Graduation practices and outcomes in intensive case management programs for severe mental illness: A systematic review.

Abstract

Intensive case management (ICM) is important in psychiatric rehabilitation but there is a need to "graduate" clients. The purpose of this research was to review the literature on criteria used and outcomes of graduating clients with severe mental illness from ICM programs. A systematic review conducted in 2019 used keyword searches in all major research databases. This search yielded 1,142 articles which were distilled to 20 studies that reported a graduation process from an ICM program (11 studies), and/or reported clinical or psychosocial outcomes after graduation (15 studies). Three main methods have been used to determine graduation: Clinician judgment (n = 8 studies), rating scales (n = 4), or shared decision-making (n = 3). Across studies, graduation rates ranged from 1% to 25% over a 1-year period, 44% to 65% over a 2-year period, and 9% to 29% over a 4-year period. After graduation, 4%-14% of graduates had to be readmitted to ICM but 60% of studies reported positive client outcomes after graduation which included significant reductions in hospitalizations, and improvements in quality of life, unmet needs for care, and family relationships. Only two studies reported negative outcomes after graduation which included hospitalizations, homelessness, incarceration, and treatment drop-out. ICM programs can successfully graduate clients to less intensive services, and there are procedures available to guide graduation decisions but no universally agreed-upon method. Additional research is needed to identify optimal methods for graduation for different client populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).