The State of Hawaii, Department of Health, Mental Health Division, is applying for a grant to evaluate the impact on clients with severe, disabling mental illness, of an augmented form of case management. As in other parts of the nation, Hawaii has made a strong commitment to providing community-based support to persons with severe disabling mental illness. As a recipient of a Robert Wood Johnson grant, the Division of Mental Health began making notable changes in 1988 at the administrative, fiscal, and service delivery levels to improve the quality of mental health services for this population of consumers. The thrust of this initiative focused on case management, with the case manager seen as a single continuous caregiver who would ensure reliable continuity of care and assume responsibility for the coordination of services. This was implemented through the hiring of new staff, the reorganization of roles amongst existing staff, and the extensive training of these workers in accordance with the principles of the Developmental Aquisition model of case management. The study proposed here describes a two-year research project that will take advantage of the momentum of these efforts. It will evaluate the impact of a strategy that additionally structures and enhances adherence to specific principles of case management. The strategy comprises an assessment instrument and procedure known as the Multi-Function Needs Assessment (MFNA) that provides case managers with a visual picture of client functioning in 13 areas. This assessment is linked to a Services Plan which seeks to engage clients in an empowering relationship as client and case manager set goals and work together towards goal achievement. This strategy is hypothesized to heighten awareness of key case management priniciples, provide case managers with continuous feedback on client functioning, and ensure continuity of care. One hundred and eighty clients with severe, disabling mental illness constitute the subjects, randomly assigned in equal numbers, to one of three groups. One group will receive the treatment; a second will have case managers proficient in MFNA usage but will be given regular case management without MFNA/Services plan case management; the third will have case managers not practiced in MFNA/Services Plan procedures, and will also receive regular case management.
