Program Case Management Research Articles

Peers plus mobile app for treatment in HIV (PATH): protocol for a randomized controlled trial to test a community-based integrated peer support and mHealth intervention to improve viral suppression among Hispanic and Black people living with HIV

BackgroundSignificant disparities continue to exist in the HIV care continuum, whereby Hispanic and Black people living with HIV (PLWH) are less likely to achieve viral suppression compared to their White counterparts. Studies have shown that intervention approaches that involve peer navigation may play an important role in supporting patients to stay engaged in HIV care. However, implementation may be challenging in real-world settings where there are limited resources to support peer navigators. Combining a peer navigation approach with scalable mobile health (mHealth) technology may improve impact and implementation outcomes.MethodsWe combined a peer navigation intervention with a mHealth application and are conducting a randomized controlled trial (RCT) to test the efficacy of this integrated “Peers plus mobile App for Treatment in HIV” (PATH) intervention to improve HIV care engagement, and ultimately sustained viral suppression, among Hispanic and Black PLWH. We will enroll up to 375 PLWH into a two-arm prospective RCT, conducting follow-up assessments every 3 months up to 12 months post-baseline. Participants randomized to the control arm will continue to receive usual care Ryan White Program case management services. Individuals randomized to receive the PATH intervention will receive usual care plus access to two main intervention components: (1) a peer navigation program and (2) a mHealth web application. The primary outcome is sustained HIV viral suppression (undetectable viral load observed at 6- and 12-month follow-up). Secondary outcomes are retention in HIV care, gaps in HIV medical visits, and self-reported ART adherence. Recruitment for the RCT began in November 2021 and will continue until June 2024. Follow-up assessments and medical chart abstractions will be conducted to collect measurements of outcome variables.DiscussionThe efficacy trial of PATH will help to fill gaps in our scientific understanding of how a combined peer navigation and mHealth approach may produce effects on HIV care outcomes while addressing potential implementation challenges of peer navigation in Ryan White-funded clinics.Trial registrationThe PATH trial is registered at the United States National Institutes of Health National Library of Medicine (ClinicalTrials.gov) under ID # NCT05427318. Registered on 22 June 2022.

Community Mental Health Services for Frequent Emergency Department Users: A Qualitative Study of Outcomes Perceived by Program Clients and Case Managers.

This study aimed to investigate the perceived outcomes and mechanisms of change of a community mental health service combining system navigation and intensive case management supports for frequent emergency department users presenting with mental illness or addiction. The study setting was a community mental health agency receiving automated referrals directly from hospitals in a midsize Canadian city for all individuals attending an emergency department two or more times within 30 days for mental illness or addiction. Qualitative interviews with 15 program clients. Focus groups with six program case managers. Data were analyzed using pragmatic qualitative thematic analysis. Participants generally reported perceiving that the program contributed to reduced emergency department use, reduced mental illness symptom severity, and improved quality of life. Perceived outcomes were more mixed for outcomes related to addiction. Reported mechanisms of change emphasized the importance of positive working relationships between program clients and case managers, as well as focused efforts to develop practical skills. Community mental health services including intensive case management for frequent emergency department users presenting with mental illness or addiction were perceived to effectively address client needs while reducing emergency department resource burden. Similar programs should emphasize the development of consistent and warm working relationships between program clients and case managers, as well as practical skills development to support client health and well-being.

Actuarial prediction versus clinical prediction of exits from a national supported housing program.

The accurate identification of persons at risk of exiting permanent supportive housing could help maximize client success and minimize attrition and premature exits from such housing. Thus, in the present study, we developed and tested multivariable prediction models of negative and positive exits from the U.S. Department of Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program using logistic regression and random forests. We compared the performance of these models with clinical predictions made by HUD-VASH program case managers. We selected a cohort of all 92,196 Veterans who entered HUD-VASH nationwide between October 1, 2014 and September 30, 2019, 70% of whom were randomly selected to serve as the development cohort and the remaining 30% of whom served as the validation cohort. Negative and positive exits were measured until September 30, 2019. A subset of 1,264 Veterans was used to compare performance of models with clinical judgment. Predictor variables included sociodemographic characteristics, health and behavioral health diagnoses, homeless/housing history, and VA service utilization history. Performance of models and clinical judgment were assessed using an array of metrics including area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, and positive predictive value. The logistic regression and random forest models had similar, modest performance in predicting negative and positive exits. These models were substantially more sensitive, yet far less specific in predicting exits than clinician ratings. Study findings highlight the challenges and tradeoffs in using actuarial models or case manager predictions to target interventions to Veterans at risk of exiting HUD-VASH. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Workplace Dynamics in Affiliational Organizations: A Case Study of a One-Stop Agency Serving Victims of Intimate Partner Violence

