No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Strengths Model Case Management Fidelity Scores and Client Outcomes
Abstract
The study examined the relationship between fidelity of strengths model case management (SMCM) and client outcomes of psychiatric hospitalization, competitive employment, postsecondary education, and independent living.
Data were collected over an 18-month period during regularly scheduled fidelity reviews for 14 case management teams representing ten agencies serving an average of 953 clients diagnosed as having a serious mental illness. Time-varying covariate linear growth modeling examined the relationship between fidelity scores and client outcomes.
A statistically significant association was found between fidelity scores and psychiatric hospitalization, competitive employment, and postsecondary education.
The study results offer promising evidence that higher SMCM fidelity has a positive effect on clients over an 18-month period, thereby providing an effective complement to current mental health treatment.
... In contrast Sang et al. (2013), in an article examining the connections between double outsider status of professors who were both women and of migrant status, noted that these women did not perceive their "otherness" to be a deficit identity, but rather drew upon the factors of a double outsider identity to enhance their contributions to academia. Indeed, as acknowledged in our discussion later in the article, elements of deficit can also be turned into our strengths (Fukui et al., 2012). ...
... As we name our deficit identities, we recognise the strength in their existence, and how they enable us to challenge oppression. Intersectionality recognises the convergence of many different identities which are both deficit and strengths-based attributes (Fukui et al., 2012). As intersectionality has evolved, common elements of the approach have become clear: ...
... We recognise that we possess much power in our roles as social work academics and registered social workers; and moreover, the duty to promote social justice and to challenge discrimination and oppression is at the heart of social work practice (SWE, 2021). Thus, the strengths approach (Fukui et al., 2012) is key to all social work practice and should inform our interactions with people and allow us to empathise and share with them our experiences of deficit. ...
Purpose
The authors are two social work academics working in a UK Higher Education Institute. Social work is underpinned by principles of anti-oppressive practice which leads to challenge discrimination and stigmatisation. The authors explored experiences of deficit imposed by others' perceptions of the physical and ethnic appearance and mental health status. The authors consider how these features influence how the authors locate themselves within the wider contexts of academic spaces in higher education institutions (HEI).
Design/methodology/approach
Using duoethnography, a collaborative research methodology, the authors recorded reflections on their experiences for five months and met weekly to discuss their material. This process enabled them to engage in dialogic narrative through collaborative writing using both structured and unstructured reflections. The authors analysed the reflections using thematic data analysis.
Findings
Four themes were generated that led to understanding how the authors could challenge oppression. The oppression became visible as the authors reflected on the common experiences of deficit. The understanding of other's oppression as well as the authors’ own became clearer as the unconscious experiences became conscious. The authors began to locate the experiences of being both privileged and oppressed in the wider social context of the HE. Finally, the authors recognised how the “deficit” identities could transform into strengths.
Originality/value
This personal journey of two academics reflecting on how they are paradoxically both privileged and yet oppressed challenges other professionals to honestly explore how they themselves can occupy both roles and become allies in confronting discrimination in all its forms.
... They concluded that 'strengths demonstrated a significantly greater advantage with symptomatology reduced by half' (Barry et al. 2003, p. 269). Fukui et al. (2012) examined the relationship between case managers' fidelity to the Strengths Model process and consumer outcomes for 14 mental health teams, within ten agencies, over an 18-month period. They found a statistically significant, positive relationship between fidelity scores, psychiatric hospitalization, competitive employment, and postsecondary education (Fukui et al. 2012). ...
... Fukui et al. (2012) examined the relationship between case managers' fidelity to the Strengths Model process and consumer outcomes for 14 mental health teams, within ten agencies, over an 18-month period. They found a statistically significant, positive relationship between fidelity scores, psychiatric hospitalization, competitive employment, and postsecondary education (Fukui et al. 2012). ...
... Working together, clinician and client construct a recovery-oriented treatment plan that promotes hope, independence, and personal recovery (Andresen et al. 2011;. Therefore, the Strengths Model offers a foundation for recovery-oriented mental health services that actively empower clients to establish and strive for individual goals, improving mental health outcomes (Fukui et al. 2012). ...
This study explored the impact of Strengths Model training, supervision and mentorship on the practice of a group of multi‐disciplinary mental health clinicians that included mental health nurses, social workers, psychologists, and occupational therapists. A qualitative approach that combined critical realism and grounded theory was used. The findings demonstrated how a substantive category, Getting to Know Clients Better, facilitated participants' progression through a basic social psychological process, Becoming a Strengths‐Informed Practitioner. This process consisted of a discernible and sustained change towards more person‐centred, hopeful, and recovery‐oriented practice. The findings also described an underlying generative mechanism for this, the Client Becomes Visible, which accorded with theoretical models of empathy, based on enhanced cognitive processing. The strength‐based approach to practice facilitated the establishment of a collaborative relationship and a stronger therapeutic alliance between the client and clinician. The research demonstrated that Strengths Model is an effective vehicle for improving recovery‐orientated mental health services.
... Field mentoring is designed to help workers develop and refine their SMCM practice skills in the field with clients. The fidelity review is conducted to ensure adherence to the key components of the model during the implementation process (Fukui et al., 2012). ...
... Similarly, our recent review (Tse et al., 2016) showed that the benefits associated with the strengths-based approach (four out of seven studies under review were directly related to SMCM) include improvements in clients' general attitudes towards recovery-relevant dimensions (e.g., self-efficacy and sense of hope) and increases in job satisfaction and morale among mental health professionals. Further, SMCM fidelity scores were found to be associated with clients' outcomes across service sites, with high-fidelity SMCM associated with lower rates of psychiatric hospitalisation and higher employment rates (Fukui et al., 2012). Recently, there have been a series of studies led by a Canadian team to explore the connection among fidelity scores, therapeutic ingredients, recovery outcomes, and management support (e.g., Briand et al., 2022;Durbin et al., 2022;Latimer et al., 2022;Roebuck et al., 2021Roebuck et al., , 2022. ...
... To ensure the SMCM group's adherence to the SMCM model, which differentiated it from the control group, two independent evaluators who had a thorough understanding of SMCM conducted a fidelity review at baseline (T 0 ) as well as at 6 (T 1 ) and 12 (T 2 ) months after the start of the intervention. The SMCM Fidelity Scale ; for further details, see Latimer et al., 2022;Roebuck et al., 2022) has been validated, including the predictive validity for client outcomes (Fukui et al., 2012) and has been identified -To ensure a supportive strengths model context through the Fidelity Scale, which was designed to assess the adequacy of SMCM implementation in three core areas: structure, supervision/supervisor, and clinical/service. ...
Objectives: Strengths-based approaches to case management for people with mental illness have been widely used in Western countries. The aim of this study was to evaluate the effectiveness of Strengths Model Case Management (SMCM) among mental health clients in Hong Kong. Method: Two hundred and nine service clients were recruited from three Integrated Community Centres. Multiple measures related to recovery progress (e.g., Recovery Assessment Scale) were reported by both the clients and caseworkers before intervention and at 6 and12 months post-recruitment. Results and conclusion: Although there were no significant differences in improvement of most outcomes between the SMCM and control groups, the recovery scores of the SMCM group remained stable over time regardless of age, and also middle-aged participants (i.e., 40–59 years old) in the SMCM group achieved higher recovery scores over time than those in the control group. Trial registration number: Australian New Zealand Clinical Trials Registry (ACTRN) 12617001435370.
... Fidelity scales have been developed for at least 14 evidence-based practices addressed to people with severe mental illness (Bond & Drake, 2020), including the SMCM (Center for Mental Health Research & Innovation [CMHRI], 2014;Fukui et al., 2012). An ideal fidelity scale will demonstrate high interrater reliability, discriminative validity, sensitivity to change, and most importantly, predictive validity (Bond & Drake, 2020). ...
