The Impact of Care Management on Youth, Family, and System Level Outcomes Among Youth: A Scoping Review

Background/Purpose:

It is estimated that 13 –20 percent of children living in the United States (approximately 1 out of 5 children) experience a serious mental illness (SMI) such as conduct disorders, severe major depression, or bipolar disorder. In a given year an estimated $247 billion is spent on childhood mental health disorders. Management of SMI is a challenge for not only the affected youth, but also their families and providers. Treatment is multifaceted and involves treatment of comorbidities, family intervention and support, psychosocial interventions, and pharmacotherapy.

In response, Intensive Case Management (ICM), has arisen to facilitate coordination of services that are both comprehensive and individualized for youth with SMI. ICM refers to a number of different multi-system case management approaches such as Wraparound, care coordination, or simply case management. ICM aims to improve family and community-based treatment and ultimately child, family, and system level outcomes. While ongoing investments are made in ICM for youth with SMI, prior scoping reviews of ICM have yet to be updated to capture the robust expansion, use, and evaluation of ICM over the last decade. Accordingly, we conducted a scoping evidence review to answer the following question: What is the impact of case management for youth with SMI on patient, family, and system level outcomes?

Methods: A scoping review was conducted using the PRISMA-ScR reporting guidelines to develop an evidence synthesis to assess effectiveness of ICM for youth with SMI. A librarian scientist assisted in developing search terms and extraction of articles which occurred on February 16, 2021. We searched for all articles published from 2016 to 2021 in the following databases: PubMed, APA Psych Info, Web of Science, and Scopus. Exclusion criteria were established and two trained researchers reviewed the 23 articles initially extracted. All relevant articles were subsequently charted and qualitatively synthesized. Diversity of intervention approaches and outcome measures engaged limited ability to conduct meta-analyses of research findings.

Results: Our review identified studies that evaluated a wide range of ICM approaches that ranged in name, length, intensity, and frequency of care management services offered. Studies also ranged in the population served, specifically whether available to all children and adolescents with SMI (5-21) or a subset of this population only (e.g., transition-age youth). Findings showed that ICM has, in some studies, decreased hospitalization, improved family function, and reduced healthcare cost.

Conclusions: The scoping review suggests ICM may support service utilization, family function, and healthcare costs. However, evidence of effectiveness on any single outcome cannot yet be ascertained from the peer reviewed literature. Additional studies are required to standardize reporting of intervention, measurement of primary and secondary outcomes, and use of rigorous research studies, with comparison groups, to support causal inference. Additional investment in hybrid implementation-effectiveness studies of Intensive Case Management is a critical next step, including attention to dose-response evaluations given the heterogeneity in implementation of ICM across studies.