Can Case Management Help Retain Adolescents in Mental Health Treatment?

Background and Purpose: Retention in treatment is one of the strongest predictors of positive client mental health outcomes. Greater service utilization often indicates a client is more engaged in his/her treatment; when clients are engaged, their participation and cooperation are enhanced, resulting in greater investment in the change process. Yet, engaging adolescents in mental health services is challenging, and retention rates are typically low with 40-75% of adolescents referred to treatment terminating prematurely. Although rarely tested empirically, case management services may increase retention in mental health services as these services are designed to link clients to services and encourage active participation. This study integrates administrative data across community mental health systems to examine the effects of participation in concurrent case management services on youths' retention in mental health treatment.

Methods: Data from 293 youth referred for mental health treatment, ranging in age from 12-18, were collected across Medicaid billing, youth services, and satisfaction extant databases in a Midwestern state. Two linear multiple regression models were analyzed to determine whether youths' participation in case management predicted their utilization of (1) individual mental health therapy and (2) psychosocial group treatment, controlling for socio-demographic, mental health status, and client satisfaction variables. Hours of case management and treatment utilization were collected from Medicaid billing records; client satisfaction was self-reported annually in a telephone-based consumer satisfaction survey; and mental health status was determined using the internalizing and externalizing subscales of the Child Behavior Checklist administered to youth at entry into the mental health system.

Results: The set of predictors accounted for a significant amount of variance in utilization of individual therapy (F=11/56 (df=11), p<.05). While youth with greater client satisfaction (B=.149, p<.05) and higher externalizing (B=.184, p=.002) and internalizing mental health symptoms (B=.120, p<.05) utilized more individual therapy, concurrent case management services were the strongest predictor of individual therapy attendance (B=.383, p<.05). Similarly, the set of predictors accounted for a significant amount of variance in utilization of psychosocial group therapy (F=6.42 (df=11), p<.05) with youth who received more case management services reporting significantly higher group participation (B=.271, p<.05), after controlling for the significant effects of externalizing (B=.308, p<.05) and internalizing problems (B=-.144, p<.05).

Implications: Findings indicate concurrent case management services are associated with greater utilization of individual and group mental health services among adolescents referred to treatment. These results suggest case management may be a potentially inexpensive tool for increasing adolescent treatment retention – a key factor in achieving positive mental health outcomes. Beyond referral to services, case management services are intended to reduce logistical barriers to participation such as scheduling and transportation which may enable youth and their families to follow through with treatment recommendations. Furthermore, case managers may offer youth and their families an opportunity to develop a consistent trusting relationship with one contact person amidst fragmented services. Future research should explore these mechanisms in an attempt to better understand how case management may act as a catalyst for engaging youth more deeply in the ongoing delivery of mental health services. 9-2010-->