ORIGINAL PAPER Intensive Case Management: A Critical Re-Appraisal of the Scientific Evidence for Effectiveness Robert King Published online: 10 June 2006 Ó Springer Science+Business Media, Inc. 2006 Abstract Intensive Case Management (ICM) is widely claimed to be an evidence-based and cost effective pro- gram for people with high levels of disability as a result of mental illness. However, the findings of recent randomized controlled trials comparing ICM with ‘usual services’ suggest that both clinical and cost effectiveness of ICM may be weakening. Possible reasons for this, including fidelity of implementation, researcher allegiance effects and changes in the wider service environment within which ICM is provided, are considered. The implications for service delivery and research are discussed. Keywords Intensive case management Æ Assertive case management Æ Severe mental illness Æ Effectiveness Introduction Intensive Case Management (ICM) is a model of com- munity based care for people suffering from mental illness who characterized by low caseloads, assertive outreach, provision of services in the patient’s own environment and practical assistance with daily living skills (Mueser, Bond, Drake, & Resnick, 1998). Assertive Community Treatment (ACT) is the most standardized (Allness & Knoedler, 2003; Salyers et al., 2003) and extensively researched (Drake et al., 2000; Herdelin & Scott, 1999) form of ICM. Other related forms include Enhanced Community Management (ECM) (Harrison-Read et al., 2002) and Mobile Intensive Treatment (MITT) (Abbott et al., 1997). Intensive case management is likely to include most of the following key features (Allness & Knoedler, 2003; McGrew & Bond, 1995; Teague et al., 1998): • Clear program identity and program processes; • Team-based service delivery and responsibility for ensuring continuity and effectiveness; • Mobile responsive services delivered in the home or local environment of the client; • Extended hours service response and capacity to deal with crises at any time; • High contact frequency (usually several times per week) that is not dependent on client initiative; • Clinical, rehabilitation and social support needs are closely integrated; and • Close liaison with family members and other client supports. From its inception in the 1970s, there have been three generations of research (initial demonstration projects, implementation studies and effectiveness studies) into ICM. ICM is considered to be an evidence-based treatment for people with high disability caused by mental illness (Drake et al., 2000). Three meta-analyses have confirmed the clinical and social effectiveness of ICM. Marshall and Lockwood R. King School of Medicine, The University of Queensland, Herston, QLD, Australia R. King School of Mental Health, The Park Centre for Mental Health, The University of Queensland, Herston, QLD, Australia R. King (&) Kids in Mind Research Centre, Mater Child and Youth Mental Health Service, Mater Health Services, Brisbane, QLD 4101, Australia e-mail: r.king1@uq.edu.au Adm Policy Ment Health & Ment Health Serv Res (2006) 33:529–535 DOI 10.1007/s10488-006-0051-5 123