Cost and Intensity of Care in Case Managers' Referrals to Psychiatric Day Programs

Objective: The purpose of the study was to determine whether case managers referred clients with different needs to programs with different goals and levels of intensity, and thus with different costs. MethodL: A total of 150 case managers were asked to select one of three day programs—day treatment, clubhouse, or supported employment—for four hypothetical clients described in case vignettes. They also were asked to choose any or all of three types of concurrent services for these clients, including a medication clinic, outpatient counseling, and a social club. They listed the five most important criteria for making their decisions. Results: The 70 case managers who responded to the survey consistently referred the most functionally impaired clients to day treatment programs and recommended fewer support services for those clients. The least impaired clients were referred to clubhouse or supported employment programs, and many support services were recommended. The most important decision-making criteria cited were clients' motivation, problem-solving ability, and history. Conclusions: Case managers differentially select day programs based on clients' functional ability. Clients referred to vocationally oriented programs are also referred to concurrent services that increase the cost of the total service package.