Intensive Case Management Intervention Research Articles

Intensive Case Management to Reduce Hospital Readmissions: A Pilot Quality Improvement Project.

Hospital readmissions burden the U.S. health care system, and they have negative effects on patients and their families. The primary aim of this study was to pilot an intensive case management (ICM) intervention to reduce 30-day hospital readmissions. A secondary aim was to obtain patient- and caregiver-reported reasons for readmission. The setting was a vertically integrated health care system located in Northern California. This pilot quality improvement project occurred over a 4-month period. The intervention was delivered by master's degree students in nurse case management through an academic-clinical partnership. Patients hospitalized with a 30-day readmission were offered the ICM intervention. A total of 36 patients were identified and 20 accepted. Patient and/or caregiver was interviewed to identify reasons for their readmission. Data were collected about pre-/post-health care utilization including subsequent 30-day readmission. Mixed methods were used to analyze the findings. Thirteen of 20 enrolled patients received the weekly ICM intervention for at least 30 days. Seven declined further contact before 30 days. Patient-reported reasons for readmission included being discharged too soon, poor communication among providers and with patients/families, lack of understanding about disease management and/or treatment options, and inadequate support. Several patients believed that their readmission was unavoidable due to the complexity of their illnesses. We compared 30-day readmissions for those who participated in and those who declined the ICM intervention, finding that those who received the ICM intervention had a lower readmission rate than those who did not receive the intervention (35% vs. 37.5%).

Evaluating outcomes of a three-year case management program for mothers with prenatal substance use according to race/ethnicity, Washington State, 2006–2017

BackgroundWell-designed public health interventions ideally aspire to reduce health disparities between racial and ethnic groups. Yet, there remains virtually no research examining racial/ethnic disparities in interventions for marginalized perinatal populations with substance use disorders (SUD). We sought to examine whether there were racial/ethnic differences at intake, in retention, and in program outcomes among pregnant or postpartum women with prenatal substance use enrolled in a three-year intensive case management intervention. We hypothesized that: (1) at baseline, numerous racial/ethnic disparities in well-being, health, and health care would be observed, and (2) after the three-year intervention few racial/ethnic disparities in maternal and child health and welfare would be found.MethodsWe used self-reported data from 3,165 women aged 18 to 45 years enrolled in the Parent-Child Assistance Program in Washington State between May 10, 2006, and September 21, 2017. We used Fisher-Freeman-Halton Exact Tests and t-tests to compare racial/ethnic groups at program enrollment and exit and logistic regression to examine likelihood of completing the intervention by group, controlling for other factors.ResultsDespite numerous racial/ethnic differences at enrollment, there were no such differences in outcomes among those who finished the program and completed an exit interview. Different racial/ethnic groups received comparable case manager time. American Indians/Alaska Natives were less likely to finish the program (Adjusted Odds = 0.66).ConclusionsParticipants who finished the program achieved comparable outcomes regardless of race/ethnicity. More work is needed to understand why American Indian/Alaska Native women were less likely than the others to finish the program and to close this service gap.

Assessing barriers to engagement in a community mental health center using the Psychosocial Assessment Tool (PAT).

Barriers in access to care prevent many individuals from benefiting from mental health services. The purpose of the current project was to assess the effectiveness and utility of incorporating the Psychosocial Assessment Tool (PAT; Kazak et al., 2001) into standard evaluation procedures at a pediatric psychiatry clinic in a diverse urban setting. As a secondary objective, PAT results were used to develop case management interventions to address identified barriers with families during initial treatment sessions. Over 6 months, the PAT was administered to 87 families during their initial psychiatric evaluation appointment. Depending on their responses, families were stratified into three different risk levels and received case management intervention accordingly to address barriers. Treatment engagement (i.e., number of sessions attended in the first treatment quarter) was utilized as an outcome measure of the effectiveness of the intervention and was compared across an intervention group and a control sample. The majority of patients identified at least one barrier to engagement in mental health services, with the majority of families experiencing barriers related to caregiver mental health needs and a lack of resources (e.g., finances, unemployment, lack of child care). Initial outcome measures for families who completed the PAT and participated in intensive case management intervention indicate improved engagement in mental health services. The PAT is an easily implemented and evidence-based measure that facilitates assessment of potential barriers to treatment engagement. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Impact of an intensive facility-community case management intervention on 6-month HIV outcomes among select key and priority populations in Uganda

