CLINICAL HANDBOOK OF SCHIZOPHRENIA

CHAPTER 31CLINICAL CASE MANAGEMENTMARGARET V. SHERRERTHOMAS O’HAREThis chapter addresses a critical component of effective treatment for schizophrenia incommunity settings: clinical case management. The chapter begins with a description ofclinical case management, with an emphasis on the variability in how these services aredelineated and implemented within a broad range of treatment settings. Next, the corefunctions of clinical case management services are presented, followed by a brief summaryof what is known about treatment effectiveness based on outcome research to date.Finally, clinical guidelines for case management are offered, with some recommendationsfor future directions in training, education, and evaluation of case management services.Often referred to as the “glue” that holds services together, clinical case managementis central to effective service delivery for people with schizophrenia. In its inception, casemanagement focused primarily on brokering and coordinating services, with little or noemphasis on the direct provision of clinical interventions. Over the past two decades,however, case management skills have been broadened considerably to include an arrayof strategies to enhance client functioning through the coordination of complex interventionsand improvement of access to other social, material, and environmental resources.This role often requires a broad scope of knowledge concerning comprehensive assessmentand treatment needs, as well as a good degree of professional initiative, leadership,and communication skills to make interdisciplinary services and bureaucratic systemswork in concert for clients. Beyond mere “brokering” of services, case management hascome to be seen as essential for coordinating multiple services and enhancing instrumentaland social supports critical to the successful treatment of schizophrenia. Continuity ofcare has become a guiding principle for case management approaches, thus avoiding thefragmentation of services that can undermine even the most effective therapeutic interventions.The case management movement began to evolve in the 1970s as a response to a NationalInstitute of Mental Health (NIMH) mandate that each state must provide communitybasedservices for people with severe and persistent mental illness. With the creation ofthe Community Support Program (CSP) in 1977, case management was identified as cru-309