Transition to low intensity case management in a VA Assertive Community Treatment model program.
OBJECTIVE
To study transition to lower intensity services in a national VA program modeled on Assertive Community Treatment (ACT).


METHODS
This study uses national VA administrative data from VA's Mental Health Intensive Case Management (MHICM) program, to compare veteran characteristics, patterns of service use and early clinical changes among veterans who were formally transitioned to lower intensity treatment and veterans who were not. Bivariate comparisons and logistic regression analyses are used to identify factors associated with transition to low intensity treatment and to characterize post-transition service use. Descriptive information on the criteria for termination and subsequent service use are also presented.


RESULTS
Among 2,137 veterans in the sample who enrolled in MHICM from FY 2002-2006 and who participated in at least one year of treatment, 196 (9.2%) were transitioned to lower intensity services. These veterans did not differ from others on baseline clinical characteristics but had a smaller number of program contacts during the first 6 months of participation, a higher quality of family relationships and overall quality of life after 6 months of treatment. Only 5.7% were reported to have needed to return to higher service intensity after the transition and they continued to have reduced levels of service use on several measures but no reduction in therapeutic alliance.


CONCLUSIONS
The VA policy did not result in frequent transition to lower intensity services. Those who did transition had shown greater clinical improvement, used fewer services, had better family relationships, and rarely required a shift back to higher intensity services.
Rosenheck
Robert A
RA
VA New England MIRECC, Yale School of Medicine, West Haven, CT 06516, USA.
Neale
Michael S
MS
Mohamed
Somaia
S
D000328:Adult; D000437:Alcoholism / Q000523:psychology / Q000534:rehabilitation*; D017028:Caregivers / Q000523:psychology; D003131:Combined Modality Therapy; D003156:Community Mental Health Services / Q000379:methods* / Q000706:statistics & numerical data; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D057187:Independent Living; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000534:rehabilitation*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000523:psychology / Q000534:rehabilitation*; D011788:Quality of Life / Q000523:psychology; D012050:Rehabilitation, Vocational; D012648:Self Care; D012917:Social Adjustment; D012944:Social Support; D019966:Substance-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D014481:United States; D014493:United States Department of Veterans Affairs; D014600:Utilization Review / Q000706:statistics & numerical data; D014728:Veterans / Q000523:psychology*