... In practice, fidelity scales inevitably can only approximate that ideal, as the attributes of practices in question, and the contexts in which they operate, are complex, and research methods cannot in practice, for instance, determine exactly the best weight to give each item in a scale, let alone the most relevant set of items (Latimer, 2010;Lockett et al., 2016). Nonetheless, many scales do exhibit significant predictive validity (Bond et al., 2012;Burns et al., 2007), including the fidelity measure for the SMCM (Fukui et al., 2012). ...
... The strengths model (or variants of it) has been evaluated using both randomized controlled trials (Barry et al., 2003;Björkman et al., 2002;Chamberlain, 1991;Macias et al., 1994;Modrcin et al., 1988;Gelkopf et al., 2016), and quasi-experimental or nonexperimental designs (Fukui et al., 2012;Kisthardt, 1993;Macias et al., 1997;Rapp & Wintersteen, 1989;Stanard, 1999). One systematic review, which considered only randomized trials, concluded that the strengths model had no positive effect on level of functioning or quality of life (QoL), and indeed, that it was less effective than other approaches at controlling symptoms (Ibrahim et al., 2014). ...
Objective:
Evidence concerning strengths model of case management (SMCM) remains mixed. This study aimed to test the hypotheses that higher fidelity to SMCM is associated with improved quality of life (QoL), hope, community participation, community functioning, more days of competitive employment and of independent living, and fewer days of hospitalization.
Methods:
SMCM was implemented over a 3-year period, at seven sites in the Canadian provinces of Newfoundland and Labrador, Québec, and Ontario. Independent assessors visited 14 teams at the seven sites to evaluate fidelity at baseline and 6, 12, 18, 24, and 36 months later. Participants (N = 311) answered standardized questionnaires at 4.5-month intervals up to 18 months. Fidelity assessments were interpolated so they could be associated with questionnaire responses. Linear mixed-effects models and generalized linear models were estimated.
Results:
Fidelity increased significantly, with all sites except one achieving or approaching good fidelity within 36 months. Fidelity was not significantly associated with any of the outcome measures, although all estimated directions of relationships were consistent with our hypotheses.
Conclusions and implications for practice:
In a pragmatic study of real-world implementation of the strengths model at seven sites, no statistically significant relationships between fidelity and outcomes were found. Low variation in fidelity across individuals, modest sample size, and limited ability to detect change over 18 months, may have contributed to these null findings. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... There have been 10 studies testing this approach. Four of the studies employed experimental or quasi-experimental designs (Modrcin et al., 1988;Macias, Farley, Jackson, & Kinney, 1997;Macias, Kinney, Jackson, & Vos, 1994;Stanard, 1999) and six used non-experimental methods (Barry, Zeber, Blow, & Valenstein, 2003;Fukui et al., 2012;Kisthardt, 1993;Rapp & Chamberlain, 1985;Rapp & Wintersteen, 1989;Ryan, Sherman, & Judd, 1994). These studies have produced positive outcomes in the areas of hospitalization, housing, employment, reduced symptoms, leisure time, social supports, and family burden. ...
... These studies have produced positive outcomes in the areas of hospitalization, housing, employment, reduced symptoms, leisure time, social supports, and family burden. The most recent study (Fukui et al., 2012) investigated the relationship between fidelity of strengths model case management implementation and the client outcomes of psychiatric hospitalization, competitive employment, involvement in post secondary education, and independent living. It found a statistically significant association between fidelity and all but independent living. ...
... Currently, there is only a single fidelity instrument for strengths case management that has been tested (Fukui et al., 2012). The development of fidelity measures would also enhance strengths-based practice in two related ways. ...
The Strengths Model/Perspective was developed by social workers and the profession continues to be the leader in its practice, research and refinement. This article traces the three decades of evolution of this approach and the continuing expansion of its use around the world. Cautionary notes are provided and an agenda for future development is proposed.
... The latter model, unlike the common deficit-oriented, illness-focused approach, takes a goal-oriented approach that focuses on the clients' strengths and emphasizes their capacity for growth and recovery (Fukui et al., 2012;Goscha, 2006, 2008). The strengths model emphasizes the importance of using and acquiring naturally existing resources in the community, and perceives the client as the one to lead his/her rehabilitation process Goscha, 2006, 2008). ...
... Recent evidence suggests that people who receive strengths-based case management (SBCM) are hospitalized less frequently, are more independent in daily life, achieve more goals, function better in the competitive employment and educational domains, report greater social support, and have overall better physical and mental health (Barry et al., 2003;Fukui et al., 2012;Rapp and Goscha, 2006). A recent meta-analysis reviewing five experimental and quasi-experimental studies concluded that SBCM might not be better than other models of service delivery in improving quality of life or functioning (Ibrahim et al., 2014), but since none of the studies reviewed have monitored fidelity, those results are not unequivocally comparable to previous evidence (e.g., Fukui et al., 2012). ...
... Recent evidence suggests that people who receive strengths-based case management (SBCM) are hospitalized less frequently, are more independent in daily life, achieve more goals, function better in the competitive employment and educational domains, report greater social support, and have overall better physical and mental health (Barry et al., 2003;Fukui et al., 2012;Rapp and Goscha, 2006). A recent meta-analysis reviewing five experimental and quasi-experimental studies concluded that SBCM might not be better than other models of service delivery in improving quality of life or functioning (Ibrahim et al., 2014), but since none of the studies reviewed have monitored fidelity, those results are not unequivocally comparable to previous evidence (e.g., Fukui et al., 2012). Nonetheless, more sound additional evidence is required regarding the effects of SBCM. ...
Case management services for people with serious mental illness are generally found to be effective, but controlled and randomized studies assessing such services are scarce. The aim of the present study was to assess the effectiveness of a new strengths-based case management (SBCM) service in Israel, using a randomized controlled approach. The sample consisted of 1276 individuals with serious mental illness, who consume psychiatric rehabilitation services (PRS) in the community, and were randomly assigned to receive or not to receive the SBCM service in addition to treatment-as-usual PRS. Quality of life, goal setting and attainment, unmet needs, self-efficacy, interpersonal relationships, symptom severity, and service utilization were assessed by clients at onset and after 20 months. Results show that SBCM participants improved in self-efficacy, unmet needs, and general quality of life, and set more goals than the control group. SBCM participants also consumed fewer services at follow-up. Results suggest that SBCM services are effective in helping individuals with serious mental illness set personal goals and use PRS in a better and more focused manner.
... Rehabilitation practices that adopt a strengths-based perspective (SBP) are known as transdisciplinary evidence-based practices [1][2][3][4][5][6]. SBPs focus on mobilizing personal strengths and community assets to build stronger support networks and facilitate community integration [1,2]. ...
... In the SM, clinicians document an individual's strengths (both personal and environmental) and accompany that individual-through supporting niches-toward achieving a personal, self-determined project by building on these strengths. Several studies attest to the positive impacts of SM on the daily lives of individuals with whom it is used [1][2][3][4][5][6]. This model supports community integration, contributes to improved quality of life, strengthens social support, and fosters hope in attaining a better future. ...