Affiliational or one-stop organizations, which provide social services from multiple agencies within a single location, hold great potential for addressing holistically the often diverse needs of clients. However, there is a paucity of research examining the unique institutional and interpersonal challenges of these workplace settings, particularly in terms of organizational cohesiveness and employee well-being. This article offers a case study of an affiliational organization whose mission is to address the multifaceted needs of victims of intimate partner violence. The research design consisted of in-depth qualitative interviews with each of the program's case managers (n = 4) and with two representatives from each community partner organization: one who was housed at the affiliational organization and one director-level staff person located off-site who was involved in the organization's formation (n = 20). The authors examine in particular the ways in which interpersonal relations, organizational structure, and occupational culture affect productivity, solidarity, and well-being in this setting.

Veränderung der psychischen Belastung von Krebspatienten im Rahmen einer strukturierten psychoonkologischen Versorgung

The aim of this health service research study was to investigate the change in the psychological distress of cancer in-patients. According to the structured psychooncological care program Case Management Psychoonkologie (CMP) the patients received psychological treatment during the acute cancer therapy. The CMP was implemented in routine healthcare practice of 6 hospitals. The improvement in the patient's symptoms of anxiety and depression was analyzed as an indication for the effectiveness of the CMP. In order to assess the psychological distress, quality of life, and the functional status the German version of the Hospital Anxiety and Depression Scale (HADS) and a checklist of single-item-scales were administered at hospital admission (t1), 120 days later (t2) and one year after the hospital admission (t3). According to the HADS, the pre-post effect sizes of the psychooncological care program for 258 patients were 0.35 at t2 and 0.46 at t3. The effect sizes of 1.05 at t2 and 1.38 at t3 were calculated for the sub-group of patients with high psychological distress at t1. In 34.4 % of these patients clinical significant improvements in symptoms of anxiety and depression could be identified at t2 and in 45.3 % of the cases at t3. Symptom changes were significantly influenced by the patient's age and the intensity of psychooncological interventions. Symptom improvement was most evident for patients with a high use of psychooncological care. The correlation between HADS and single Item scales is in the moderate to high range. This is an indication of improvement not only in the psychological domain but also in the quality of life and functional status one year after the beginning of cancer treatment. These findings implicate that this study is one of the first to demonstrate the potential effectiveness of structured psychooncological care interventions in routine hospital care.

Development of Local Program Theory: Using Theory-Oriented Evaluation to Make a Difference

The aim of this article is to explicate the local program theory of an adolescent pregnancy and parenting program using a mix of methods. By bracketing these methods, local program theory is developed and subsequently used to distinguish between the validity of program theory and the validity of program implementation. Theory is then used as a tool to construct a model of how the program is supposed to work. This is followed by an assessment of the extent to which the program's theories are actually implemented in the field. The intent of using a mix of methods during this process is to gather an extensive, intensive, and comprehensive view of program case managers' thoughts about their work. Analysis is based on the evaluator's recognition of patterns of meaning that contribute to an enhanced contextual and theoretical understanding of the overall effectiveness of this program.

Parent Satisfaction with Case Managed Systems of Care for Children and Youth with Severe Emotional Disturbance

Case management has emerged as an integral component of current efforts to reform the delivery of mental health services to children and youth with Severe Emotional Disturbance (SED). We examined parental satisfaction with one program's case management system for SED children. In order to validly address parental satisfaction, the program first turned to a group of its parents to develop a satisfaction measure, the Family Satisfaction Survey (FSS). Of the 51 parents who returned an FSS, 74% of the parents were generally satisfied while 26% indicated that they were dissatisfied with their families' case management services. Multivariate regression analyses were employed to examine the role played by client, service, and outcome variables in predicting parental satisfaction. After controlling for child diagnoses, severity of impairment, and levels of psychosocial stress, parent satisfaction with case management services was best predicted by the frequency of monthly contact and fewer days is a psychiatric hospital proportional to length of service. Our results suggest that parent satisfaction is based not only on what case managers do but on how this service impacts SED children's ability to remain at home and in their communities.

Comprehensive case management in the private sector for patients with severe mental illness.