IntroductionKey and priority populations (with risk behaviours and health inequities) are disproportionately affected by HIV in Uganda. We evaluated the impact of an intensive case management intervention on HIV treatment outcomes in Kalangala District, predominantly inhabited by fisher folk and female sex workers.MethodsThis quasi-experimental pre-post intervention evaluation included antiretroviral therapy naïve adults aged ≥ 18 years from six health facilities in the pre-intervention (Jan 1, 2017–December 31, 2017) and intervention phase (June 13, 2018–June 30, 2019). The primary outcomes were 6-month retention and viral suppression (VS) before and after implementation of the intervention involving facility and community case managers who supported participants through at least the first three months of ART. We used descriptive statistics to compared the characteristics, overall outcomes (i.e., retention, lost to follow up, died), and VS of participants by phase, and used mixed-effects logistic regression models to determine factors associated with 6-month retention in care. Marginal (averaging over facilities) probabilities of retention were computed from the final multivariable model.ResultsWe enrolled 606 and 405 participants in the pre-intervention and intervention phases respectively. Approximately 75% of participants were aged 25–44 years, with similar age and gender distributions among phases. Approximately 46% of participants in the intervention were fisher folk and 9% were female sex workers. The adjusted probability of 6-month retention was higher in the intervention phase, 0.83 (95% CI: 0.77–0.90) versus pre-intervention phase, 0.73 (95% CI: 0.69–0.77, p = 0.03). The retention probability increased from 0.59 (0.49–0.68) to 0.73 (0.59–0.86), p = 0.03 among participants aged 18–24 years, and from 0.75 (0.71–0.78) to 0.85 (0.78–0.91), p = 0.03 among participants aged ≥ 25 years. VS (< 1,000 copies/mL) was approximately 87% in both phases.ConclusionsAfter implementation of the case management intervention, we observed significant improvement in 6-month retention in all age groups of a highly mobile population of predominantly fisher folk.

Patterns of Service Use in Intensive Case Management: A Six Year Longitudinal Study

An Intensive Case Management (ICM) intervention has been developed in Lausanne, Switzerland. It aims to promote access to care for people with severe mental disorders who have difficulties to engage with mental health services because of the severity of their disorders and/or their marginality. ICM embrace components of assertive community treatment and critical time intervention. It is time limited and focused on critical phases of recovery. The goal of this study was to examine the heterogeneity of service use patterns of people who required ICM interventions and identify differences in patterns of duration and timing of the intervention. Records of 471 patients from the Department of Psychiatry of Lausanne University Hospital for whom the ICM team intervention was requested were analysed over a 6 year period with discrete sequential-state analysis. Trajectories could be split between six meaningful clusters including service light use and critical time intervention (58.0%), transition to long-term regular ambulatory-care (11.3%), partial transition to ambulatory care (14.4%), alternative to hospitalization (10.4%), continued ICM (4.9%) and long hospital stays (1.1%). Diagnoses of substance abuse were overrepresented among heavy users and diagnoses of schizophrenia were the most frequent diagnostic overall. Profiles of service use for ICM patients were very diverse. Long term interventions were frequently not necessary. A time-limited intervention was likely sufficient to stabilize the situation and/or engage the patient in care. A small number of situations required a sustained and long-term investment and did not always allowed for a reduction in the need for hospitalization. A general reflection on alternatives to hospitalization must be pursued, in particular for these patients.

Predictors of Depression in Healthcare Patients at Risk of Self-Neglect

More than half of reports to Adult Protective Services agencies nationwide involve allegations of self-neglect. An intensive case management intervention for preventing self-neglect was evaluated in a longitudinal study conducted collaboratively by a large healthcare system, Adult Protective Services, and a gerontological research institute. Patients (444) who were older (60+ years) and/or disabled (18+ years) were randomly selected for participation from 19 primary-care clinics if they had risk factors for self-neglect, including depression, substance abuse, dementia, and/or impairment in activities of daily living. Average age was 68 years (SD=12.5), 68% were Hispanic, 68% had monthly income of less than $1,361, and 67% were female. Clinics were randomized into intervention and control groups. Intervention clinic patients received intensive case management services; control clinic patients received usual care, including social work services. Subjects were interviewed at baseline and four months later. The Stress Process Model guided a multiple regression analysis. Domains of background characteristics, primary and secondary stressors, and support (patients in intervention or control group) were entered in blocks to predict depression levels at post-test. While no significant differences were found in post-test depression levels between intervention and controls, the final model was statistically significant (adjusted R2=.452). Significant predictors of depression were: younger age (disabled adults), poorer self-rated physical and emotional health, greater loneliness, and less social support. Future analyses will examine effects of moderating variables on post-test depression levels. Practice implications of preliminary analyses include addressing disabled adults’ mental health needs, especially if they are isolated and lack social support.

