Acknowledging abuse backgrounds of intensive case management clients.

Routine inquiry about abuse experiences as children and adults yielded high levels of positive responses among 89 intensive case management clients. Through structured interviews administered by their case managers, clients disclosed backgrounds in families with one or more alcoholic adults, incest, other childhood sexual abuse, and extensive physical abuse. Gender played a major role. Being an ACOA also predicted extensive additional abuse. Clients were not treated for abuse, nor diagnosed for its impact, nor responded to when they initiated discussion with mental health providers. Later outcomes include frequent hospitalizations, substance abuse and self-mutilation.