CHARACTERISTICS AND ACTIVITIES OF CASE MANAGERS IN THE RWJ FOUNDATIONPROGRAM ON CHRONIC MENTAL-ILLNESS

Objective: Case management was seen as the major strategy for integrat ing mental health, housing, and social supports for clients in the Rob ert Wood Johnson Foundation Program on Chronic Mental Illness, a five- year multisite demonstration project designed to test the effects of r eorganizing mental health systems in large urban areas. The authors as sessed data on case management programs in the demonstration project t o try to explain the lack of consistent improvement in clients' outcom es that was found in the national evaluation of the project. Methods: Data on case management programs from five demonstration sites-Baltimo re; Cincinnati; Columbus, Ohio; Denver;and Toledo, Ohio-were reviewed. Data sources included on-site interviews, documentary material, studi es of case managers' contact with community agencies that were conduct ed in 1989 and 1991, and telephone interviews with coordinators of cas e management programs. Results: The characteristics and activities of case managers changed little between 1989 and 1991. Case managers tend ed to become the principal service providers for their clients rather than coordinating service provision among multiple service providers. Case managers reported that their clients received few services from o ther agencies in the local community support system, Conclusions: Alth ough lack of change in case managers' activities during the demonstrat ion project may help explain clients' lack of improvement over time, c ase management by itself does not constitute comprehensive treatment. More attention must be paid to the development and refinement of commu nity-based medical-psychiatric and psychosocial treatments with a prov en track record of improving clients' level of symptoms and quality of life.