Introduction: Rehabilitation practices that adopt a strengths-based perspective are known as transdisciplinary evidence-based practices. However, little is known about whether and how such a perspective is experienced by people living with a neurological condition during their rehabilitation. Objective: To explore how core components of a strengths-based rehabilitation perspective (i.e., hope, self-determination, and mobilization of personal strengths) are envisioned and experienced in outpatient-based rehabilitation by adults living with multiple sclerosis or spinal cord injury. Methods: A descriptive exploratory study with mixed data collection was conducted with adults living with spinal cord injury (n = 9) or multiple sclerosis (n = 11). Participants completed two semi-structured interviews and the Recovery Promoting Relationship Scale (RPRS). The qualitative analysis relied on a hybrid inductive and deductive approach. Results: Four themes depict a strengths-based rehabilitation perspective: (1) The mobilization of personal strengths (e.g., what a strengths-based perspective could offer); (2) hope (e.g., what hinders hope in rehabilitation); (3) accessing information for decision-making (e.g., navigating the system); and (4) exercising self-determination (e.g., influencing the length or intensity of rehabilitation services). Conclusions: Hope, self-determination, and the mobilization of personal strengths are of the utmost importance throughout the rehabilitation of adults living with multiple sclerosis and or spinal cord injury. This paper raises awareness about elements specific to the contexts in which services are offered or to the therapeutic relationships influencing how these three strength-based constructs are envisioned and experienced in rehabilitation.
... This model is most integrated into the natural environment of the user (Petitqueux-Glaser et al., 2010;Rapp & Goscha, 2006). It is also one of the ten important elements for recovery-based services (Fukui et al., 2012;Substance Abuse and Mental Health Services Administration, 2005). ...
... Conceptually, this program fits into the Strengths Model Case Management (SMCM). This is a goal-oriented approach, which aims to help users identify their talents, skills and environmental strengths in order to achieve their goals (Fukui et al., 2012;Rapp & Goscha, 2006). The PASSVers program is also operationally inspired by RACT (Falloon & Optimal Treatment Project Collaborators, 1999), which is congruent with the previous model. ...
The way the social protection system in France is organized frequently leads to coordination difficulties between the social and healthcare sectors. A health and social program has been implemented in a French medical-psychological center to optimize the coherence of the pathway for people living with schizophrenia. This study evaluated the way users and professionals perceive this program so as to assess the relevance of double case management. Semi-structured interviews were conducted with users (N = 21) and professionals (N = 11) of this program and then analyzed with Alceste software. The results highlight the overall satisfaction of the participants with the program, and the double case management was shown to be beneficial in supporting people living with schizophrenia in their life project. These results indicate that this program enabled the emergence of a collective empowerment, which could assist with the recovery process of schizophrenia.
... My professional status often requires me to deny and reject the parts of the lived-experience identity when feeling low, stressed, and lacking motivation. It is rejected by others who don't want to recognize the vulnerability of this identity, because they wish J. Fox to hear stories of resilience presented as strengths (11). During the process of service user involvement in mental health research (12) or participatory inquiry (13), the lived-experience identity is admired; however, when it negatively affects the professional self, it is denied and rejected by both others and-also-seemingly by me, as I struggle to hide these complex responses. ...
... When boundaries are fluid, I can transition between these roles more freely (17); however, if the role identities are divergent, it can make moving between them more difficult. When lived experience is presented from a strengths position (11) it is easy to move between these identities; yet, when I am feeling vulnerable, moving between these 2 experiences can be both physically and emotionally draining. Others expect that expertise-by-experience can be presented merely at willhowever, it can and does cause distress. ...
... Implementation of strengths model case management for people with severe mental illnesses (SMI) is increasing internationally. [1][2][3][4][5] However, few studies to date have focused on its implementation process, 6 and none have specifically addressed the implementation experience of direct-service practitioners. Implementation studies state that it is important to develop staff skills and resources and provide better support, but no studies have focused on how to achieve these objectives. ...
... symptoms, quality of life and functioning, reduced hospitalizations, and increased participation in competitive employment or postsecondary education. 1,18 Evidence of effectiveness in reducing hospitalization, and the model's principle of relying on community resources, suggest it may also be cost-effective. ...
Rationale:
Implementation of strengths model case management is increasing internationally. However, few studies have focused on its implementation process, and none have specifically addressed the implementation experience of direct-service practitioners.
Objective:
This paper presents factors that facilitate and impede the successful implementation of the strengths model, with a specific focus on practitioners who deliver the intervention directly to service recipients.
Method:
To address this objective, a qualitative study of seven mental health agencies that implemented the model was conducted, involving a combination of participant observations and qualitative semistructured interviews with case managers, team supervisors, and senior managers. Qualitative data were analyzed using open coding followed by axial coding. Finally, the findings were aligned with an adapted Consolidated Framework for Implementation Research.
Results:
Implementation of the strengths model involved a significant change in practice for case management practitioners. The results confirm that at the beginning of implementation, the strengths model was perceived as complex and not always adaptable to on-the-ground realities. With time, and with support from management, ongoing training and supervision sessions, and reflection and discussion, practitioners regained feelings of competence and resistance to the model diminished. The use of the model's structured team-based supervision tools was fundamental to supporting the implementation process by enabling an interactive and concrete training approach.
Conclusions:
The more an approach leads to changes in daily practice and is perceived as complex, the more concrete support is needed during implementation. This article highlights the importance of attending to a practitioner's sense of personal effectiveness and competence in the adoption of new practices.
... Social work profession has a long tradition in commitment to enhance individual well-being using the social work strengths model of mental health recovery (Rapp & Sullivan, 2014). A review of 14 strengths model case management (SMCM) teams serving persons with serious mental illness showed that patients in teams with higher fidelity scores in adherence to the SMCM components showed significant improvement in reduction of psychiatric hospitalization, higher percentage of postsecondary education attendance and marginally significant 13 improvement in rates of competitive employment (Fukui et al., 2012). Similarly, a review of five studies of strengths-based interventions for persons with serious mental illness showed improved outcomes in hospitalization rates, employment/educational attainment and sense of self-efficacy and hope (Tse et. ...
... The case illustration demonstrates the clinical utility of the Social Work Strengths Model to provide a framework based on a comprehensive psychosocial history to identify unique strengths and areas to develop capacity for change, and assist with the coding of protective factors of SAPROF to focus on the Key and Goal protective factors to formulate an individualized risk management plan that balances the safety of the public and the recovery needs of the person found NCRMD for the RB. The Social Work Strengths Model has the support of emergent evidence of positive recovery outcomes from the social work strengths model of mental health recovery (Fukui et al., 2012;Tse et. al., 2016). ...
A Strengths Model of violence risk assessment, integrating a strengths-based psychosocial history in mental health recovery and protective factors of violent risk reduction, is proposed to address the concern about overprediction of violence in assessment with forensic mental health patients based on risk factors of violence. A case illustration is presented to demonstrate the Model’s capability to promote a more balanced violence risk assessment and formulate individualized risk management and recovery plan predicated on the person’s strengths and resources. Implications for clinical practice and the potential in research to enhance predictive validity and accuracy in violence risk assessment are discussed.
... Most studies have found strengths-based interventions to be effective in improving some outcomes such as employment and reported improved physical and mental health. For example, there has been a reduction in the duration of stay in hospital among service users who received case management under the strengths model (Björkman, Hansson, & Sandlund, 2002;Blow et al., 2000;Fukui et al., 2012) and their satisfaction with service also increased (Björkman et al., 2002); service users also have improved psychological well-being such as self-esteem, self-efficacy, personal confidence, sense of hope, and life satisfaction (Barry, Zeber, Blow, & Valenstein, 2003;Fukui et al., 2010;Green, Janoff, Yarborough, & Paulson, 2013;Hui et al., 2015); and these improvements could also enhance their employability and educational attainments (Green et al., 2013). However, the evidence is inconclusive because most of these study designs were moderate or poor, for example, the Hui and associates' study used a single group, pre-and posttreatment design, and without fidelity tracking (Ibrahim, Michail, & Callaghan, 2014;Tse et al., 2016) and they failed to differentiate the confounding variables of the strength-based approach. ...
