What do case managers do? An investigation of case manager interventions and their relationship to client outcome

Background: The aim of the present study, which forms part of a wider case management multicenter study, was to explore the content of case managers' work, service patterns, and their relationship to client outcome. Methods: Client background characteristics were registered at admission, and needs o f care and psychosocial functioning were assessed at admission to the servi ce and after Is months. In seven of the services an extended follow-up was performed, which included assessments regarding quality of life, level of s ymptoms and social network. The study comprised 176 severely mentally ill c lients, of whom 153 participated in a general 18-month follow-up (87%), wit h 113 clients out of 134 participating in an extended follow-up sample (84% ). Results: The investigation of service patterns showed that clients recei ved services in a great variety of life areas using a number of different t ypes of interventions. The results support the assumption that severely men tally ill clients are in need of case management services that offer more t han brokerage services and coordination. A more active rehabilitation-orien ted approach was found towards younger clients and clients who had a job, w hich may reflect a higher level of ambition in assisting younger clients to gain access to and stay in education and the labor market. Several types o f intervention were related to client outcome. Brokerage, intervention plan ning and more interventions in the area of skills relating to activities of daily living were related to a more pronounced decrease in needs of care. More time spent on indirect work on behalf of the clients was related to a better outcome with regard to psychiatric symptoms and social network. Conc lusions: The results indicate that specific service components have a more obvious distinct impact than others on outcome, and that this increase in e ffectiveness varies with the outcome targeted.