To the Editor: The authors of the article "Comparison of ACT and Standard Case Management for Delivering Integrated Treatment for Co-occurring Disorders" (1) in the February issue use the misleading adjective "standard" to describe the comparison intervention. As described in the article, the "standard case management" used was actually a sophisticated "clinical case management team" (2,3,4) that provided multidisciplinary, integrated treatment with ongoing expert consultation. The clinical case managers had a larger caseload than the assertive community treatment team, and cases were assigned to individual case managers rather than to a team. However, even with these differences, the clinical case management approach used in the study has much in common with the assertive community treatment model.

Although one wishes that this type of treatment were "standard," case management today too often involves a poorly trained, paraprofessional staff operating apart from other treatment interventions (5). "Comparison of ACT and Clinical Case Management …" would have been a more apt title for this informative article.

Mr. Kanter is in private practice in Silver Spring, Maryland.

1.Essock SM, Mueser KT, Drake RE, et al: Comparison of ACT and standard case management for delivering integrated treatment for co-occurring disorders. Psychiatric Services 57:185-196, 20062.Kanter J: Clinical case management: definition, principles, components. Hospital and Community Psychiatry 40:361-368, 19893.Kanter J (ed): Clinical Studies in Case Management. New Directions in Mental Health Services, no 65. San Francisco, Jossey-Bass, 19954.Walsh J: Clinical Case Management With Persons Having Severe Mental Illness: A Relationship-Based Perspective. Belmont, Calif, Brooks/Cole, 20005.Floersch, J: Meds, Money, and Manners: The Case Management of Severe Mental Illness. New York, Columbia University Press, 2002