... Second, fidelity was monitored at all three of the intervention sites, but only one intervention site (supported hostels) succeeded in achieving a high overall fidelity score (an average of 4/5 in all of the core items). Consistent with the earlier work of Fukui et al. (2012), in the high-fidelity setting of the present study, improvements were found in the psychological processes of service users and in their relationships with their caseworkers (therapeutic alliance). To the best of our knowledge, this is the first study that has provided preliminary evidence to support the finding that high-fidelity SMCM can have a positive impact on service users' outcomes to have been completed outside the United States within a different health-care system (e.g., Hong Kong has a much higher caseload for community psychiatric social workers with only 5.9 social workers per 100,000 population as compared to 17.93 social workers per 100,000 population in the United States as of 2011; Word Health Organization, 2011). ...
This study evaluates the effectiveness of the strengths model of case management (SMCM) for people with severe mental illness in Hong Kong. This is the first controlled trial outside the United States to investigate the impacts of SMCM on caseworkers as well as service users alongside fidelity measures.
... Fidelity to the strength-based model including the SBGS component of the model is thought to be essential for improvement in client outcomes to be realized. In a USA study of 14 case management teams over an 18-month period, it was found that fidelity to the strengths model was related to improvements in consumer outcomes (Fukui et al. 2012). Separate effects of SBGS were not reported. ...
... Separate effects of SBGS were not reported. It was noted that although most teams were able to achieve high fidelity within 12 months, for much of the 18-month study period, mental health teams did not achieve high fidelity (Fukui et al. 2012). There is a need to assess whether the strengths model can be applied successfully in other countries. ...
The strengths model (SM) is a recovery-oriented model of mental health care. Historically, training alone has been insufficient to ensure implementation of SM skills in practice. The aim of the current study was to determine whether improvements in recovery attitudes and attendance at Strength-Based Group Supervision (SBGS) following training are associated with greater skill implementation in practice. Mental health providers (N = 76) were trained in SM interventions and surveyed immediately before and after training and at a 6-month follow-up on various recovery attitude measures and SBGS attendance. Results showed that providers’ attitudes were significantly improved after completing the training programs; however, only willingness to support consumers in positive goal-oriented risk taking remained significantly improved at 6-month follow-up. The frequency of attendance at SBGS sessions was low, and this may have contributed to a lack of consistent evidence that SBGS attendance was associated with sustained improvements in attitudes or SM skill implementation. Future research is needed to clarify the ability of public sector mental health organizations to successfully implement and sustain SM approaches in practice. The role of ongoing SBGS in this process also requires continued investigation.
... Strengths model case management (SMCM) denotes a specific use of the strength model to enhance recovery among people with psychiatric disabilities (Fukui et al., 2012). Full implementation of SMCM consists of structural components (low caseload sizes, low supervisor-to-case manager ratio, weekly group supervision using a structured format for case presentations, and so on) and practice components (such as use of the strengths assessment and personal recovery plan tools, use of naturally occurring resources to achieve goals, and in-person service delivery). ...
... It also requires specific supervisory behaviors to teach and reinforce practice skills of frontline staff. Studies testing the effectiveness of using SMCM to assist people with psychiatric disabilities have reported positive outcomes in the areas of hospitalization, housing, employment, symptoms, leisure time, social support, and family burden (Fukui et al., 2012). ...
This chapter explores the interfaces between positive psychology and social work, to highlight common and complementary aspects of each profession, and to offer an integrative view. It presents the basic underpinnings of positive psychology and social work and discuss the similarities between their definitions and goals; and also makes note of their differences. The chapter focuses on two major areas of intervention in social work, namely, domestic violence and mental health. Lastly, it discusses the challenges likely to arise from the integration of positive psychology principles and social work strategies into a unified new concept of positive regard for people and their environments. Positive psychology and social work both focus on promoting well-being and identifying personal strengths. Positive psychology principles and social work strategies ought to be synergized into a unified new concept of positive regard for people and their environments.
... Further, an examination of international guidelines would suggest that the integration of client strengths into treatment planning is widely recognized as an expected competency (APA Presidential Task Force on Evidence-Based Practice, 2006; Australian Health Ministers' Advisory Council, 2013; National Alliance on Mental Illness [US], 2016). Strength-based approaches have developed synergistically, and in some cases in parallel to each other, across a variety of disciplines, for example, in nursing (Gottlieb et al., 2012) and psychiatric social work (Fukui et al., 2012). Strength-based services have also been connected to other advances in the care of individuals with mental illness including, for instance, procedural justice, the recovery model, trauma-informed care, and person-centered care (Vandevelde et al., 2017). ...
This chapter provides a succinct review of the literature demonstrating that the general mental health literature has largely integrated the principles of positive psychology and that the importance of including strengths is firmly entrenched in mental health as standard, evidence‐based practice. It considers the importance of integrating strength‐based approaches as well as the alignment of existing models (such as RNR) to facilitate desistance from aggression and crime. The Safewards Model, Recovery Model, Reasoning and Rehabilitation, Enhanced Thinking Skills, Tidal Model, Therapeutic Communities, and Changing Lives and Changing Outcomes are outlined. In addition, Promising practices such as art therapy, mindfulness, meditation and yoga are reviewed. The chapter concludes that there is a growing body of solid research evidence to support the use of strength‐based approaches for the treatment of offenders with mental illness.
... Studies with SMCM have shown that the intervention can lead to improvements in clients' quality of life, life satisfaction, and goal attainment compared with other forms of community supports (10)(11)(12)(13)(14). One study found that SMCM fidelity is associated with clients' achieving higher levels of employment and education and having lower levels of hospitalization (15). Another study reported trends toward higher hope, greater well-being, and better recovery in a high-fidelity SMCM subgroup compared with treatment as usual (13). ...
Objective:
The purpose of this study was to examine how the client–case manager working alliance in strengths model case management (SMCM) mediates the relationship between fidelity to the SMCM intervention and clients’ quality of life, hope, and community functioning.
Methods:
In total, 311 people with severe mental illness, served at seven community mental health agencies in Canada, participated in the study. They were new to SMCM and participated in five structured interviews every 4.5 months for 18 months to measure the quality of the client–case manager working alliance and clients’ quality of life, hope, and community functioning. The team-level SMCM fidelity scale was administered six times over 3 years. Ordinary least-squares path analysis was used to test simple mediation models.
Results:
Higher fidelity to SMCM was associated with better client outcomes indirectly through the working alliance. Higher SMCM fidelity predicted a stronger working alliance, which in turn predicted greater improvements in client quality of life (at 9 months and 18 months), hope (at 18 months), and community functioning (at 9 months).
Conclusions:
The results support the view that SMCM is an effective intervention. When the intervention was implemented as planned, it fostered stronger working alliances between clients and case managers and contributed to greater improvements in the quality of life, hope, and functioning of people with severe mental illness. The findings of this study highlight the value of ongoing monitoring of implementation fidelity to achieve high-fidelity interventions that may lead to positive client outcomes.
... The development of the SMCM Fidelity Scale has enabled the assessment of strengths model fidelity in both research and practice contexts (Teague et al., 2012), with feedback used to monitor and improve the quality of delivery. The scale has been used in two recent studies where higher fidelity of implementation was associated with better client outcomes in a number of domains, including hospitalization rates, employment/educational attainment and intrapersonal outcomes such as hope and well-being (Fukui et al., 2012;Tsoi et al., 2019). While both studies reported improvements in total fidelity over time, item and sub-domain scores were not reported, limiting learning to improve implementation. ...
