Intensive Case Management (ICM)
What Is Intensive Case Management?
Designed to assist young people who have been diagnosed with a psychiatric disability and their families residing in the community, Intensive Case Managers (ICM) work intensively with a child's family and coordinate with teachers and other helping professionals to develop an individualized comprehensive service plan. Qualified and specially trained professionals assess and coordinate the supports and services necessary to help children and adolescents live successfully at home and in the community, (Burns et al., 1999). Caseloads are small (twelve recipients to one ICM) and the intensity level of ICM for children and youth is demonstrated by the 24-hours a day, 7-days per week response capacity.
Why Is Intensive Case Management Important?
Research and experience indicates that case management is both a valuable and widespread element of mental health services for children with severe emotional disturbance. In two controlled studies the Children and Youth Intensive Case Management program was evaluated. In the first study, the authors found that children in the ICM program spent significantly more days in the community between episodes of psychiatric hospitalization and were hospitalized for fewer days than before enrollment (Evans et al., 1994). A subsequent study looked at a random sample of children enrolled in ICM. Findings at a three-year follow up showed major behavioral improvements and decreases in unmet medical, recreational and educational needs compared with findings at enrollment. In addition, although children in the ICM spent more days in psychiatric hospitals before enrollment, they used inpatient services after enrollment significantly less than did non-enrollees in ICM, (Evans & Huz et al, 1996, Evans & Arnstrong et al., 1996).
Family, Youth, Cultural PerspectivesThe development of the descriptions for each OMH Priority Set for Evidence-Based Practices included extensive involvement from clinical experts, mental health recipients, youth and family members, and people who represent culturally diverse viewpoints. Their perspectives are critical to the understanding of these important practices and programs in mental health.
Family Perspective
Intensive Case Management and all OMH Children's Initiatives are based upon the values and principles of the Child and Adolescent Service System Principles (CASSP). The guiding principles of the CASSP system of care include the concept that children diagnosed with emotional disorders should be provided with case management or similar mechanisms, to ensure that multiple services are delivered in a coordinated and therapeutic manner and that they can move through the system of services in accordance with their changing needs. In addition, families and surrogate families of children diagnosed with emotional disorders should be full participants in all aspects of the planning and delivery of services (Stroul & Friedman, 1986).
Youth Perspective
Young people have noted that more staff is needed for provision of case management and services. Additionally, ICM should work to prevent the youth from hospitalization or out-of-home placement. If a waiting list is in effect for a particular program/service, the ICM should find alternative services to be offered while the young person is on the waiting list. ICM should also assist the young person with accessing available services at any level of need including support services.
Cultural Perspective
A cornerstone of intensive
case management is the flexible connection to community resources to bridge
child and family needs with community-based supports.
Provider's ability to engage families, understand community roles and participation,
and address the cultural considerations will impact the response to treatment.
Mental health programs founded on individual, family and community strengths
have the potential for both ameliorating risk and fostering resilience. Furthermore,
culturally and linguistically relevant services are needed to educate families
about the possibility of recovery, and the availability of services. (DHHS 2001)
Understanding the various cultural considerations that influence who families
are, how they participate in community life and the factors that impact their
views of help seeking and acceptance is essential to engagement. It is necessary
to understand and effectively address existing barriers presented by issues
of culture- including but not limited to - ethnicity, gender, age, language,
literacy, spirituality, sexual orientation, parenting, immigration and community
roles. Providers can prepare to address some of these challenges by establishing
a trusted presence in the community at large. For example, relationships with
formal and informal community leaders and "cultural brokers " can assist to
increase overall community knowledge and understanding of barriers to access
and cultural adaptation of services.
Goals and Principles of Intensive Case Management
The OMH Intensive Case Management initiative is designed to assist young people who have been diagnosed with a psychiatric disability and their families residing in the community. Well-qualified and specially trained professionals assess and coordinate the supports and services necessary to help children and adolescents live successfully in the community. The Intensive Case Manager works intensively with the child's family and coordinates with other helping professionals. Services are based on the specific needs and desires of the child and his or her family and are made available for as long as necessary. Flexible service dollars are available to provide services and supports otherwise not available.
Intensive Case Management
is now available in both a Flexible and/or Blended and Flexible Model.
Flexible allows there to be a titration of service based on need and Blended
allows ICM's and/or Supportive Case Managers to work as a team with a shared
caseload vs. individual caseloads. Case managers work in partnership with local
Single Points of Accountability. OMH is evaluating the relative advantages of
these different models of case management.
Children and Adolescent Service System Principles
All OMH Children's Initiatives are based upon the principles of the Child and Adolescent Service System Principles (CASSP). View the CASSP.
Evans, ME, Banks, SM, Huz, S, and McNulty, TL. (1994). Initial hospitalization and community tenure outcomes of intensive case management for children and youth with serious emotional disturbance. Journal of Child and Family Studies, 3, 225-234.