Strengths-based Case Management Intervention Research Articles

A strengths-based case management intervention to link HIV-positive people who inject drugs in Russia to HIV care.

Objective:To determine whether the Linking Infectious and Narcology Care strengths-based case management intervention was more effective than usual care for linking people who inject drugs (PWID) to HIV care and improving HIV outcomes.Design:Two-armed randomized controlled trial.Setting:Participants recruited from a narcology hospital in St. Petersburg, Russia.Participants:A total of 349 HIV-positive PWID not on antiretroviral therapy (ART).Intervention:Strengths-based case management over 6 months.Main outcome measures:Primary outcomes were linkage to HIV care and improved CD4+ cell count. We performed adjusted logistic and linear regression analyses controlling for past HIV care using the intention-to-treat approach.Results:Participants (N = 349) had the following baseline characteristics: 73% male, 12% any past ART use, and median values of 34.0 years of age and CD4+ cell count 311 cells/μl. Within 6 months of enrollment 51% of the intervention group and 31% of controls linked to HIV care (adjusted odds ratio 2.34; 95% confidence interval: 1.49–3.67; P < 0.001). Mean CD4+ cell count at 12 months was 343 and 354 cells/μl in the intervention and control groups, respectively (adjusted ratio of means 1.14; 95% confidence interval: 0.91, 1.42, P = 0.25).Conclusion:The Linking Infectious and Narcology Care strengths-based case management intervention was more effective than usual care in linking Russian PWID to HIV care, but did not improve CD4+ cell count, likely due to low overall ART initiation. Although case management can improve linkage to HIV care, specific approaches to initiate and adhere to ART are needed to improve clinical outcomes (e.g., increased CD4+ cell count) in this population.

Jail, an unappreciated medical home: Assessing the feasibility of a strengths-based case management intervention to improve the care retention of HIV-infected persons once released from jail

BackgroundLinkage to and retention in care for US persons living with HIV (PLWH) after release from jail usually declines. We know of no rigorously evaluated behavioral interventions that can improve this. We hypothesized that a strengths-based case management intervention that we developed for PLWH leaving jail would increase linkage/retention in care (indicated by receipt of laboratory draws) and a suppressed HIV viral load (VL) in the year following release.Methods and findingsWe conducted a quasi-experimental feasibility study of our intervention for PLWH jailed in Atlanta. We recruited 113 PLWH in jail starting in 2014. “SUCCESS” (Sustained, Unbroken Connection to Care, Entry Services, and Suppression) began in jail and continued post-release. Subjects who started the intervention but subsequently began long-term incarcerations were excluded from further analysis. Persons who were retained in the intervention group were compared to contemporaneously incarcerated PLWH who did not receive the intervention. Identities were submitted to an enhanced HIV/AIDS reporting system (eHARS) at the state health department to capture all laboratories drawn. Both community engagement and care upon jail return were assessed equally. For 44 intervention participants released to Atlanta, 50% of care occurred on subsequent jail stays, as documented with EventFlow software. Forty-five receiving usual services only were recruited for comparison. By examining records of jail reentries, half of participants and 60% of controls recidivated (range: 1–8 returns). All but 6 participants in the intervention and 9 subjects in the comparison arm had ≥1 laboratory recorded in eHARS post-release. Among the intervention group, 52% were retained in care (i.e., had two laboratory studies, > = 3 months apart), versus 40% among the comparison group (OR = 1.60, 95% CI (0.71, 3.81)). Both arms showed improved viral load suppression.ConclusionsThere was a trend towards increased retention for PLWH released from jail after SUCCESS, compared to usual services. Measuring linkage at all venues, including jail-based clinics, fully captured engagement for this frequently recidivating population.Trial registrationClinicalTrials.gov NCT02185742

A Strengths-Based Case Management Intervention to Reduce HIV Viral Load Among People Who Use Drugs.

Engaging highly marginalized HIV positive people in sustained medical care is vital for optimized health and prevention efforts. Prior studies have found that strengths-based case management helps link people who use drugs to HIV care. We conducted a pilot to assess whether a strengths-based case management intervention may help people who use injection drugs (PWID) or smoke crack cocaine (PWSC) achieve undetectable HIV viral load. PWID and PWSC were recruited in Oakland, California using targeted sampling methods and referral from jails and were tested for HIV. HIV positive participants not receiving HIV care (n=19) were enrolled in a pilot strengths-based case management intervention and HIV positive participants already in HIV care (n=29) were followed as comparison participants. The intervention was conducted by a social worker and an HIV physician. Special attention was given to coordinating care as participants cycled through jail and community settings. Surveys and HIV viral load tests were conducted quarterly for up to 11 visits. HIV viral load became undetectable for significantly more participants in the intervention than in the comparison group by their last follow-up (intervention participants: 32% at baseline and 74% at last follow-up; comparison participants: 45% at baseline and 34% at last follow-up; p=0.008). In repeated measures analysis, PBO intervention participants had higher odds of achieving undetectable viral load over time than comparison participants (p=0.033). Strengths-based case management may help this highly vulnerable group achieve undetectable HIV viral load over time.