While strengths approaches are important to recovery-oriented practice, implementation can be challenging. This study implemented the strengths model of case management (SMCM) in 11 CM teams and assessed the fidelity of delivery and staff perceptions of the model after 36 months using the SMCM fidelity scale and the Readiness Monitoring Tool. Paired sample t-tests assessed change in fidelity from baseline to 36 months. Adjusted regression analyses compared survey responses of direct and management staff. While fidelity ratings significantly improved across all domains, at 36 months they remained suboptimal in supervision practices and use of model tools. Staff perceptions were generally positive but consistently lower for front-line than management staff. Implementing SMCM into existing case management practice with good fidelity is feasible. However, clear support from management may strengthen staff motivation and delivery. A review of practice later in implementation can flag challenges for sustainability and guide implementation support.
... My reflections also revealed the importance of professionals including and supporting both me and my mother but reiterated the need to enable me to reassert my agency in treatment choices and appointments, disrupting the sense of codependency. Despite this, my mother emphasized a message of hope and optimism as suggested in the recovery model (19), as denoted in the CHIME model 1, and encouraged me to focus on my strengths (20). Such reinforcement can support people who experience mental distress to improve and sustain their sense of wellbeing, as my mother did in my case. ...
It is difficult to understand what it feels like for people with mental ill-health to be cared-for and supported by family members; this experience is often little-explored. Narratives about caring have been increasingly written alongside first-person accounts of recovery, however, there is a dearth of literature written to gain the perspective of being cared-for because of mental distress. Thus, using autoethnography, I present three critical incidents occurring at different points in my recovery to enable exploration of experiences of being cared-for. Firstly, a critical incident at the point of acute unwellness is introduced, secondly an incident during a consultation with a health professional is highlighted, and finally a moment of transition when embarking on an independent life with my husband-to-be is described. I use autoethnography to connect “the autobiographical and personal to the cultural, social, and political”. I consider how the identity of a carer is continually negotiated in a relationship with the service user in both the “private” and the “public” worlds during recovery. I reflect on how professionals can support both service users and carers in a triangle of care, by providing information and support, alongside promoting the development of independence and agency for the service user whilst in the caring relationship. Finally, I introduce a service model which promotes a family network approach to empower the service user, and highlight training programs on recovery that enable carers. I conclude by suggesting the potential of both approaches to support carers to promote the recovery of the service user.
... Thus, the selfempowerment and self-determination of service users are well supported so that they can have control over their well-being. The existing literature (including the SMCM-specific studies) supports the effectiveness of generic strengths-based case management in improving client outcomes, such as reducing hospitalization, improving physical and mental health, increasing employment, and increasing social support and satisfaction with life [1,[9][10][11][12][13][14][15][16][17]. Aside from client outcomes, Tsoi and colleagues [18] found that the SMCM was effective for reducing emotional exhaustion among case workers. ...
Background
The strengths model of case management (SMCM), which was developed by Rapp and Goscha through collaborative efforts at the University of Kansas, assists individuals with mental illness in their recovery by mobilizing individual and environmental resources. Increasing evidence has shown that the utilization of the SMCM improves outcomes, including increased employment/educational attainment, reduced hospitalization rates, higher self-efficacy, and hope. However, little is known about the processes through which the SMCM improves outcomes for mental health service users. This study explores the views of case workers and service users on their experience of providing or receiving the SMCM intervention.
Methods
A qualitative design was employed using individual interviews with service users and case workers drawn from two study conditions: the SMCM group and the control group (treatment as usual). For both study conditions, service users were recruited by either centres-in-charge or case workers from integrated community centres for mental wellness (ICCMWs) operated by three non-governmental organizations (NGOs) in different districts of Hong Kong. Through purposeful sampling, 24 service users and 14 case workers from the SMCM and control groups joined the study. We used an inductive approach to analyse the qualitative data.
Results
We identified two overarching themes: service users’ and case workers’ (1) perceptions of the impacts of the interventions (SMCM and control group) and (2) experiences of the interventions, such as features of the interventions and the factors that facilitated the outcomes. The results showed that there were improvements in the functional recovery of the SMCM group in areas such as employment and family relationships, how self-identified goals were achieved, and how service users gained a better understanding of their own strengths and weaknesses. Regarding their experience of the interventions, participants in both the SMCM group and the control group reported that a good relationship between service users and case workers was vital. However, some concerns were raised about the use of SMCM tools, including the strengths assessment and the personal recovery plan (PRP) and the risk of case workers being subjective in the presentation of cases in group supervision sessions.
Conclusion
The results were promising in terms of supporting the use of the SMCM, with some refinements, in mental health services for Chinese clients.
Trial registration
The Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12617001435370 , registered on 10/10/2017.
... The feasibility of rehabilitation methods based on the Strength model is well established in mental health/psychiatry settings. This is illustrated by its association with positive results on different outcomes including decreased hospitalisation, improved quality of life, and improved social functioning [16,[28][29][30]. During the conduct of our study the results of another study, one on the effectiveness of CARe, a Strength-based method, were published [31]. ...
Background:
For people with disabilities, chances to find or keep work are negatively affected by multiple problems like lower education, poverty and poor health. Furthermore, although active labour market policies proved to be effective for unemployed in general, success rates are poor for persons who are unemployed due to multiple problems. The present study aims to describe the development of a method as well as professional training to teach its application, and to assess the feasibility of method and training. The Strength-based method (CARm) aims to promote employment of work-disability benefit recipients with multiple problems.
Methods:
The main principles of the Strength model were redesigned for better applicability in a population of work-disability beneficiaries, resulting in the CARm method. As part of the CARm method, a training module for Labour Experts (LEs) was developed. To assess the new designed method and training, a one-group, pre-post design was used. Data were collected from eight participating LEs, five female and 3 male, aged between 41and 55 years and having 2-17 years working experience. We used self-report questionnaires and a semi-structured discussion meeting after the training sessions with the LEs.
Results:
Eight labour experts (LEs) from the Dutch Social Security Institute participated in the study. Most LEs felt an improvement in their ability to ascertain developmental needs, opportunities and threats in the client's situation. Three months after the training, LEs almost unanimously agreed on the statements 'I expect to use the CARm method more frequently in the future' and 'I use the CARm method in daily practice whenever possible'. The overall rating for the training on a scale from 1 to 10 was 7.6 (range 7-9). The overall satisfaction with the trainers was good.
Conclusions:
The CARm method and training was found to be a feasible approach to facilitate LEs working at the UWV reintegration service to support clients with multiple problems. Sufficient managerial support for participating LEs is a key factor for successful implementation of CARm. Results show that CARm is worth testing for efficacy in a future trial.
... This process of reflection helps social workers to create safe spaces to talk about concerns, experiences and future visions as to how spirituality can facilitate recovery. Moreover, social workers uniquely work from a strengths perspective in order to assist a service user to identify their own potential on their recovery journey (Fukui et al., 2012); thus helping the person to find their purpose. Furthermore, we need to help service users to frame the experience to take control, regardless of their religious or faith belief. ...
