The efficacy of case management with persons who have substance abuse problems: A three-level meta-analysis of outcomes.

Abstract

Objective: Case management has been widely used as an intervention in the treatment of substance abuse problems. Its effectiveness has been associated with over 450 outcomes, some consistent with case management's traditional functions of linking (treatment tasks) and others typical of treatment outcomes such as substance use (personal functioning). Method: Meta-analyses were conducted on 21 randomized clinical trials in which we compared the efficacy of case management with standard-of-care conditions and active interventions. Characteristics of case managementincluding targeted outcomes, case management model, location on the treatment continuum, and intervention quality-were treated as moderators, as were 2 study features, length of follow-up, and methodological quality. Results: Results showed that case management was efficacious across all targeted outcomes when compared with standard of care (␦ ϭ 0.15, SE ϭ 0.037), although the overall effect was weak. There was a significant difference, F(1, 429) ϭ 25.26, p Ͻ .0001, between case management's effect on treatment task outcomes such as linking with and staying in treatment (␦ 2 ϭ .29, p ϭ .001) and improving individuals' functioning of persons with substance abuse problems in areas such as substance use and HIV risk behaviors (␦ 1 ϭ 0.06, p ϭ .05). Moderator analyses demonstrated that (a) 4 case management models were more effective than standard of care in improving treatment task outcomes and (b) case management was effective either in or out of treatment. Conclusions: Our results demonstrate that case management is effective across a wide range of treatment task outcomes, but more limited in its effectiveness with personal functioning outcomes.

Fitting three-level meta-analytic models in R: A step-by-step tutorial

“…In this case, including that single discrete variable as a moderator in the syntax (i.e., after the mods~element) would suffice. However, it has become rather common to report on the mean effect (as well as significance and confidence interval) of all categories of a discrete potential moderating variable (see, for instance, Assink et al, 2015;Houben et al, 2015;Rapp, Van den Noortgate, Broekaert, & Vanderplasschen, 2014;Van der Hallen, Evers, Brewaeys, Van den Noortgate, & Wagemans, 2015;Van der Stouwe, Asscher, Stams, Dekovic, & Van der Laan, 2014;Weisz et al, 2013 # Determine the potential moderating effect of publication status; # Unpublished studies are now tested against published # studies, so published studies serve as the reference category; # Print the results stored in the object "published" on screen. published <-rma.mv(y, v, mods =~pstatnotpub, random = list(~1 | effectsizeID,1 | studyID), tdist=TRUE, data=dataset) summary(published, digits=3)…”

Reprise: Case Management in Substance Use Services in the Age of the Affordable Care Act

“…Rapp & Goscha, 2012). These positive results have seemingly held in alcohol and drug treatment (R. Rapp, 1997Rapp, , 2006R. Rapp et al, 2014).…”

“…Rapp, 2006;Vanderplasschen, Rapp, Wolf, & Broekaert, 2007). Over the many years in which the impact of case management in substance abuse treatment has been assessed, the positive contribution of this service to engagement and retention remains the most robust finding to date (Kim et al, 2011;Krupski, Campbell Rapp et al, 2014;Sosin & Durkin, 2007;Vanderplasschen et al, 2004Vanderplasschen et al, , 2007Winn et al, 2013). In a recent meta-analysis, R. Rapp and associates (2014) noted the impact of case management on treatment tasks, in particular activities that link clients to a range of needed services, as well as treatment retention.…”

“…Although case management has not always been an easy sell in substance use treatment (see Sullivan, Hartmann, Dillon, & Wolk, 1993), it is now routine fare in many intensive community-based programs (Kirk, Di Leo, Rehmer, Moy, & Davidson, 2013;R. Rapp, Van Den Noortgate, Broekaert, & Vanderplasschen, 2014;Siegal & Rapp.…”

Optimising health and safety of people who inject drugs during transition from acute to outpatient care: narrative review with clinical checklist

“…113 The use of case management to help patients acquire housing, insurance, other benefits and access to education and job training may be effective in linking patients to and retaining them in care. 116 …”