Intervention Summary

Brief Strengths-Based Case Management for Substance Abuse

Brief Strengths-Based Case Management (SBCM) for Substance Abuse is a one-on-one social service intervention for adults with substance use disorders that is designed to reduce the barriers and time to treatment entry and improve overall client functioning. The intervention is a time-limited version of SBCM that focuses on substance abuse. SBCM differs from conventional case management in its use of a strengths perspective. This perspective defines how to carry out the five functions of SBCM's case management component: assessment, planning, linkage, monitoring, and advocacy. The case manager helps the client identify personal skills, abilities, and assets through discussion; supports client decisionmaking so that the client sets treatment goals and determines how the goals will be met; encourages client participation in seeking informal sources of assistance; and works to resolve any client-identified barriers to treatment, such as lack of transportation, child care, and social support. Although broad system change is not the intent, the case manager also advocates with treatment providers and seeks system accommodation on behalf of the client. The case manager strives to develop a strong working alliance with the client, which is considered central to the process of linking with and using substance abuse treatment services effectively. Unlike SBCM, which is usually structured over many months and sometimes years, Brief SBCM for Substance Abuse is delivered in a maximum of five sessions over a limited, predetermined period. Sessions typically average 90 minutes, with some requiring more than 2 hours. Each session is flexible, providing an opportunity to develop and implement a personal, client-driven plan that improves the individual's overall functioning and/or addresses specific barriers to linking with treatment.

Descriptive Information

Areas of Interest	Substance use disorder treatment
Outcomes	1: Entrance into substance abuse treatment within 90 days of intake
Outcome Categories	Alcohol Drugs Treatment/recovery
Ages	18-25 (Young adult) 26-55 (Adult) 55+ (Older adult)
Genders	Male Female
Races/Ethnicities	Black or African American White Race/ethnicity unspecified
Settings	Inpatient Residential Outpatient Other community settings
Geographic Locations	Urban Suburban
Implementation History	Approximately 250 adults with substance use disorders in the United States have participated in Brief SBCM for Substance Abuse since it was implemented. The intervention has also been used in Belgium.
NIH Funding/CER Studies	Partially/fully funded by National Institutes of Health: Yes Evaluated in comparative effectiveness research studies: Yes
Adaptations	The intervention has been adapted to assist individuals recently diagnosed with HIV in accessing HIV-related medical care.
Adverse Effects	No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories	IOM prevention categories are not applicable.

Quality of Research

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Rapp, R. C., Otto, A. L., Lane, D. T., Redko, C., McGatha, S., & Carlson, R. G. Improving linkage with substance abuse treatment using brief case management and motivational interviewing. Drug and Alcohol Dependence, 94(1-3), 172-182.

Supplementary Materials

Carr, C. J. A., Xu, J., Redko, C., Lane, D. T., Rapp, R. C., Goris, J., et al. Individual and system influences on waiting time for substance abuse treatment. Journal of Substance Abuse Treatment, 34(2), 192-201.

McLellan, A. T., Kushner, H., Metzger, D., Peters, R., Smith, I., Grissom, G., et al. The Fifth Edition of the Addiction Severity Index. Journal of Substance Abuse Treatment, 9(3), 199-213.

Rapp, R. C., Carr, C. A., Lane, D. T., Redko, C., & Carlson, R. G. Development of the Pretreatment Readiness Scale for substance abusers: Modification of an existing motivation assessment. Substance Abuse, 29(4), 39-50.

Rapp, R. C., & Lane, D. T. Implementation of brief strengths-based case management: An evidence-based intervention for improving linkage with care. In D. Saleebey (Ed.), The strengths perspective in social work practice (5th ed., pp. 146-160). New York: Pearson Education.

Rapp, R. C., Xu, J., Carr, C. A., Lane, D. T., Redko, C., Wang, J., et al. Understanding treatment readiness in recently assessed, pre-treatment substance abusers. Substance Abuse, 28(1), 11-23.

Rapp, R. C., Xu, J., Carr, C. A., Lane, D. T., Wang, J., & Carlson, R. G. Treatment barriers identified by substance abusers assessed at a centralized intake unit. Journal of Substance Abuse Treatment, 30(3), 227-235.

Outcomes

Outcome 1: Entrance into substance abuse treatment within 90 days of intake
Description of Measures	Data on entrance into substance abuse treatment services were obtained from each participant's medical record. Entrance into treatment was defined as meeting with a treatment center counselor in individual, group, or family counseling within 90 days of intake (including an assessment) at a centralized intake unit. The decision to use 90 days after intake as a threshold was based on State regulations that require a new assessment to be performed if treatment entry has not occurred within that timeframe. A trained research assistant used the Reducing Barriers Project Services Tracking Record to extract data on entrance into treatment from participant records.
Key Findings	Clients seeking publicly subsidized substance abuse treatment services underwent a standardized assessment at a centralized intake unit and were randomly assigned to receive up to five 90-minute sessions of Brief SBCM for Substance Abuse, one 60-minute motivational interviewing (MI) counseling session, or usual care, which consisted of a recommendation for treatment level (i.e., residential, drug-free outpatient, outpatient methadone maintenance) and referral to a specific program. Clients in the usual care control condition were instructed to call the intake unit 1 week after intake to obtain a treatment start date. In this study, the percentage of clients entering substance abuse treatment within 90 days of intake was higher in the intervention group (55.0%) than in the MI group (44.7%; p < .05) or control group (38.7%; p < .001). Assignment to the intervention condition was the strongest predictor of treatment entry, with intervention participants being more than twice as likely as control group participants to enter substance abuse treatment (p < .001). This difference was associated with a small effect size (odds ratio = 2.13).
Studies Measuring Outcome	Study 1
Study Designs	Experimental
Quality of Research Rating	3.3 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study	Age	Gender	Race/Ethnicity
Study 1	18-25 (Young adult) 26-55 (Adult) 55+ (Older adult)	63.3% Male 36.7% Female	51% White 48.1% Black or African American 0.9% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

