BEHAVIOR "tHERAPY 30, 453473, 1999 Predictors of Decompensation among Consumers of an Intensive Case Management Program CAREY S. RYAN University of Pittsburgh PAUL S. SHERMAN Resources for Human Services Managers, Inc. DEBBIE R. ROBINSON University of Pittsburgh Recent work suggests that some people who have severe and persistent mental ill- nesses can be transferred to less intensive services without suffering ill effects. How- ever, the factors that affect the success of such transitions remain unknown. This longitudinal study examines consumer characteristics and types of intensive case management services that predict decompensation. We examined the trajectories of 86 individuals in an intensive case management program after they attained the highest level of functioning, identifying three patterns: stability, immediate decline followed by improvement, and gradual decline. Number of hospitalizations prior to program entry, being judged suicidal at program entry, and greater use of psychiatric services during program participation consistently predicted decompensation. Sub- stance abuse and psychiatric symptomatology at program entry also predicted de- compensation, but did so less consistently. Predictors of differences in specific patterns of decompensation are explored. Intensive case management services have received a great deal of attention from researchers, policy-makers, and practitioners for more than 20 years. In the wake of the deinstitutionalization movement, problems such as homeless- Hess, incarceration, and repeated hospitalizations became increasingly prob- lematic among people with severe and persistent mental illnesses. It became clear that some mechanism was needed to help people negotiate complex, fragmented, and sometimes inaccessible community-based services. It also became clear that many people needed help learning or re-learning a variety of daily living skills (Dion & Anthony, 1987), and that such skills were best Address correspondence to Carey S. Ryan, Ph.D., Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260; e-mail: cryan@vms.cis.pitt.edu 453 005-7894/99/0453-0473 $1.00/0 Copyright 1999by Association for Advancement of BehaviorTherapy All rights for reproductionin any form reserved.