Ryan C S, Sherman P S, Judd C M
Department of Psychology, University of Pittsburgh, Pennsylvania 15260.
J Consult Clin Psychol. 1994 Oct;62(5):965-74. doi: 10.1037//0022-006x.62.5.965.
Three methods of accounting for case manager effects in tests of the efficacy of mental health services are explored. These methods include (a) treating the case manager as a fixed factor, (b) treating the case manager as a random factor, and (c) examining service effects within the case manager. They are demonstrated with data from a nationally known case management program serving individuals with serious and persistent mental illness. Specifically, 3 conceptually distinct types of services provided or brokered by case managers are identified: habilitation-rehabilitation, community support, and traditional psychiatric services. The effectiveness of each in improving clients' adjustment is then examined with multiple regression adjustment strategies and each of the 3 methods to account for case manager effects. The results provide strong support for effects attributable to case managers and some support for the efficacy of habilitation-rehabilitation and community support services beyond the effects of traditional psychiatric services.
探讨了在心理健康服务疗效测试中考虑个案管理员效应的三种方法。这些方法包括：(a) 将个案管理员视为固定因素；(b) 将个案管理员视为随机因素；(c) 在个案管理员内部考察服务效果。通过一个全国知名的为患有严重和持续性精神疾病的个体提供服务的个案管理项目的数据对这些方法进行了演示。具体而言，确定了个案管理员提供或促成的3种概念上不同类型的服务： habilitation-rehabilitation（ habilitation康复）、社区支持和传统精神科服务。然后，使用多元回归调整策略以及上述三种考虑个案管理员效应的方法中的每一种，来检验每种服务在改善客户适应能力方面的有效性。结果为个案管理员的效应提供了有力支持，并为 habilitation-rehabilitation（ habilitation康复）和社区支持服务的疗效提供了一定支持，这些疗效超出了传统精神科服务的效果。