Effect of Case Management on HIV Outcomes for Community Corrections Population: Results of an 18-Month Randomized Controlled Trial.

Evidence-based interventions that engage community-dwelling, justice-involved, people living with HIV (PLWH) in care are urgently needed. Project Bridge, an intensive case management intervention, has demonstrated efficacy for linking PLWH to care transitioning from prison to the community. We assessed whether a modified Project Bridge model was effective for increasing rates of HIV treatment engagement, antiretroviral therapy receipt, and adherence for community-dwelling individuals supervised on probation and parole. Baltimore, Maryland. In this study, the 18-month outcomes of a randomized controlled trial in which PLWH were also on probation or parole received either Project Bridge (n = 50) or treatment as usual (n = 50) were assessed. HIV treatment engagement (primary outcome), antiretroviral therapy prescription, and adherence (secondary outcomes) are evaluated using the intent-to-treat approach. There were no statistically significant differences in rates of HIV treatment engagement, antiretroviral therapy prescription receipt, or adherence between groups over the 18-month study period. Across groups, participants were 5.6 times more likely to receive HIV care, 5.8 times more likely to receive an antiretroviral therapy prescription, and 4 times more likely to report antiretroviral therapy adherence at each follow-up period. Future research is needed to identify potentially less-intensive interventions that target the unique needs of PLWH under community supervision.

Enhanced Telehealth Case Management Plus Emergency Financial Assistance for Homeless-Experienced People Living With HIV During the COVID-19 Pandemic.

Boston Health Care for the Homeless Program, in Boston, Massachusetts, implemented an intensive telehealth case management intervention combined with emergency financial assistance for 270 homeless-experienced people living with HIV (PLWH) to reduce COVID-19 transmission and promote HIV care retention during Boston's first pandemic peak (March 16-May 31, 2020). Our telehealth model successfully maintained prepandemic case management and primary care contact levels, highlighting the importance of such programs in supporting the care engagement of homeless-experienced PLWH and addressing the dual COVID-19 and HIV epidemics.

Cost-effectiveness of Housing First Intervention With Intensive Case Management Compared With Treatment as Usual for Homeless Adults With Mental Illness

In the At Home/Chez Soi trial for homeless individuals with mental illness, the scattered-site Housing First (HF) with Intensive Case Management (ICM) intervention proved more effective than treatment as usual (TAU). To evaluate the cost-effectiveness of the HF plus ICM intervention compared with TAU. This is an economic evaluation study of data from the At Home/Chez Soi randomized clinical trial. From October 2009 through July 2011, 1198 individuals were randomized to the intervention (n = 689) or TAU (n = 509) and followed up for as long as 24 months. Participants were recruited in the Canadian cities of Vancouver, Winnipeg, Toronto, and Montreal. Participants with a current mental disorder who were homeless and had a moderate level of need were included. Data were analyzed from 2013 through 2019, per protocol. Scattered-site HF (using rent supplements) with off-site ICM services was compared with usual housing and support services in each city. The analysis was performed from the perspective of society, with days of stable housing as the outcome. Service use was ascertained using questionnaires. Unit costs were estimated in 2016 Canadian dollars. Of 1198 randomized individuals, 795 (66.4%) were men and 696 (58.1%) were aged 30 to 49 years. Almost all (1160 participants, including 677 in the HF group and 483 in the TAU group) contributed data to the economic analysis. Days of stable housing were higher by 140.34 days (95% CI, 128.14-153.31 days) in the HF group. The intervention cost $14 496 per person per year; reductions in costs of other services brought the net cost down by 46% to $7868 (95% CI, $4409-$11 405). The incremental cost-effectiveness ratio was $56.08 (95% CI, $29.55-$84.78) per additional day of stable housing. In sensitivity analyses, adjusting for baseline differences using a regression-based method, without altering the discount rate, caused the largest change in the incremental cost-effectiveness ratio with an increase to $60.18 (95% CI, $35.27-$86.95). At $67 per day of stable housing, there was an 80% chance that HF was cost-effective compared with TAU. The cost-effectiveness of HF appeared to be similar for all participants, although possibly less for those with a higher number of previous psychiatric hospitalizations. In this study, the cost per additional day of stable housing was similar to that of many interventions for homeless individuals. Based on these results, expanding access to HF with ICM appears to be warranted from an economic standpoint. isrctn.org Identifier: ISRCTN42520374.

