CASE-MANAGEMENT FOR THE MENTALLY-ILL - A COMPARATIVE-EVALUATION OF CLIENT SATISFACTION

This paper reports on client satisfaction with community mental health services. A Client Satisfaction Interview was used as one outcome mea sure in a randomized controlled study of clinical case management vs, standard community care. The Interview had high internal consistency r eliability (Cronbach's alpha = 0.89) with very high inter-rater reliab ility for overall scores (r=0.99) and good inter-rater reliability for individual items (kappa over 0.9 for 18 of 22 items). Case management clients had significantly higher total satisfaction scores than contr ol group clients who received standard community care at 9 months (t=2 .02 P=0.05) but not at baseline (t=0.59, P=0.55) or 18 months (t=1.76, P=0.09). In addition to a quantitative measure of satisfaction, clien ts were asked to provide more qualitative accounts of their experience with services. The findings are discussed in relation to the team's m odel of case management and the differences between case management an d central services. The limitations of this study are considered in th e context of methodological issues surrounding measurement of client s atisfaction and the study's own methodological shortcomings.