Columbia University Mailman School of Public Health

Case-Management/Linking Families to Services

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Introduction

In the context of childhood mental health services, the research literature has defined the process of engagement as involving the recognition of a mental health problem, connecting the child to mental health resources (typically via referral), and the initiation and ongoing provision of services to the child.1 Ensuring that families engage with services, from the beginning of services through ongoing attendance, is a challenge. Studies have shown that no-show rates at initial appointments are typically close to or just above 50 percent, and that 40 to 60 percent of children receiving services participate in few sessions or quickly drop out.2 Supporting engagement can help to address the negative consequences associated with treatment dropout.3

One promising approach that may support infant and early childhood mental health service engagement is targeted case management. While case-management may take different forms, it typically involves a specially trained professional who offers support and assistance to families to help them engage with mental health services and obtain other supports that might be beneficial (e.g., assistance with basic needs to reduce family stress). Case-management activities are tailored to families’ needs and might include helping families develop a plan of care, working with multiple providers to coordinate roles, identifying and linking families to community resources, and following up with families to ensure they are receiving appropriate care and assistance.

Case management approaches are used across a wide range of service contexts and the features of specific approaches vary. In Medicaid, case management covers “services that will assist individuals eligible under the [State] plan in gaining access to needed medical, social, educational, and other services.”4 Targeted case management (TCM) services under Medicaid are provided to specific populations in a state as designated by its Medicaid plan. TCM services include assessment, development of care plans, referrals, and monitoring, but not the direct delivery of medical and other services to which individuals are referred. North Carolina’s Care Coordination for Children (CC4C) provides case management services to at risk children from birth to five through the state’s Medicaid program (see North Carolina state profile for more information on CC4C).

State Profiles that Include Case-Management/Linking Families to Services

Research Support for Case-Management/Linking Families to Services

Case management has shown promise in a number of early childhood policy and program contexts, including early child development (Help Me Grow, HealthySteps), early intervention (IDEA Part C), and child mental health (family peer advocacy approaches).

  • HealthySteps: In the HealthySteps model for infants and toddlers, a pediatric clinic-based HealthySteps specialist (HSS) “partners with families during well-child visits, coordinates screening efforts, and problem-solves with parents for common and complex challenges in child-rearing and other areas. The HSS is trained to provide tailored guidance and referrals, on-demand support between visits, and even care coordination and home visits when needed.”5 A national evaluation of HealthySteps found that families receiving HealthySteps services were more likely than control families to receive information about community services, receive non-medical referrals, attend well-visits on time, and have a developmental assessment.6 (See New York State profile for more information on HealthySteps.)
  • Help Me Grow: The centralized access point is one of the four components of the Help Me Grow system model, which is implemented in states and communities across the country and aims to connect vulnerable children and families to community-based programs and services. The centralized access point is often a call center, staffed by care coordinators who “work to provide education and support to families around specific developmental or behavioral concerns or questions, help families recognize typical developmental milestones, provide referrals to community-based supports, empower families to overcome barriers to services, and follow up with them to make sure linkages are successful.”7 In Connecticut, 80 percent of families who used Help Me Grow services were successfully connected to services.8 An analysis of Help Me Grow in Orange County, California, indicated that the program successfully referred families to community-based programs rather than unnecessary medical or behavioral health specialists, which produced an estimated savings of more than $2,300 per child.9 (See Alabama profile for more information on Help Me Grow.)
  • Part C Early Intervention: Part C of the Individuals with Disabilities Education Act (IDEA) assists states in providing early intervention (EI) services to infants and toddlers with or at-risk of disabilities, and their families. States are required to provide service coordination to families who participate in Part C EI. The role of the service coordinator “includes coordinating all services across agency lines and serving as the single point of contact to help families obtain the services and assistance they need.”10 When examining service coordination outcomes, a study found that the length of time an EI coordinator worked with a family was related to the amount and frequency of services children received.11 Coordination models in which coordinators provide service coordination along with early intervention services (mixed delivery), in combination with more frequent contact with families and use of family-centered help-giving practices, were associated with positive coordinating practices.12 Families served by dedicated coordinators reported lower levels of helpfulness and ease of contact.13 However, given that service coordinators in dedicated models had higher caseloads than in mixed delivery models, these findings may indicate that coordination is more successful when coordinators maintain frequent and ongoing contact with families.
  • Peer advocates: In the field of child mental health, a number of approaches to enhancing family engagement have involved the use of peer advocates. These paraprofessional advocates are typically parents who themselves have experiences in the child mental health system.