Intensive case management for severely psychiatrically ill patients is a relatively new phenomenon in the private sector. The authors describe a comprehensive case management program designed at Blue Cross Blue Shield of Massachusetts to meet the needs of the most severely ill psychiatric patients in a private managed care environment. The case management program emphasizes involvement of patients in creating comprehensive treatment plans; development of a relationship between case managers, patients and their families, and providers; and clinical coordination between the public and private sectors to create individualized treatment plans. The program's case managers are able to flex the benefit limitations of a managed care or indemnity plan to integrate public and private services and can enlist providers outside a managed care network. The paper describes service utilization by the first 33 patients who participated in the program for one year.

CASE MANAGEMENT‐THE DREAM AND THE REALITY

ABSTRACTThis paper summarises the author's impressions of the use of case management in programs for elderly people in America. The hopes for case management as independent brokerage able to organise the community and service system to meet the needs of individual elderly people has not been realised. This has not stopped its widespread establishment in community‐based long‐term care for relatively minor gains at high cost, but with a belief that it is doing much more. Australians are likely to embrace case management for the same reasons as Americans and will be just as disappointed. Despite this lack of real effectiveness of case management, a highly individualised response to elderly people's needs is still required but, this experience indicates, will only be achieved with a much broader strategy.

Hospital Case Management: Bridging Acute And Long-Term Care

Since the early 1980s, policymakers and analysts have urged hospitals to be more active in managing the care of their patients beyond the hospital walls. In particular, hospitals have been criticized for failing to address the postdischarge needs of elderly patients with chronic health problems. An influential essay in The New England Journal of Medicine observed that “most of these institutions have no comprehensive geriatric program geared to the long-term medical, rehabilitative, and social needs that are linked to acute illness. To provide quality care, hospitals must make a commitment to long-term care for the chronically ill elderly patient. It is becoming apparent that no one else can.” As part of a strategy for addressing this perceived shortcoming, the authors argued, “Unlike other providers, hospitals could offer comprehensive case management of patients, from home care to acute care, thus ensuring continuity of services.” Under this approach, hospital-based case managers would identify clients, assess their needs, develop care plans, coordinate service delivery, and monitor results. Since many of these activities would take place after the patient left the hospital, hospital-based case management would be a considerable extension of hospitals’ typical discharge planning activities. In part, it was expected that the costs of hospital-based case management programs would be covered through user fees. If the hospital also offered long-term care services, hospital-based case management could generate additional revenues through increased use of these services. If it facilitated the earlier discharge of Medicare patients and reduced Medi-

Autonomy and Risk: The Role of Client Wishes in Community-Based Long-Term Care

This study examines the extent to which a client's choices are incorporated in care decisions within a prepaid, community-based long-term care program. Decision criteria used by the program's case management team regarding client autonomy included indicators of risk to client stability and of limits on organizational resource capacity. Under certain "high-risk" conditions, self-determination could decrease in importance in light of the care needs of the program's total client population.

Patterns of case management activity in an intensive community support program: the first year.

Changes in activity patterns of 12 case managers over the first year of an intensive community support program are described and a method and format for the collection and analysis of time budget data in case management are presented. During the first six months of the program case managers recorded the predominant activity for each 15 minute period throughout the day. Mean values of proportional time were 35.3% for direct services, 40.3% for indirect services, and 24.4% for nonclinical services. The relatively high (64.7%) combination of indirect and nonclinical services deserves careful consideration in program cost analysis.

A descriptive analysis of community support program case managers serving the chronically mentally ill.

This article presents a description of case managers who serve community-based chronically mentally ill (CMI) persons through the Community Support Program (CSP). Information is presented on case managers' demographic characteristics, education, job training, job history, current job activities, and locus of employment. Data were generated through the Case Manager Background Questionnaire, a 23-item self-administered instrument developed in conjunction with the CSP, a pilot Federal-State collaboration project designed to explore strategies for improving the delivery of community-based mental health and related services to the CMI. Results of the study suggest that a typical CSP case manager is white, female and in the mid-thirties. Case managers are a highly educated group; nearly one-half have graduate degrees and about two-thirds have participated in an in-service or continuing education program. Currently, two out of three CSP case managers are employed at Community Mental Health Centers and about one-third of their time is spent in direct service provision. While CSP case managers have been working at their present location for about one and one-half years, they have been in the community-based mental health system for about four years, and with the mentally disabled an average of seven years. A critical issue emerging from this analysis is the need for future research on the relationships among job training, education, job functions, and service delivery.