Examining the effects of targeted case management on behavioral and service outcomes for children and youth experiencing severe emotional disturbances

This study examined the effects of Targeted Case Management and In Home Behavioral Services on functional and service outcomes for youth experiencing severe emotional disturbances in Maine. The study sample included a total of 308 children enrolled in Targeted Case Management Services for at least 12 months. Youth in the study sample were divided into two treatment groups: a Targeted Case Management Only (TCM) group and a Targeted Case Management plus In Home Behavioral Services group (TCM plus IH) and matched at the start of the study on gender, age, and level of functional challenge. The Child and Adolescent Functional Assessment Scale (CAFAS) and the Child and Adolescent Level of Care Utilization System (CALOCUS) were used to assess functional outcomes. Behavioral and functional assessments were completed at baseline, six, and 12 month post service entry. Youth in both the TCM and TCM Plus IH treatment groups exhibited significant functional improvement in overall functioning and on a number of CAFAS Subscales, including: Home, Behavior Toward Others, and Self-Harmful Behavior. In-Home Behavioral Services combined with Targeted Case Management Services did not lead to greater functional improvements for youth compared to those found for the TCM group alone. Both groups improved at comparable rates over the study period. The study findings indicated reductions for both study groups in the number of days spent in psychiatric inpatient settings. This study also examined the effects of youth and caregiver acceptance and engagement on change in youth functional outcomes over time. Youth who were rated as being highly engaged with their case manager and treatment team exhibited greater functional improvements over time compared to low engaging youth. Exploratory analyses were also performed to assess the extent to which a number of youth descriptive and diagnostic factors contribute to change in functional outcomes. Implications of the study findings for program and service improvement are discussed.