The Enduring Relevance of Case Management

Correspondence to Peter Ryan, School of Health, Biological and Environmental Sciences, Middlesex University, Archway, 7, Highgate Hill, London N19 5NF Summary This article summarizes the main results and policy implicationsof a Department of Health funded mental health case managementresearch and development project. The project implemented casemanagement services in four different sites, and worked withclients who were severely disabled with long-term mental illness.Higher levels of engagement (95 per cent) were achieved by case-managedas compared to control clients. They were also linked to a widerrange of community services. However, costs of the experimentalservices were higher, and client outcome variable. In two sites,case-managed clients achieved significant improvements in psycho-socialadjustment, whereas on the third site, there were no differencesin outcome between the control andexperimental clients. The article concludes that case management continues to be amode of service delivery which can achieve real benefits forclients in terms of preventing them from falling through thenet, and in linking them in responsive ways to community services.However, the increased costs can make it an unattractive optionfor purchasers, and ways need to be found to retain the establishedbenefits, whilst reducing the costs to service purchasers.     

Indeed: Cost of the NSERC Science Grant Peer Review System Exceeds the Cost of Giving Every Qualified Researcher a Baseline Grant

NSERC (Natural Sciences and Engineering Research Council of Canada) offers Discovery Grants averaging Can$30,000 to about 70% of its applicants. If the total budget for these grants were evenly divided amongst the 10,000 people qualified to apply, the average grant size would be Can$41,000. The additional costs of writing and reviewing grant applications in our previous analysis only serve to accentuate the loss of funds that could otherwise be spent on the research itself. Baseline grants for the early stages of research, to all qualified researchers, would significantly enhance innovation of Canadian scientists.     

APPLICATIONS OF SPECTRAL ANALYSIS

The basic concepts and application of spectral analysis are explained. Stationary time series and autocorrelation are first defined. Autocorrelation is related to the familiar concepts of variance and covariance. The use of autocorrelation analysis is explained in estimating the interdependent relationship of a time series over discrete time lags. In order to measure the behavior of the time series using autocorrelation, it would be necessary to examine a very large number of autocorrelation lags. Alternatively, the technique of Fourier analysis can be used to transform the autocorrelation function of the time series into a continuous function, termed a spectrum. The spectrum has a one to one correspondence to the autocorrelation for the time series and has the advantage of representing all possible autocorrelations over the discrete time lags. The spectrum can then be examined as a measure of the behavior of the time series. Spectral analysis indicates the reliability of the analysis of autocorrelated variables when familiar statistical techniques such as sample means and variances are used. The application of spectral analysis to management science problems in three general areas is illustrated: (1) inventory demand, (2) transportation simulation, and (3) stock market price behavior. Spectral analysis was used to detect cycles and trends in the data. Analyses were focused on the spectrum which provides a measure of the relative contribution of cycles in a band of frequencies to the total variance of the data.     

"Contract" and Admission to Old People's Homes

Summary Various authors have recently recommended that residents inOld People's Homes should have ‘contracts’. Thisarticle begins by discussing the nature of contracts in general,and the circumstances under which contracts are or are not feltto be appropriate. The nature of Old People's Homes is discussed, and it is shownthat, under what would be considered good practice, there arefew reasons why Homes should not offer contracts. A final sectionputs forward some advantages which contracts might bring.