COST-EFFECTIVENESS EVALUATION OF 3 APPROACHES TO CASE-MANAGEMENT FOR HOMELESS MENTALLY-ILL CLIENTS

Objective: In this study the authors compared the cost-effectiveness o f three approaches to case management for individuals with severe ment al illness who were at risk for homelessness: assertive community trea tment alone, assertive community treatment with community workers, and brokered case management (purchase of services). Method: Individuals were randomly assigned to the three treatment conditions and followed for 18 months. Eligibility requirements included a severe DSM-III axis I diagnosis, such as schizophrenia, and either current homelessness o r risk for homelessness based on prior history of homelessness. Partic ipants were recruited from the emergency rooms and inpatient units of local psychiatric hospitals. Data on 85 people were available for anal yses: 28 in assertive community treatment alone, 35 in assertive commu nity treatment with community workers, and 22 receiving brokered case management (purchase of services). Results. Clients assigned to the tw o assertive community treatment conditions had mole contact with their treatment programs, experienced greater reductions in psychiatric sym ptoms, and were move satisfied with their treatment than clients in th e brokered condition. There was no statistically significant differenc e between treatment conditions in terms of the total costs of treating the participants, However, the assertive community treatment conditio ns spent less money on inpatient services than brokered case managemen t, but more on case management services and maintenance (i.e., food st amps, housing subsidies, and Supplemental Security Income payments). C onclusions: Assertive community treatment has better client outcomes a t no greater cost and is, therefore, more cost-effective than brokered case management.