Predictors of Length of Time in Service: Characteristics of People in Intensive Case Management for Longer Than Five Years

Background and Purpose: Intensive case management (ICM) is a form of community support for people with serious mental illness that aims to reduce hospitalizations and improve independent living outcomes. Services are typically delivered by individual case managers, assisting a person to strengthen their ties to formal and informal supports in the community, and providing practical and emotional support. ICM supports are personalized and open-ended in duration allowing people to move forward on goals at their own pace. There is a lack of literature on the characteristics of who stays in ICM for short durations and who stays for long periods of time. Overall, few studies have addressed the recommended length of ICM services and how to determine “readiness” to move on from these intensive supports. Such an examination could help to identify gaps in supports, as well as potential challenges for facilitating closures for people with certain characteristics. The aim of this study was to examine the characteristics of people who stay in intensive case management (ICM) for longer than 5 years.

Methods: We conducted a secondary analysis of client data collected by a community mental health organization from 2012 to 2022. This organization was also a partner in this study and assisted with the development of this analysis. Using the Gelberg-Andersen Model for Access to Health Services, we conducted a logistic regression with 22 predictor variables, predicting clients in ICM for 5 years or less (N = 531) and those in ICM for longer than 5 years (N = 289).

Results: People who were older, those with psychotic disorder, co-occurring substance use disorder, dual diagnosis (with developmental disability), chronic medical condition, and those also in another program in the same agency were more likely to be in ICM for longer than 5 years. People who were returning ICM clients and those who completed the ICM program (rather than withdrawing or disengaging) were more likely to be in ICM for 5 years or less. Higher dose of ICM (in contacts) predicted a shorter time in ICM.

Conclusions and Implications: People with serious mental illness, dual diagnosis, concurrent substance use, chronic medical conditions, and those who are older may need additional supports within ICM and when transitioning out of ICM. People in ICM for longer have lower numbers of contacts, indicating that a less intense service may meet their needs. These findings clarify the type of service recipients who may need additional supports within ICM programs and when transitioning out of these services. The findings also have implications for policies and practices around how to make room for new clients entering ICM and how to improve overall client flow through the service system.