Effects of case management on global functioning among persons with schizophrenia at high risk of violence

Abstract

Case management is a pivotal strategy for managing patients with schizophrenia at high risk for violence (SMI-V), aiming to ensure continuity of care and holistic coordination. This quasi-experimental, one-group pretest-posttest study aimed to evaluate and compare mean global assessments of functioning (GAF) among SMI-V patients before and after the implementation of a case management program. The sample consisted of 33 schizophrenia patients with a high risk for violence receiving services at the Psychiatric and Substance Abuse Clinic, at a secondary care hospital in a northern border province of Thailand Participants were selected using simple random sampling according to predefined inclusion criteria. Research instruments included the Global Assessment of Functioning (GAF) Scale and the 10-Domain Chronic Psychiatric Patient Tracking Form for Community Risk Groups. Content validity was verified by experts, yielding an Index of Item-Objective Congruence (IOC) between 0.75 and 1.00, while the reliability, measured by Cronbach’s alpha coefficient, was 0.83. Data were analyzed using descriptive statistics and the t-test. The results revealed that, after receiving case management, the subjects' mean GAF scores increased significantly (t=-19.80, p<.001). These findings demonstrate that case management effectively enhances social functioning, mitigates triggers for violence, and promotes successful community living. It is recommended that this case management model be integrated into primary healthcare systems to systematically and sustainably improve care quality for high-violence-risk chronic psychiatric patients.