Increasingly, experts-by-experience want to explore their spiritual and religious needs as part of their mental health recovery; the contribution of social workers to the journey of spiritual recovery is under-developed. A first-person narrative about spiritual recovery experienced by the first author, an expert-by-experience and an academic, is presented to illuminate understanding of the elements supporting this journey. The method builds on evidence that acknowledges the significance of understanding direct expertise-by-experience alongside a tradition of using creative writing to facilitate professional reflection. Both authors use iterative processes to analyse the narrative and propose a tentative model of spiritual recovery. It is then argued that social work, with its foundation in the bio-psycho-social model and its specific practice methods is well placed to support the spiritual recovery of people who experience mental distress. Moreover social workers have an ethical duty to promote respect for cultural diversity and to demonstrate cultural competency. We discuss how professionals can work effectively with service users to support their mental health and spiritual recovery. Ensuring that social work education is based on anti-discriminatory practice, and that social workers have access to training to develop knowledge about spirituality, will enhance their abilities to meet the spiritual needs of experts-by-experience in their recovery
... To enhance the sense of self-worth of an individual, an important strategy for community mental health services is the adoption of a strength-based practice , which has been suggested to be effective in promoting personal recovery for people with severe mental illness (Tse et al. 2016). For example, a strength-based self-help workbook has been shown to be effective in promoting self-esteem (Fukui et al. 2012), personal confidence, and hope (Green et al. 2013) for self-help group participants with severe mental illness. However, as there is a lack of research studies on the effectiveness of the strength-based practice in Chinese communities, more research studies are needed in this area in the nearest future. ...
This research study aims to identify the psychosocial factors predicting the personal recovery of people with severe mental illness in a Chinese society. A cross-sectional research design was adopted that involved a random sample of 266 community-dwelling people with severe mental illness in Hong Kong. These individuals were assessed in terms of their personal recovery, self-esteem, and self-stigma by using standardized assessment scales. While personal recovery is related to and/or predicted by various psychosocial factors, the results of hierarchical multiple linear regression analyses showed that self-stigma subscales were significant predictors of personal recovery, while self-worth was the strongest predictor of personal recovery. Thus, it is important to enhance the sense of self-worth and reduce self-stigma of people with severe mental illness to facilitate their personal recovery.
... Patient navigation involves a paraprofessional or experienced peer helping persons link to health care and services, assist with insurance, problem solve barriers to care, and provide supportive counseling and follow-up to motivate engagement and retention in health and prevention services. Coaching is based on the strengths-based model [106], which has demonstrated positive impact with homeless youth [107] and persons living with HIV [108]. Critical components of the model include identifying personal and interpersonal strengths rather than deficits and then setting, problem-solving, and accomplishing long-and short-term client-centered goals selected by participants in collaboration with coaches with a focus on hierarchies of needs (housing, food, and employment) as well as programmatic priorities. ...
Background:
America's increasing HIV epidemic among youth suggests the need to identify novel strategies to leverage services and settings where youth at high risk (YAHR) for HIV can be engaged in prevention. Scalable, efficacious, and cost-effective strategies are needed, which support youth during developmental transitions when risks arise. Evidence-based behavioral interventions (EBIs) have typically relied on time-limited, scripted, and manualized protocols that were often delivered with low fidelity and lacked evidence for effectiveness.
Objective:
This study aims to examine efficacy, implementation, and cost-effectiveness of easily mountable and adaptable, technology-based behavioral interventions in the context of an enhanced standard of care and study assessments that implement the guidelines of Centers for Disease Control and Prevention (CDC) for routine, repeat HIV, and sexually transmitted infection (STI) testing for high-risk youth.
Methods:
Youth aged between 12 and 24 years (n=1500) are being recruited from community-based organizations and clinics serving gay, bisexual, and transgender youth, homeless youth, and postincarcerated youth, with eligibility algorithms weighting African American and Latino youth to reflect disparities in HIV incidence. At baseline and 4-month intervals over 24 months (12 months for lower-risk youth), interviewers monitor uptake of HIV prevention continuum steps (linkage to health care, use of pre- or postexposure prophylaxis, condoms, and prevention services) and secondary outcomes of substance use, mental health, and housing security. Assessments include rapid diagnostic tests for HIV, STIs, drugs, and alcohol. The study is powered to detect modest intervention effects among gay or bisexual male and transgender youth with 70% retention. Youth are randomized to 4 conditions: (1) enhanced standard of care of automated text-messaging and monitoring (AMM) and repeat HIV/STI testing assessment procedures (n=690); (2) online group peer support via private social media plus AMM (n=270); (3) coaching that is strengths-based, youth-centered, unscripted, based on common practice elements of EBI, available over 24 months, and delivered by near-peer paraprofessionals via text, phone, and in-person, plus AMM (n=270); and (4) online group peer support plus coaching and AMM (n=270).
Results:
The project was funded in September 2016 and enrollment began in May 2017. Enrollment will be completed between June and August 2019. Data analysis is currently underway, and the first results are expected to be submitted for publication in 2019.
Conclusions:
This hybrid implementation-effectiveness study examines alternative models for implementing the CDC guidelines for routine HIV/STI testing for YAHR of acquiring HIV and for delivering evidence-based behavioral intervention content in modular elements instead of scripted manuals and available over 24 months of follow-up, while also monitoring implementation, costs, and effectiveness. The greatest impacts are expected for coaching, whereas online group peer support is expected to have lower impact but may be more cost-effective.
Trial registration:
ClinicalTrials.gov NCT03134833; https://clinicaltrials.gov/ct2/show/NCT03134833 (Archived by WebCite at http://www.webcitation.org/76el0Viw9).
International registered report identifier (irrid):
DERR1-10.2196/11165.
... Next, results from recent studies showed that SMCM fidelity affects intervention outcomes across service sites, with high-fidelity SMCM associated with lower rates of psychiatric hospitalisation and higher employment rates. 32 However, little is known about the important constituent of the strengths model approach and how the fidelity scores (or distribution across different items) have impacted on service users' recovery outcome. Finally, the conceptualisation of strengths is culturally defined through linguistics, metaphors, icons and folklore traditions. ...
Introduction
Strengths-based approaches mobilise individual and environmental resources that can facilitate the recovery of people with mental illness. Strengths model case management (SMCM), developed by Rapp and Goscha through collaborative efforts at the University of Kansas, offers a structured and innovative intervention. As evidence of the effectiveness of strengths-based interventions come from Western studies, which lacked rigorous research design or failed to assure fidelity to the model, we aim to fill these gaps and conduct a randomised controlled trial (RCT) to test the effectiveness of SMCM for individuals with mental illness in Hong Kong.
Methods and analysis
This will be an RCT of SMCM. Assuming a medium intervention effect (Cohen’s d=0.60) with 30% missing data (including dropouts), 210 service users aged 18 years or above will be recruited from three community mental health centres. They will be randomly assigned to SMCM groups (intervention) or SMILE groups (control) in a 1:1 ratio. The SMCM groups will receive strengths model interventions from case workers, whereas the SMILE groups will receive generic care from case workers with an attention placebo. The case workers will all be embedded in the community centres and will be required to provide a session with service users in both groups at least once every fortnight. There will be two groups of case workers for the intervention and control groups, respectively. The effectiveness of the SMCM will be compared between the two groups of service users with outcomes at baseline, 6 and 12 months after recruitment. Functional outcomes will also be reported by case workers. Data on working alliances and goal attainment will be collected from individual case workers. Qualitative evaluation will be conducted to identify the therapeutic ingredients and conditions leading to positive outcomes. Trained outcome assessors will be blind to the group allocation.
Ethics and dissemination
Ethical approval from the Human Research Ethics Committee at the University of Hong Kong has been obtained (HRECNCF: EA1703078). The results will be disseminated to service users and their families via the media, to healthcare professionals via professional training and meetings and to researchers via conferences and publications.
Trial registration number
12617001435370; Pre-results.
... Coaching is based on the strengths-based model [137], which has demonstrated positive impacts with persons living with HIV [138] and for HIV prevention. Identifying and accomplishing goals are critical components of the model. ...