LINC – A strengths-based case management intervention to LINK HIV-infected PWID in Russia to HIV care – RCT results

When the design of a new nuclear facility begins, project teams have little more than a customer specification and a very long list of stakeholders who must all be satisfied with the outcome. This chapter describes a structured approach to designing nuclear facilities, one which enables designers to demonstrate that the end result is not simply “a” solution but, with all factors considered, is the “best” that can be achieved. The chapter guides readers through a process of analyzing how the various areas of a proposed new facility must interact with each other, an exercise which is captured in a building flow diagram (BFD), and the importance of identifying constraints that will govern how a facility's design is assembled. This is followed by examples of considerations, which demonstrate just how complex the design process is, and underline the importance of tackling the whole process in a structured and systematic manner.

Impact of a strengths-based case management intervention on HIV viral load among people who use drugs in Oakland, California

Impact of a strengths-based case management intervention on HIV viral load among people who use drugs in Oakland, California

Effectiveness of Strengths-Based Case Management for People with Mental Health Problems in Hong Kong

This study examined the effectiveness of a 6-month strengths-based case management intervention with 45 Chinese participants with mental health problems in Hong Kong. Social workers provided service according to the strengths-based case management (SCM) model developed at the University of Kansas. Changes in participants’ recovery components (Stage of Recovery Scale), mental health symptoms (GHQ), and satisfaction with life were assessed using a single group pretest and posttest design. Results suggest that participants had some improvement in their autonomy, hope, and overall well-being as well as satisfaction with life after receiving services. No significant improvements in the other recovery components and GHQ score were found. Significantly, a number of participants progressed from stages of being overwhelmed or struggling with disability to stages of living with or beyond disability. Strengths-based practice helped participants develop a transformed self which sees hope and possibility despite the vulnerabilities caused by their illness. Though further refinement and testing are vital, adoption of SCM in Hong Kong mental health services is promising.

Adherence to Scheduled Sessions in a Randomized Field Trial of Case Management: The Criminal Justice-Drug Abuse Treatment Studies Transitional Case Management Study.

The Transitional Case Management (TCM) study, one of the projects of the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) cooperative, was a multi-site randomized test of whether a strengths-based case management intervention provided during an inmate’s transition from incarceration to the community increases participation in community substance abuse treatment, enhances access to needed social services, and improves drug use and crime outcomes. As in many intervention studies, TCM experienced a relatively large percentage of treatment-group participants who attended few or no scheduled sessions. The paper discusses issues with regard to participation in community case management sessions, examines patterns of session attendance among TCM participants, and analyzes client and case manager characteristics that are associated with number of sessions attended and with patterns of attendance. The average number of sessions (out of 12) attended was 5.7. Few client or case manager characteristics were found to be significantly related to session attendance. Clinical and research implications of the findings and of adherence in case management generally are discussed.

Predictors of opiate agonist treatment retention among injection drug users referred from a needle exchange program

Aims The aim of this study was to examine the effect of a case management intervention on retention in opiate agonist therapy among injection drug users (IDUs) referred from a needle exchange program (NEP). Design, intervention, participants, and setting A randomized trial of a strengths-based case management intervention versus passive referral (control) was conducted among NEP attendees requesting and receiving referrals to subsidized, publicly funded opiate agonist treatment programs in Baltimore, MD. Measurements Multivariable Cox regression models were used to identify predictors of treatment retention using an ecological model approach, taking into account factors at the individual, social, and environmental level. Findings Of 245 IDUs, 127 (51.8%) entered opiate agonist treatment, for whom median retention was 7.9 months. The intervention was not associated with longer retention ( p = .91). Individual-level factors predictive of shorter retention included being employed and greater levels of psychiatric distress. Participants who had prior treatment experience and multiple treatment requests were retained significantly longer. Social factors adversely affecting treatment retention included unstable housing and buying drugs for others. Living further away from the treatment site was an environmental barrier that negatively affected treatment retention. Conclusions Multilevel interventions that address individual, social, and environmental factors are necessary to improve substance abuse treatment retention and treatment outcomes among IDUs referred from NEP.

The Effect of a Case Management Intervention on Drug Treatment Entry Among Treatment-Seeking Injection Drug Users With and Without Comorbid Antisocial Personality Disorder

We examined the effect of a case management intervention on drug treatment entry among injection drug users (IDUs) with and without comorbid antisocial personality disorder (ASPD). Injection drug users attending the Baltimore Needle Exchange Program who sought and were granted referrals to opioid agonist treatment were randomized to receive a strengths-based case management intervention or passive referral. Of 162 IDUs, 22.8% met the DSM-IV criteria for ASPD. Compared to those without ASPD, IDUs with comorbid ASPD who spent 25 or more minutes with their case manager prior to their treatment entry date were 3.51 times more likely to enter treatment than those receiving less than 5 min, adjusting for intervention status, race, and treatment site (95% confidence interval 1.04-11.89). Providing case management services to IDUs with comorbid ASPD may facilitate treatment entry and reduce the negative consequences of drug abuse.