Pitfalls in Evaluating the Effectiveness of Case Management Programs for Homeless Persons

Abstract

It is generally believed that homeless individuals—particularly those with substance abuse problems or mental illness—are unable to access the full range of available benefits and com munity services on their own. In recent years, community service providers have increasingly looked toward case management as the intervention of choice for solving this problem. Yet the evaluation findings of the National Institute on Alcohol Abuse and Alcoholism Community Demonstration Program, which included three case management projects, showed few clear indications of case management effectiveness. The results of these studies—which focused on homeless clients with alcohol and other drug problems—are consistent with studies of case management services for the homeless mentally ill. This article identifies several phenom ena that potentially explain the apparent lack of positive effects and suggests that the reasons for negative findings may lie as much with the evaluations as with the interventions. These phenomena include bias due to differential attrition from measurement, lack of intervention intensity, lack of distinction between groups, contextual factors, and additional design and measurement issues. Suggestions for improving future evaluations of case management effec tiveness are offered.

Effectiveness of Different Models of Case Management for Substance-Abusing Populations

“…First, bias may occur due to lower attrition rates in the case management group Kilbride et al 2000;Drake et al 1998). Due to the nature of the case management process itself, case managers can track even the most difficult cases that would normally be lost at follow-up when receiving standard treatment (Orwin et al 1994).…”

A test of the efficacy of court-mandated counseling for domestic violence offenders: The broward experiment

“…Alternately, Dunford (2000), using domestic violence victims residing on a naval base, was able to retain 78% of the women over a one-year follow-up period. However, studies indicating low retention rates when tracking difficultto-follow subjects longitudinally are much more typical (Orwin, Sonnefeld, Garrison-Mogren, & Smith, 1994). For instance, Dobash, Dobash, Cavanagh, and Lewis (1996) reported a 41% victim response rate at the 3-month follow-up and a 22% rate at the end of 12 months, and Palmer et al (1992) reported a 22% response rate at 16-18 months posttreatment.…”

Utilization of community-based services among homeless persons: An application of a theoretical model

“…with substance abuse problems (Morse, Calsyn, Allen, & Kenny, 1994;Mowbray & Bybee 1996;Orwin, Sonnefeld, Garrison-Mogren, & Smith, 1994;Rife, First, Greenlee, & Miller, 1991). However, despite previous reports indicating low levels of service use, few studies have provided information on the characteristics of those members of the homeless population who are more likely to use social services and on the types of assistance they receive (DiBlasio & Belcher, 1992;Morse & Calsyn, 1986;Mulkern & Bradley, 1986;Padgett, Struening, & Andrews, 1990).…”