BACKGROUND
America’s increasing HIV epidemic among youth suggests the need to identify novel strategies to leverage services and settings where youth at high risk (YAHR) for HIV can be engaged in prevention. Scalable, efficacious, and cost-effective strategies are needed, which support youth during developmental transitions when risks arise. Evidence-based behavioral interventions (EBIs) have typically relied on time-limited, scripted, and manualized protocols that were often delivered with low fidelity and lacked evidence for effectiveness.
OBJECTIVE
This study aims to examine efficacy, implementation, and cost-effectiveness of easily mountable and adaptable, technology-based behavioral interventions in the context of an enhanced standard of care and study assessments that implement the guidelines of Centers for Disease Control and Prevention (CDC) for routine, repeat HIV, and sexually transmitted infection (STI) testing for high-risk youth.
METHODS
Youth aged between 12 and 24 years (n=1500) are being recruited from community-based organizations and clinics serving gay, bisexual, and transgender youth, homeless youth, and postincarcerated youth, with eligibility algorithms weighting African American and Latino youth to reflect disparities in HIV incidence. At baseline and 4-month intervals over 24 months (12 months for lower-risk youth), interviewers monitor uptake of HIV prevention continuum steps (linkage to health care, use of pre- or postexposure prophylaxis, condoms, and prevention services) and secondary outcomes of substance use, mental health, and housing security. Assessments include rapid diagnostic tests for HIV, STIs, drugs, and alcohol. The study is powered to detect modest intervention effects among gay or bisexual male and transgender youth with 70% retention. Youth are randomized to 4 conditions: (1) enhanced standard of care of automated text-messaging and monitoring (AMM) and repeat HIV/STI testing assessment procedures (n=690); (2) online group peer support via private social media plus AMM (n=270); (3) coaching that is strengths-based, youth-centered, unscripted, based on common practice elements of EBI, available over 24 months, and delivered by near-peer paraprofessionals via text, phone, and in-person, plus AMM (n=270); and (4) online group peer support plus coaching and AMM (n=270).
RESULTS
The project was funded in September 2016 and enrollment began in May 2017. Enrollment will be completed between June and August 2019. Data analysis is currently underway, and the first results are expected to be submitted for publication in 2019.
CONCLUSIONS
This hybrid implementation-effectiveness study examines alternative models for implementing the CDC guidelines for routine HIV/STI testing for YAHR of acquiring HIV and for delivering evidence-based behavioral intervention content in modular elements instead of scripted manuals and available over 24 months of follow-up, while also monitoring implementation, costs, and effectiveness. The greatest impacts are expected for coaching, whereas online group peer support is expected to have lower impact but may be more cost-effective.
CLINICALTRIAL
ClinicalTrials.gov NCT03134833; https://clinicaltrials.gov/ct2/show/NCT03134833 (Archived by WebCite at http://www.webcitation.org/76el0Viw9)
INTERNATIONAL REGISTERED REPOR
DERR1-10.2196/11165
... First, CTI was fairly implemented in the participating organizations (de Vet et al. 2017b). Research shows that high-fidelity programs produce better client outcomes (Fukui et al. 2012;McHugo et al. 1999). Better outcomes may have been obtained in the experimental group if CTI had been delivered with higher fidelity to the model. ...
Objectives:
To examine the effectiveness of critical time intervention (CTI)-an evidence-based intervention-for abused women transitioning from women's shelters to community living.
Methods:
A randomized controlled trial was conducted in nine women's shelters across the Netherlands. 136 women were assigned to CTI (n = 70) or care-as-usual (n = 66). Data were analyzed using intention-to-treat three-level mixed-effects models.
Results:
Women in the CTI group had significant fewer symptoms of post-traumatic stress (secondary outcome) (adjusted mean difference - 7.27, 95% CI - 14.31 to - 0.22) and a significant fourfold reduction in unmet care needs (intermediate outcome) (95% CI 0.06-0.94) compared to women in the care-as-usual group. No differences were found for quality of life (primary outcome), re-abuse, symptoms of depression, psychological distress, self-esteem (secondary outcomes), family support, and social support (intermediate outcomes).
Conclusions:
This study shows that CTI is effective in a population of abused women in terms of a reduction of post-traumatic stress symptoms and unmet care needs. Because follow-up ended after the prescribed intervention period, further research is needed to determine the full long-term effects of CTI in this population.
... Furthermore, IPS has a strong effect on vocational outcomes [23,30,31]. The strengths model is associated with positive results on different outcomes [32][33][34] including decreased hospitalization and improved quality of life and social functioning [33,35]. Although research on rehabilitation methods thus shows promising results, their effectiveness remains largely unknown. ...
Background
The CARe methodology aims to improve the quality of life of people with severe mental illness by supporting them in realizing their goals, handling their vulnerability and improving the quality of their social environment. This study aims to investigate the effectiveness of the CARe methodology for people with severe mental illness on their quality of life, personal recovery, participation, hope, empowerment, self-efficacy beliefs and unmet needs. MethodsA cluster Randomized Controlled Trial (RCT) was conducted in 14 teams of three organizations for sheltered and supported housing in the Netherlands. Teams in the intervention group received training in the CARe methodology. Teams in the control group continued working according to care as usual. Questionnaires were filled out at baseline, after 10 months and after 20 months. A total of 263 clients participated in the study. ResultsQuality of life increased in both groups, however, no differences between the intervention and control group were found. Recovery and social functioning did not change over time. Regarding the secondary outcomes, the number of unmet needs decreased in both groups. All intervention teams received the complete training program. The model fidelity at T1 was 53.4% for the intervention group and 33.4% for the control group. At T2 this was 50.6% for the intervention group and 37.2% for the control group. Conclusion
All clients improved in quality of life. However we did not find significant differences between the clients of the both conditions on any outcome measure. Possible explanations of these results are: the difficulty to implement rehabilitation-supporting practice, the content of the methodology and the difficulty to improve the lives of a group of people with longstanding and severe impairments in a relatively short period. More research is needed on how to improve effects of rehabilitation trainings in practice and on outcome level. Trial registrationISRCTN77355880, retrospectively registered (05/07/2013).
... To address low rates of engagement in care and increase viral suppression rates, strategies to improve retention in care represent a promising approach. One example is a strengths-informed approach which focuses on leveraging client strengths and recognizing the talents of each individual, rather than focusing on their perceived deficits, weaknesses, or illnesses [13,14]. The strengths model of case management, as defined by Marty et al. is comprised of six domains: engagement; strengths assessment; personal planning; resource acquisition; collective collaboration; and graduated disengagement [15]. ...
Engagement in HIV care is critical to achieve viral suppression and ultimately improve health outcomes for people living with HIV (PLWH). However, maintaining their engagement in care is often a challenging goal. Utilizing patient navigators, trained in an adapted ARTAS intervention, to help re-engage out-of-care PLWH has proven to be a valuable resource. This qualitative study describes the encounters between PLWH (n = 11) and their care re-engagement navigators (n = 9). Participants were interviewed in-person; interviews were transcribed and analyzed using the strengths model of case management. PLWH shared how working with navigators increased their motivation to return to HIV care and assisted them to overcome barriers that were a hindrance to care engagement. Navigators described a strengths-based approach to working with their clients, thus helping facilitate PLWH care re-engagement goals and successes. Results from this study may inform the development of effective HIV navigation programs to re-engage out-of-care PLWH, often the hardest-to-engage.
... Another explanation could be that the between-group difference in the primary outcome would have been more pronounced if CTI had been delivered with higher model fidelity. A fidelity assessment showed that, with an overall fidelity score of 3 of 5, CTI was fairly implemented in a representative subsample of 35 participants and research has shown that more faithfully implemented evidencebased practices produce better outcomes (Cuddeback et al., 2013;Fukui et al., 2012). However, this explanation is unlikely given there was little room left for improvement on this outcome in both conditions. ...