Recruitment and effectiveness by cohort in a case management intervention among American Indians and Alaska Natives with diabetes.

In real-world settings, eligible populations and intervention effectiveness for a translational intervention likely vary across time. To determine the optimal strategies for effective large-scale implementation of evidence-based interventions, it is critical to investigate these potential variabilities. The purpose of this study is to evaluate whether patient characteristics and intervention effectiveness differed by year of enrollment in a multiyear evidence-based translational intervention. The Special Diabetes Program for Indians Healthy Heart (SDPI-HH) Demonstration Project is an intensive case management intervention designed to reduce cardiovascular disease risk among American Indians and Alaska Natives with diabetes. SDPI-HH participants recruited from 2006 through 2008 were included. Baseline characteristics were compared by year of enrollment. We also evaluated the differences in improvements in clinical and behavioral risk factors for cardiovascular disease among participants recruited in different years. The baseline characteristics of the three cohorts significantly differed in demographics, diabetes duration, health behaviors, level of motivation, and clinical measures. Improvements in 13 clinical and behavioral outcomes also differed by enrollment year with the 2006 cohort having the greatest number of significant improvements and the highest rates of participation and retention. Further investigation into the ways to modify the intensive case management model to address differences in levels of motivation and participation is warranted to improve the management of chronic disease in Indian health. Given the evolving nature of translational initiatives of this kind, our analysis results highlight the need to understand and adapt during the natural progression of health behavioral interventions.

A Randomized Controlled Trial of Intensive Case Management (Project Bridge) for HIV-Infected Probationers and Parolees.

Individuals on probation and parole are disproportionately at high risk for HIV infection and experience significant barriers to accessing health care. This study was a two-group randomized controlled trial conducted at a community corrections office and was designed to link HIV positive probationers/parolees to HIV treatment in the community. HIV positive participants were assigned to one of the two treatment conditions: (1) Project Bridge (PB), an intensive case-management intervention; or (2) treatment as usual (TAU), involving standard referral to treatment. We hypothesized that PB would be more effective than TAU in terms of initiating individuals in community HIV treatment. We found no difference in rates of, or time to, treatment initiation when comparing the PB to TAU (all ns>0.05). Additionally, there was no statistically significant difference between HIV medication regiment initiation by treatment condition (p>0.05). Despite limitations, we found that probationers and parolees were willing to be screened and linked to treatment.

Early truancy evaluation: Replication of an evaluation using a regression discontinuity design

This study replicates the evaluation of an early truancy intervention using a Regression Discontinuity Design. The current study assesses the effectiveness of the intervention for three cohorts of students (N=2760). Approximately half of the students for each year of the intervention received the high risk, intensive case management intervention, while the other half received a warning letter only. The truancy intervention proved to significantly reduce truancy among participants in the high-risk intervention among two of the three cohorts (p<0.01), while truancy among control group participants remained at pre-intervention levels. Successful case closure was associated with a reduction in truancy (p<001). Findings continue to support the efficacy of the intervention. However, the intervention should be replicated with more diverse population and in other geographic locations.

Abstract P030: Recruitment and Effectiveness by Cohort in a Case Management Intervention Among American Indians and Alaska Natives with Diabetes

Introduction: To determine the optimal strategies for effective large-scale implementation of evidence-based interventions, it is critical to investigate continued effectiveness as an intervention rolls out to large, diverse populations. The purpose of this study is to evaluate whether patient characteristics and intervention effectiveness differ by year of enrollment in a multi-year evidence-based translational intervention. Hypothesis: We hypothesize the patients recruited early may have a higher level of readiness to change their behaviors and achieve more improvements in their intervention outcomes than patients enrolled in later years. Methods: The Special Diabetes Program for Indians Healthy Heart (SDPI-HH) Demonstration Project is an intensive case management intervention designed to reduce cardiovascular disease (CVD) risk among American Indian and Alaska Native patients with diabetes. SDPI-HH participants recruited from 2006 through 2008 were included (n=2,910). Baseline characteristics were compared by year of enrollment. We also evaluated the differences in improvements in CVD risk factors among participants recruited in different years. Results: The baseline characteristics of the three cohorts revealed significant differences in demographics, diabetes duration, health behaviors, level of motivation, and clinical measures. Improvements in 13 clinical and behavioral outcomes differed by enrollment year with the 2006 cohort having the greatest number of statistically significant improvements (Table 1). The 2006 cohort also had the highest rates of participant participation and retention. Conclusions: The SDPI-HH participants recruited later had fewer improvements in CVD risk factors, potentially due to the decline in participant motivation over the three years. Further investigation into ways to modify the intensive case management model to address differences in levels of motivation and participation is warranted to improve the prevention of chronic disease in Indian health.

