ICM and Assertive Community Treatment (ACT) both provide similar services and long-term support. The main difference is that ICM provides service to clients through individual case managers and links them with other community services, whereas ACT provides a multidisciplinary team for "one-stop shopping" treatment. ACT teams are mandated to be available 24 hours a day, seven days a week, whereas the hours of service can vary among ICM programs. CMHA Ottawa's program, for example, now has extended hours of service on evenings and weekends. Both programs provide services in the community rather than at an agency office. Caseloads for ACT are typically 10 clients per staff member, while the Ottawa ICM has a slightly higher load of 12 to 15 clients per staff member.

While many tools have been developed to determine fidelity to the ACT model, there have not been similar tools created to capture the distinguishing features of ICM. Ottawa researchers have developed the Intensive Case Management Key Component Profile, a tool to clearly define ICM services, determine the extent to which ICM is being delivered to the target population in the intended manner, and make it easier to compare functions from one case management program to another. (The tool is available here.)

After 18 months, how are participants doing?

All study participants showed significant improvement over 18 months in overall functioning in the community and greater life satisfaction, particularly in relation to housing, daily activities, health, social relations, and finances (see graph showing MCAS scores). However, analyses conducted to date show no significant differences in improvement between ICM clients and those in the standard care group, a finding which needs further study. It may mean that early intervention — specifically, stabilization of housing — has broader, longer-term benefits than originally expected. There was, for example, a significant reduction in the number of nights clients in both groups spent on the streets or in a shelter — from an average of 43 nights per year at baseline, to less than two nights during the first nine months of the study. This overall housing stability has continued through the 18-month followup.

Were there other benefits from this research?

More than 30 graduate students have been involved in this study, receiving extensive clinical experience with an under-served population and indepth training in community mental health research. Other case-management programs in Ottawa have adopted some of the study measures in their own data collection and training, resulting in additional research projects on similar programs. For a detailed description of researchers' experiences, see Heather Smith Fowler and Marnie Smith, "Practical Considerations for Conducting Research with Marginalized Populations: A Case Study," available at www.vserp.ca.

As part of a multisite project, the Ottawa researchers gained a broader perspective on mental health research across Ontario and developed new links with other community mental health researchers in the province. New collaborations have evolved, such as the evaluation of the Ministry of Health and Long-Term Care Phase 1 Homelessness Initiative by the Ottawa researchers with John Trainor, Centre for Addiction and Mental Health, and Geoff Nelson, Wilfrid Laurier University.

For more information about this study, see the project description.

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