierarchical block discriminant function analysis. Contrary to the hypothesis, more clients in the experimental condition returned to jail within a year. No differences were found among the three conditions in social or clinical outcomes. Greater jail recidivism among clients receiving the more intensive service raises questions concerning tendencies to emphasize monitoring with this population.

Randomized controlled trials (RCTs) have been the gold standard for health and social service research for generations of professionals. However, even with the development of methods to accommodate a large number of professional perspectives and fields of intervention, there is still no comprehensive resource for learning how to deal with the complex nature of RCTs conducted in community settings. In this book, the authors draw on their extensive experience conducting randomized controlled trials to compile a practical and accessible guide to RCTs in community-based practice settings.

From the initial stage of planning the RCT and developing its conceptual foundations through implementation, the authors provide a wealth of detail and case studies from social work practice research that assist readers to comprehend the detailed information provided.