Perceived Case Management Needs and Service Preferences of Frequent Emergency Department Users: Lessons Learned in a Large Urban Centre.

ObjectivesThis study aimed to explore the service needs and preferences of frequent emergency department users with mental health and addictions concerns who participated in a brief intensive case management intervention.MethodsWe conducted semi-structured individual interviews with 20 frequent emergency department users with mental health and addictions challenges, 13 service providers involved in the delivery of a brief case management intervention, and a focus group with intervention case managers. Thematic analysis was used to explore perceived service user profiles, service needs and preferences of care.ResultsService users experienced complex health and social needs and social isolation, while exhibiting resilience and the desire to contribute. They described multiple instances of stigmatization in interactions with healthcare professionals. Components of the brief intensive case management intervention perceived to be helpful included system navigation, advocacy, intermediation, and practical needs assistance. Frequent service users valued relational responsiveness, a non-judgmental stance, and a recovery orientation in case managers.ConclusionInterventions for frequent service users in mental health may be enhanced by focusing on the engagement of formal and informal social supports, practical needs assistance, system navigation, advocacy and intermediation, and attention to the recovery goals of service users.

Integrating care for frequent users of emergency departments: implementation evaluation of a brief multi-organizational intensive case management intervention.

BackgroundAddressing the needs of frequent users of emergency departments (EDs) is a health system priority in many jurisdictions. This study describes stakeholder perspectives on the implementation of a multi-organizational brief intervention designed to support integration and continuity of care for frequent ED users with mental health and addictions problems, focusing on perceived barriers and facilitators to early implementation in a large urban centre.MethodsCoordinating Access to Care from Hospital Emergency Departments (CATCH-ED) is a brief case management intervention bridging hospital, primary and community care for frequent ED users experiencing mental illness and addictions. To examine barriers and facilitators to early implementation of this multi-organizational intervention, between July and October 2012, 47 stakeholders, including direct service providers, managers and administrators participated in 32 semi-structured qualitative interviews and one focus group exploring their experience with the intervention and factors that helped or hindered successful early implementation. Qualitative data were analyzed using thematic analysis.ResultsStakeholders valued the intervention and its potential to support continuity of care for this population. Service delivery system factors, including organizational capacity and a history of collaborative relationships across the healthcare continuum, and support system factors, such as training and supervision, emerged as key facilitators of program implementation. Operational challenges included early low program referral rates, management of a multi-organizational initiative, variable adherence to the model among participating organizations, and scant access to specialty psychiatric resources. Factors contributing to these challenges included lack of dedicated staff in the ED and limited local system capacity to support this population, and insufficient training and technical assistance available to participating organizations.ConclusionsA multi-organizational brief intervention is an acceptable model to support integration of hospital, primary and community care for frequent ED users. The study highlights the importance of early implementation evaluation to identify potential solutions to implementation barriers that may be applicable to many jurisdictions.

"A Twenty-Hour-a-Day Job": The Impact of Frequent Low-Level Criminal Justice Involvement on Family Life.

In the growing field of research on the consequences of criminal justice contact for family life, a heavy emphasis has been placed on how imprisonment influences the emotional, physical, and socioeconomic wellbeing of prisoners' loved ones. In this article, I elaborate on and analyze the experiences of family members of people with frequent, low-level criminal justice involvement. I draw on ethnographic data collected in partnership with a clinical social worker over the course of a three-year study of an intensive case management intervention for HIV-positive individuals. Findings indicate that loved ones' brief jail stays and community supervision through probation and parole pose hardships for family members that are distinct from those hardships that arise during imprisonment. These experiences are uniquely destabilizing, may confer specific risks to family members' wellbeing, and merit further study to inform programs, social services, and public policy.

Improving continuity of care for frequent users of emergency departments: service user and provider perspectives.