    In Oregon, a program trained paraprofessional helpers called Family Associates to provide information, support, and help connecting with treatment resources to low-income families through the state’s Medicaid Early and Periodic Screening, Diagnosis and Treatment program.14 A study comparing counties with and without Family Associates found that families in counties with associates were more likely to make and keep a first appointment and reported greater levels of empowerment. However, there were no differences in appointment attendance or discontinuing services prematurely, which suggests barriers to regular attendance beyond those addressed by the Family Associates.15

The findings from research into these case management approaches are consistent with other research on strategies that help increase family engagement with child mental health programs16: targeted case management that is individualized, intensive, and integrated into existing programs and services shows the most promise for supporting family engagement with infant and early childhood mental health services.

References

  1. McKay, M. M., & Bannon, Jr., W. M. (2004). Engaging families in child mental health services. Child and Adolescent Psychiatric Clinics of North America, 13(4), 905-921.
  2. Gopalan, G., Goldstein, L., Klingenstein, K., Sicher, C., Blake, C., & McKay, M. M. (2010). Engaging families into child mental health treatment: Updates and special considerations. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 19(3), 182-196.
  3. de Haan, A. M., Boon, A. E., de Jong, J. T. V. M., Hoeveg, M., & Vermeiren, R. R. J. M. (2013). A meta-analytic review on treatment dropout in child and adolescent outpatient mental health care. Clinical Psychology Review, 33(5), 698-711.
  4. U.S. Department of Health and Human Services, Office of Inspector General. (2019). Missouri claimed some unallowable Medicaid payments for targeted case management services (A-07-17-03219). Washington, DC: U.S. Department of Health and Human Services, Office of Inspector General.
  5. Zero to Three. (2017). The model. Retrieved from https://www.healthysteps.org/the-model
  6. Guyer, B., Barth, M., Bishai, D., Caughy, M., Clark, B., Burkom, D., et al. (2003). Healthy Steps: The first three years: The Healthy Steps for Young Children program national evaluation. Baltimore, MD: Johns Hopkins Bloomberg School of Public Health, Women's and Children's Health Policy Center.
  7. Help Me Grow National Center. (2019). The HMG system model. Retrieved from https://helpmegrownational.org/what-is-help-me-grow/hmg-system-model/
  8. Hughes, M., & Damboise, M. C. (2009). Help Me Grow: 2008 annual evaluation report. Hartford, CT: University of Hartford, Center for Social Research.

    Hughes, M., & Joslyn, A. (2014). Help Me Grow: 2014 evaluation report. West Hartford, CT: University of Hartford, Center for Social Research.
  9. Taylor, C., & Help Me Grow National Center Staff. (2012). Cost benefits of "de-medicalizing" childhood developmental and behavioral concerns: National replication of Help Me Grow. Hartford, CT: Help Me Grow National Center.
  10. Bruder, M. B. (2005). Service coordination and integration in a developmental systems approach to early intervention. In M. J. Guralnick, (Ed.), The developmental systems approach to early intervention. Baltimore, MD: Paul H. Brookes (pp. 29-58).
  11. Bruder, M. B., & Dunst, C. J. (2007, Fall). Relationship between service coordinator practices and early intervention services. Journal of the American Academy of Special Education Professionals, 3.
  12. Bruder, M. B., & Dunst, C. J. (2008). Factors related to the scope of early intervention service coordinator practices. Infants and Young Children, 21(3), 176-185.
  13. Roberts, R. N. (2005). An outcomes-based approach to evaluating service coordination models: Final report. Logan, UT: Utah State University, Early Intervention Research Institute.
  14. Koroloff, N. M., Koren, P. E., Elliott, D. J., & Friesen, B. J. (1994). Connecting low-income families to mental health services: The role of the Family Associate. Journal of Emotional and Behavioral Disorders, 2(4), 240-246.
  15. Koroloff, N. M., Elliott, D. J., Koren, P. E., & Friesen, B. J. (1996). Linking low-income families to children's mental health services: An outcome study. Journal of Emotional and Behavioral Disorders, 4(1), 2-11.
  16. Ingoldsby, E. (2010). Review of interventions to improve family engagement and retention in parent and child mental health programs. Journal of Child & Family Studies, 19(5), 629-645.