Home > Overview of case management related to work with people who use drugs.

Lyons, Suzi (2022) Overview of case management related to work with people who use drugs. Drugnet Ireland, Issue 81, Spring 2022, pp. 18-19.

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Internationally, case management (CM) was first adapted in the 1980s to work with people who use drugs; however, the concept had emerged first in the 1920s.1 In 2010, the Health Service Executive (HSE) published the National Drugs Rehabilitation Framework Document,2 in which CM was outlined as a key component. This framework was in response to the earlier policy document, Report of the Working Group on Drugs Rehabilitation,3 which recommended ‘a framework through which service providers will ensure that individuals affected by drug misuse are offered a range of integrated options tailored to meet their needs and create for them an individual rehabilitation pathway’ (p. 7).2

The framework document also supplied definitions of ‘case management’ and ‘case manager’ (p. 29):2

Case management is the process of coordinating the care of a service user through a shared care plan and resolving any gaps and blocks that arise.

Case manager is the named person who has the formal lead role in the management of interagency communication and the provision of coordinated care for the service user in question. 

Models of case management

Six basic models of CM have been identified by Vanderplasschen et al. and as outlined by Nic Gabhainn et al.  (p. 7):1,4

  • The brokerage model: Case managers act as ‘brokers’, assisting clients to identify their needs and gain access to other services or supports; generally, it involves a brief engagement with clients with only one or two meetings.
  • Generalist models: Case managers work with clients to identify needs and negotiate access to required services and supports; a longer-term and closer relationship with clients is developed over time.
  • Assertive community treatment (ACT): Case managers work in teams to help identify client needs and provide services directly to clients through assertive outreach.
  • Intensive case management (ICM): Case managers work on a more intensive, individual basis with clients and usually have a lower caseload; they identify needs, provide services directly and link clients with relevant services.
  • The strengths perspective: Case managers seek to empower the client to identify their own strengths to build on, rather than primarily focusing on correcting their deficits; this approach encourages the use of informal sources of support and help.
  • Clinical case management: Case managers provide direct clinical input to clients and combine that with assistance in accessing other resources, particularly from the health and social care sector.

Review of evidence

In 2016, the Health Research Board (HRB) published a scoping review of the evidence from peer-reviewed non-experimental research on CM (2003–2013).4 The review sought to answer three questions, which are briefly summarised below. 

1 What additional knowledge regarding the nature of case management can we gain from a review of recent non-experimental research on the topic?

The literature showed that there was an expectation that CM would achieve multiple objectives, many directly related to the client, such as reducing substance use and improving social and psychological issues to broader operational issues (e.g. improving service coordination). The review found that there were some key elements of CM that improved outcomes, including duration and intensity of the intervention and team-based CM, with the engagement of case managers identified as important in successful outcomes. 

2 What outcomes have been evaluated in the non-experimental research literature?

Almost all of the studies included (17/20) found evidence that CM improved outcomes for clients in at least one area. However, it was not definitive if the improved outcomes reported were directly related to CM or other factors which were outside the scope of the studies reported. 

3 What are the gaps in the non-experimental literature?

One of the major gaps of the literature reviewed was in the identification of the specific aspects of CM that lead to improved outcomes. The number of types of outcomes evaluated in studies should be expanded to include quality-of-life perspectives from clients. To have a better understanding, CM would benefit from studies that examine different aspects of CM in different areas and for different client groups, with more rigorous or appropriate evaluation methods. 


An external review of the shared framework of CM in the Cork/Kerry region was conducted in 2017.5 This found that the model used in the region was a blend of several models which had evolved over a number of years. In general, participants were positive about CM, in particular in relation to consistency of care, reduction of work duplication, improved clarity, and standardisation of roles and paperwork. While optimal interagency working was identified as key to success, participants reported that it could be difficult to engage all relevant agencies, with ‘missing partners’ a theme that emerged throughout the study. Participants were divided on the benefits of the CM supervisor role that worked across all sectors, which was part of the project in the region. Other weaknesses reported were hierarchy, loss of professional identify, and burden of administration. While the participants reported that one of the benefits of CM was that it was client-centred, one of the limitations of the study was the limited involvement of service users in the evaluation. 

1  Vanderplasschen W, Wolf J, Rapp RC and Broekaert E (2007) Effectiveness of different models of case management for substance-abusing populations. J Psychoactive Drugs, 39(1): 81–95.

2  Doyle J and Ivanovic J (2010) National Drugs Rehabilitation Framework Document. Dublin: Health Service Executive. https://www.drugsandalcohol.ie/13502

3  Working Group on Drugs Rehabilitation (2007) National drugs strategy 2001-2008: rehabilitation. Report of the Working Group on Drugs Rehabilitation. Dublin: Department of Community, Rural and Gaeltacht Affairs. https://www.drugsandalcohol.ie/6267/

4  Nic Gabhainn S, D’Eath M, Keane M and Sixsmith JA (2016) Scoping review of case management in the treatment of drug and alcohol misuse, 2003–2013. HRB Drug and Alcohol Evidence Review 3. Dublin: Health Research Board. https://www.drugsandalcohol.ie/26681/

5  Ivers J-H and Barry J (2017) An evaluation of a framework for case-management in the Cork/Kerry region. Dublin: Trinity College Dublin. https://www.drugsandalcohol.ie/29012/

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