Culturally congruent intensive case management service for three refugee communities

In 1999 an intensive case management (ICM) mental health service targeting Afghan, Sri Lankan, and Somali communities was established in Toronto. The program provides culturally and linguistically appropriate ICM. Using administrative data of clients enrolled in the program from 2006 to 2010, we examined the effectiveness of the program by assessing the enrollment status two years after program admission, the estimated length of stay, as well as changes in length of hospitalization, medication adherence, and employment status from baseline to two-year follow-up. At two-year follow-up, 22% had met treatment objectives and left the program, whereas 42% remained in the program. About 25% withdrew from the program, 8% relocated, and 2% died. The estimated median length of stay in the program was 790 days. Compared with a baseline measurement period ranging from six months to one year, clients had fewer hospital visits by two years postadmission), improved treatment adherence, and better employment outcomes. No change in hospitalization days was observed. Given the lack of control group in this study, the results provide some preliminary evidence for effectiveness of a culturally congruent ICM for refugee communities.