Reliability of measures
Validity of measures
Intervention fidelity
Missing data and attrition
Potential confounding variables
Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome	Reliability of Measures	Validity of Measures	Fidelity	Missing Data/Attrition	Confounding Variables	Data Analysis	Overall Rating
1: Entrance into substance abuse treatment within 90 days of intake	3.0	3.0	3.0	3.5	3.0	4.0	3.3

Study Strengths

The use of administrative records to determine treatment entrance was a strong outcome measure. There was excellent attention to fidelity through the use of a manual, trainings of case managers by clinical supervisors, and ongoing monitoring using a fidelity ratings form. Full outcome data were available for all randomized participants. An intent-to-treat statistical approach was used with appropriate chi-square and logistic regression analyses to fully evaluate the outcome.

Study Weaknesses

Few details were provided about the psychometric properties of the fidelity instrument or about the number of cases for which fidelity was rated. Study participants may have been motivated to link with treatment, having made the decision to be assessed for a substance abuse problem at the intake unit and subsequently providing informed consent and participating in the study.

Readiness for Dissemination

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Center for Interventions, Treatment, and Addictions Research. Treatment linkage case management: Improving linkage among persons referred to substance abuse treatment. Dayton, OH: Wright State University Boonshoft School of Medicine.

Rapp, R. C. Assessing the implementation of Strengths-Based Case Management (SBCM). Dayton, OH: Author.

Rapp, R. C. RBP Services Tracking Record. Dayton, OH: Author.

Rapp, R. C. RBP Services Tracking Record code book. Dayton, OH: Author.

Rapp, R. C. RBP Services Tracking Record decision rules. Dayton, OH: Author.

Rapp, R. C. Strengths-Based Case Management contact note summary sheet. Dayton, OH: Author.

Rapp, R. C. Strengths-Based Case Management training curriculum (brief intervention). Dayton, OH: Author.

Rapp, R. C. Using Strengths-Based Case Management to facilitate linkage with treatment. [PowerPoint slides]. Dayton, OH: Author.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

Availability of implementation materials
Availability of training and support resources
Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation Materials	Training and Support Resources	Quality Assurance Procedures	Overall Rating
4.0	4.0	3.3	3.8

Dissemination Strengths

The implementation manual is well organized, provides examples, and offers information for agency executives and supervisors regarding policies and procedures, selection of staff, and strategies for ensuring the accuracy of referral sources. The materials also include an intervention overview that is provided to consumers as part of an engagement strategy. The high-quality training materials, which are clearly presented and written, include learning objectives and specific activities for each training phase and provide clear instructions for program implementation. The training is both didactic and experiential and is based upon principles of adult learning. Ongoing support is available via follow-up visits by the program developer. The case staffing guidelines are useful for ensuring that both the supervisor and case manager focus on strengths-based activities. Quality assurance is supported by program assessment, a 2-day preceptorship (including a question-and-answer session, trainee observation of experienced case managers in client sessions, and trainee observation of a client focus group), and site visits to assess implementation fidelity.

Dissemination Weaknesses

The fidelity instrument is overly reliant on case manager self-report. Although a supervisor also completes the instrument, assessment does not appear to be based on independent observations of case manager behavior. While program assessment, preceptorship, and site visit procedures are outlined, there are no direct references in the materials indicating that they are part of the quality assurance procedure.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description	Cost	Required by Developer
Implementation materials	Free	Yes
Training	Varies depending on site needs	Yes
Brief email or telephone consultation	Free	No
Ongoing technical assistance	Varies depending on site needs	No

Additional Information

The primary ongoing costs of implementation are the personnel costs associated with hiring one or more case managers. These costs depend on the location of the organization and the academic level and experience of the person(s) hired. Other ongoing costs may include reimbursement for case manager travel mileage and funds to address basic client needs to further the goal of linking with treatment.

Replications

Selected citations are presented below. An asterisk indicates that the document was reviewed for Quality of Research.

Craw, J. A., Gardner, L. I., Marks, G., Rapp, R. C., Bosshart, J., Duffus, W. A., et al. Brief strengths-based case management promotes entry into HIV medical care: Results of the Antiretroviral Treatment Access Study-II (ARTAS-II). Journal of Acquired Immune Deficiency Syndromes, 47(5), 597-606.

Gardner, L. I., Metsch, L. R., Anderson-Mahoney, P., Loughlin, A. M., del Rio, C., Strathdee, S., et al. Efficacy of a brief case management intervention to link recently diagnosed HIV-infected persons to care. AIDS, 19(4), 423–431.

Strathdee, S. A., Ricketts, E. P., Huettner, S., Cornelius, L., Bishai, D., Havens, J. R., et al. Facilitating entry into drug treatment among injection drug users referred from a needle exchange program: Results from a community-based behavioral intervention trial. Drug and Alcohol Dependence, 83(3), 225–232.