Evaluating the effectiveness of an integrated community continuum of care program for individuals with serious mental illness

Abstract

Objective

To evaluate effectiveness of an “Continuum of Care Program” (CCCP) for persons with serious mental health conditions in reducing inpatient use, and building a continuum of integrated care that enhanced employment and residential stability. The program combined components of Assertive Community Treatment with a comprehensive wrap-around program.

Methods

A cohort of 1154 individuals admitted to four outpatient CCCPs between December 2003 and May 31 2004 was identified and followed for 1 year. Outcome measures included clinical functioning level, drug/alcohol use, employment, residential arrangement and inpatient use. Regression was employed to explain changes in outcomes between baseline and follow-up as a function of services.

Results

Statistically significant changes were seen over a 1-year period in all outcomes. Housing, employment and mental health improved, whereas inpatient utilization and level of care need increased. Older individuals receiving higher levels of care at baseline and those with higher case management and medical service utilization reported higher inpatient use. Outcomes also varied by provider suggesting the contribution of workforce differences to outcomes.

Conclusions

Although significant, changes in outcomes were small. Outcome effectiveness was mixed and generally unrelated to services. These findings imply that significant changes in outcomes may require several years to obtain.

Keywords:

• psychiatric outpatient rehabilitation program
• seriously mentally ill
• pre–post evaluation study
• intensive service interventions
• effectiveness research

Acknowledgement

This study was funded through a contract from the DSAMH, Delaware Health and Human Services Administration, New Castle, DE.

Declaration of Interest: The authors report no conflict of interest.