The first 18 months of operation of a team providing high intensity case management is presented. A key-worker/co-worker system was adopted, with regular team meetings to review the progress of all clients. Low case-loads (10 clients per case manager) enabled the team to carry out detailed assessments of need, offer assertive outreach and crisis intervention and coordinate complex packages of community care. The case management team provided an accessible and effective service. However, not all patients appeared to benefit and the intensive nature of the work was very demanding on staff.
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