This study explored service user and provider perspectives on barriers and facilitators of continuity of care for frequent users of emergency departments (ED) participating in a brief intensive case management intervention. We conducted semistructured interviews with 20 frequent ED users with mental health and addiction challenges participating in a brief intensive case management intervention, eliciting experiences of care and care continuity. We interviewed 13 service providers working with this population. We used thematic analysis to determine shared and unique barriers and facilitators to continuity of care, and we gave priority to themes reported by both service users and providers. Within fragmented systems of care, strong working relationships between service users and providers, timely access to coordinated services and seamless transitions to needed supports increased perceived care continuity. Barriers to continuity of care included difficulties engaging this population, short intervention duration and the lack of a single accountable service provider to address health and social needs. Although brief intensive case management interventions have the potential to improve continuity of care for frequent ED users, continuity of care, especially for people with complex health and social needs, may be compromised by program and personal characteristics as well as lack of broader system integration.

Case management to reduce cardiovascular disease risk in American Indians and Alaska Natives with diabetes: results from the Special Diabetes Program for Indians Healthy Heart Demonstration Project.

We evaluated cardiovascular disease (CVD) risk factors in American Indians/Alaska Natives (AI/ANs) with diabetes in the Special Diabetes Program for Indians Healthy Heart (SDPI-HH) Demonstration Project. Multidisciplinary teams implemented an intensive case management intervention among 30 health care programs serving 138 tribes. The project recruited 3373 participants, with and without current CVD, between 2006 and 2009. We examined data collected at baseline and 1 year later to determine whether improvements occurred in CVD risk factors and in Framingham coronary heart disease (CHD) risk scores, aspirin use, and smoking status. A1c levels decreased an average of 0.2% (P < .001). Systolic and diastolic blood pressure, low-density lipoprotein (LDL) cholesterol, and triglyceride levels decreased, with the largest significant reduction in LDL cholesterol (∆ = -5.29 mg/dL; P < .001). Average Framingham CHD risk scores also decreased significantly. Aspirin therapy increased significantly, and smoking decreased. Participants with more case management visits had significantly greater reductions in LDL cholesterol and A1c values. SDPI-HH successfully translated an intensive case management intervention. Creative retention strategies and an improved understanding of organizational challenges are needed for future Indian health translational efforts.

Reducing Service and Substance Use Among Frequent Service Users: A Brief Report From the Toronto Community Addictions Team

The Toronto Community Addictions Team (TCAT) is an intensive case management intervention designed to serve people with addictions who are frequent service users, thus addressing a health system priority. Questionnaires given to 65 participants at baseline, 3 months, and 6 months and semi-structured interviews of 10 program participants explored participants’ outcomes and experiences with the program. Qualitative findings, analyzed using thematic content analysis, suggest that participants value the program's commitment to harm reduction, financial trusteeship, and recovery orientation. Quantitative findings from paired t-tests reveal that participants improved in community functioning and decreased days of problematic substance use and money spent on alcohol and drugs as early as 3 months after program participation. Future research should used a controlled design and explore predictors of positive outcomes in this vulnerable population.

Systematic Review and Narrative Synthesis of the Effectiveness of Contraceptive Service Interventions for Young People, Delivered in Educational Settings

Study ObjectiveThis review was undertaken to determine the effectiveness of contraception service interventions for young people that were delivered in educational settings. DesignWe conducted a systematic review and narrative synthesis. SettingInterventions were included where they were delivered in educational institutions, including schools, colleges, and pupil referral units. ParticipantsYoung people aged 19 and under. Studies of wider age groups were included if the majority of participants were aged under 19 years. InterventionsWe included interventions which consisted of contraceptive service provision, and also interventions to encourage young people to use existing contraceptive services. Main Outcome MeasuresThe main outcome measures used in the studies were: rate of teenage pregnancy, rate of contraceptive use, and sexual behavior. Many outcome measures were self reported. ResultsTwenty-nine papers were included which reported on interventions to prevent adolescent pregnancy (and repeat pregnancy), school-based health centers, contraceptive use in college students, and multicomponent interventions. Intensive case management intervention conducted by a culturally matched school-based social worker (along with other components including peer education) were shown to be effective in preventing repeat adolescent pregnancy, at least for the duration of the intervention. Also, school-based health centers appear to be most effective when contraception provision is made available on site. ConclusionsThe evidence from these papers is limited, in terms of both quality and quantity, along with consistency of findings, but some recommendations in relation to effective interventions can be made.