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The aim of this study is to assess the feasibility of introducing clinical case management into a youth alcohol and other drug treatment setting.

Case management as usual (CMAU), the current brokerage model operating as a control group was compared to clinical case management (CCM). Individual client outcomes were compared with the site as the grouping variable.

Although alcohol and drug outcomes were similar, arguably slightly favouring the intervention group, results suggest that young people receiving clinical case management showed potentially greater improvement across a range of other health outcomes including mental health, treatment utilisation and social outcomes than the CMAU brokerage model.

The study examined the feasibility of training clinicians in a youth alcohol and drug treatment agency in a clinical case management model and examined whether this more intensive case management approach could improve substance use and mental health outcomes for young people.

Although widely used, much less is known about the efficacy of case management within substance use treatment settings, where case management tends to be loosely defined and encompasses a broad range of activities. The originality of this study is that little is known about the effectiveness of case management in youth services, where it tends to be the primary service offered.

Policy requires that those with complex long‐term needs be offered case management, a primary care led service dependent on local health and social care resources. This paper explores the arrangement of networks for a number of case management services, using data from a postal questionnaire.

Two major reform movements have shaped child and adolescent mental health services over the past quarter-century: the Systems of Care movement, and more recently, the movement toward evidence-based practice. Results from several studies indicate that youth served in traditional residential or inpatient care may experience difficulty re-entering their natural environments, or were released into physically and emotionally unsafe homes (Bruns & Burchard, 2000; President's Commission on Mental Health, 1978; Stortz, 2000; Stroul & Friedman, 1986; U.S. Department of Health and Human Services, 1999). The cost of hospitalizing youth also became a policy concern (Henggeler et al., 1999b; Kielser, 1993; U.S. Department of Health and Human Services, 1999). For example, it is estimated that from the late 1980s through 1990 inpatient treatment consumed nearly half of all expenditures for child and adolescent mental health care although the services were found not to be very effective (Burns, 1991; Burns & Friedman, 1990). More recent analyses indicate that at least 1/3 of all mental health expenditures for youth are associated with inpatient hospitalization (Ringel & Sturm, 2001).

This paper reviews the current issues in risk assessment and risk management facing practitioners, and draws upon current literature to argue for an holistic approach to assessment. The demands of risk management in a climate of risk avoidance are briefly reviewed, and key principles for effective risk management offered.

Case management has been widely used with the intent of improving clinical outcomes while reducing medical costs. Studies of case management, however, have shown variable effectiveness. This study assessed the impact of a state health department case management program on hospitalizations, emergency department (ED) visits, and preventive services among persons with diabetes receiving Medicaid fee‐for‐service health care. The patients enrolled in the non‐disease‐specific case management program were low‐income, chronically ill and medically complex. Nurse case managers authorized and coordinated services in the home for these patients and established links to health‐care professionals and community resources. A retrospective, non‐randomized, controlled time series design using paid claims files was employed. Case management reduced admissions and hospital days but did not significantly impact ED visits or use of preventive services.

Based on a postal survey in 1995 of all front‐line staff in Wales with an assessment and/or care management role, findings are reported about how tasks and roles were operationalised following the full introduction of the new community care in April 1993. Further information was obtained by interviews with managers in health and social services. Only a fifth of social services posts were designated or titled as care management posts. The majority of these workers were located in services for elderly and physically disabled people. Although few had a specific budget, the majority considered that they had greater control over financial resources than before April 1993. The analysis of tasks undertaken by front‐line staff shows that there remains a broad overlap between the roles of care managers and social workers. The results highlight the nature of increasing demands on staff and raise issues about the impact of increased workloads and administration on service quality. They also highlight tensions between care management and traditional professional roles. Some pointers for continuing debate are provided.

A new service was developed to provide transitional care between acute and secure services for people with serious mental illness who are considered “difficult to manage”. The purpose of this paper is to evaluate the work of the service by examining referrals made, strategies employed for each referral, and patient outcomes, as well as investigating issues in the service's development and implementation.

A retrospective descriptive study by review of 38 case notes, and qualitative interviews of 47 staff within the service and those referring to the service.

In the first eight months, 38 patients were referred due to violence, aggression and management problems. Most interventions provided by the service involved working with referring staff, rather than direct patient contact. Subsequently, 16 per cent required referral to higher levels of security. Interviews showed the team's aims needed to be more clearly established, but that ward staff found the service to be a useful and productive resource.

The study is descriptive and retrospective, but showed that the service provided appropriate interventions for managing patients with serious mental illness and challenging behaviour.

A transitional service may have value in keeping patients in the least restrictive setting. Careful planning is needed in designing novel interventions, ensuring clear aims and effective management.

The service under study was novel, and may be useful in facilitating successful transfer from, or preventing admission to, secure services.

The purpose of this paper is to analyze the nation's first hospital to housing for homeless individuals. The Chicago Housing for Health Partnership (CHHP), a Housing First and Harm Reduction model, creates a new comprehensive system of health care, housing and supportive services.

The researchers conducted a year long process evaluation of the housing program using a multi‐method approach, which involved qualitative interviews, focus groups, document analysis and observations. The paper examined the CHHP system at three different levels (the administrative, service provision and the client levels).

The study allowed the organizational participants the ability to better understand their program by visually modeling the system for the first time and documenting its effectiveness. It also furthered the understanding of how and why the housing first model is best accompanied by a harm reduction approach. Finally, the paper was able to show how and why organizational system design is important in creating the most effective environment in which programs have a real impact.

The authors were able to help CHHP program leaders conduct strategic planning and to present their program as an effective model future funding agencies and to policy makers. CHHP has incorporated the recommendations into their permanent model. In addition, the CHHP leadership, in a network with other Housing First advocates, has disseminated the findings at national conferences and networking meetings. The authors' relationship with CHHP will continue with the design of a second stage research strategy in order to continue research on Harm Reduction Housing and policy advocacy.