Highlights
This study contributes to a European evidence base for effective interventions for homeless people.
It is the first RCT conducted in Dutch shelter services; this is uncommon outside the United States.
In this sample, recurrent homelessness was rare 9 months after moving from a shelter to housing.
Beneficial effects of CTI on mental health seem to be independent of health care system or context.
... The formalization of SBP emerged as an alternative to the pathology-laden treatments for psychiatric disorders (Weick, Rapp, Sullivan, & Kisthardt, 1989), which focused on diagnosis, deficits, labelling, and problem solving (Saleebey, 2000(Saleebey, , 2001. Correlational, quasi-experimental, and experimental research in the context of social work and mental health care has shown that SBP have a favorable influence on a variety of outcomes, including social skills, stress tolerance, psychiatric symptomatology, physical health, quality of life, and education (Fukui et al., 2012;Macias, Farley, Jackson, & Kinney, 1997;Macias, Kinney, Farley, Jackson, & Vos, 1994;Modrcin, Rapp, & Poertner, 1988;Stanard, 1999). Moreover, a strengths-based treatment of families and children with mental disabilities led to significant improvements in parental competency, child behaviors, and the level of cohesion and adaptability in these families at the 6-month follow-up (Lee et al., 2009). ...
In this article, we review theory and research on strengths use in an organizational context. We identify important antecedents of strengths use, including personal initiative, organizational support for strengths use, autonomy, and opportunities for development. In addition, we position strengths use in Job Demands–Resources theory as one of the possible proactive behaviors that may foster the acquisition of personal and job resources, and indirectly promote work engagement and performance. Since strengths use has important ramifications for employee functioning, strengths use interventions seem an important next step in strengths use research. We outline important questions for future research, and discuss practical implications of our theoretical analysis. We conclude that organizations should encourage employees to use their strengths, because when employees capitalize on their strong points, they can be authentic, feel energized, and flourish.
Background The strengths-based approach (SBA) was initially developed for people living with mental health issues but may represent a promising support option for community participation of people living with a traumatic brain injury (TBI). A community-based organisation working with people living with TBI is in the process of adapting this approach to implement it in their organisation. No studies explored an SBA implementation with this population. This study explores the implementation of key components of the SBA in a community-based organisation dedicated to people living with TBI. Methods A qualitative descriptive design using semi-structured interviews (n = 10) with community workers, before and during implementation, was used. Transcripts were analysed inductively and deductively. Deductive coding was informed by the SBA fidelity scale. Results Group supervision and mobilisation of personal strengths are key SBA components that were reported as being integrated within practice. These changes led to improved team communication and cohesiveness in and across services, more structured interventions, and greater engagement of clients. No changes were reported regarding the mobilisation of environmental strengths and the provision of individual supervision. Conclusion The implementation of the SBA had positive impacts on the community-based organisation. This suggests that it is valuable to implement an adaptation of the SBA for people living with TBI.
The strengths of model of case management is a recovery‐oriented model of community mental health care that has been linked to positive consumer outcomes. The aim of this qualitative study was to explore the consumer perspective of the strengths model of case management using a descriptive phenomenological approach. Data were collected through in‐depth, semi‐structured interviews. In total, six consumers from a metropolitan community mental health service were interviewed. Interview transcripts were analysed using Colaizzi's phenomenological method. Three major themes were identified: the relationship between the consumer and the case manager is valuable, the strengths assessment supports identifying strengths and areas for action and the strengths model of case management promotes recovery and goal achievement. Implications for practice include an increased understanding of consumer preferences and promoting the consumer voice, thereby supporting the provision of higher quality evidence‐based practice.
In this article we discuss the nature of service user involvement in Higher Education (HE) social work programmes in both England and Slovenia. This discussion is based on our experiences of supporting such programmes alongside evidence derived from the literature. Firstly, we present a discussion of the effective development of service user involvement in the respective HEIs in our two countries. Secondly, we explore how the involvement of experts-by-experience in HEIs benefits the learning of social work students. Thirdly, we investigate how the emergence of Covid-19 has influenced the delivery of social work education and the involvement of service users in our respective social work programmes. We conclude by noting that our social work programmes have been forced to adapt to the needs of students in an online community and have embraced inclusive education. As a result of this, we suggest that the needs of experts-by-experience should inform the development of social work education and that they should be consulted on how they choose to be involved in educational practice. Key words experiential knowledge, expertise-by-experience, service user involvement, England, Slovenia
Case management has been a core component of the mental health service delivery system since the 1960s. While the term has remained constant in the vernacular to the present time, there has been confusion about what the term means and what it entails. Case management has evolved since its original conceptualization. The evolution of case management has been shaped by multiple factors including cost containment efforts associated with the advent of managed care, the rise of the peer movement and the paradigm shift of mental health recovery, and the expansion of populations targeted to receive case management. The evolution of various case management models that differ widely in their structure, function, and scope of service has further compounded the ambiguity around the term. While there are common core elements shared across these models, the manner in which these functions are carried out and the role of the case manager related to provision of services vary substantially. In this chapter, we trace the history of case management specifically as it applies to persons diagnosed with serious mental illness, review the evidence for specific models, outline key elements that distinguish each of the major models (i.e., Assertive Community Treatment, Strengths Model, Intensive Case Management), enumerate general principles of effective case management, and discuss current challenges.
ZUSAMMENFASSUNG
Der Übergang von der kinder- und jugendpsychiatrischen und -psychotherapeutischen Versorgung (KJPP) zu Versorgungsangeboten im Erwachsenenbereich stellt für junge Menschen mit psychischen Erkrankungen eine Herausforderung dar. Es drohen Behandlungsabbrüche, die Behandlungs- und Versorgungskontinuität ist gefährdet. Erfahrungen zeigen, dass nur ein kleiner Teil der jungen Erwachsenen einen reibungslosen Übergang erlebt, während die Mehrheit in die „Transitionslücke“ fällt. Nach einer Übersichtsdarstellung zu Forschungsergebnissen zu hiermit verbundenen Hindernissen innerhalb des Gesundheits- und Sozialsystems, stellt dieser Artikel traditionelle und neue digitale Möglichkeiten (ProTransition-App) zur Unterstützung junger Menschen in dieser Lebensphase vor.
An evaluation plan should be developed as the first step in evaluating a program or intervention at the heart of a demonstration. This plan can include decisions about the types of evaluation to conduct (the menu includes process analysis, impact analysis, and cost-benefit analysis). For impact analyses, the plan includes whether to use an experimental design, a quasi-experimental design, or some other approach; how to select the geographic area(s) to include in the evaluation; whom to include in the research population (e.g., everyone affected by the intervention being evaluated or just those who volunteer to participate in the evaluation); the outcomes to assess (e.g., earnings, transfer benefit amounts, health status, mortality); the number of years over which to assess those outcomes; the data to collect or obtain and use (e.g., survey data, administrative data, observation data); and the statistical methods to use. Decisions concerning these topics can cause enormous variation in how evaluations are conducted and the conclusions that they produce.
The chapter first discusses these topics, using the evaluation designs from 16 SSA evaluations to illustrate the points we make. These 16 evaluations, 12 of which were based on random assignment experiment, include all the SSA evaluations for which a published impact evaluation exists and where either the Social Security Disability Insurance (SSDI) program or the Supplemental Security Income (SSI) program was involved. Because the findings from these evaluations are described elsewhere in the book, we do not cover findings here, instead focusing on design and analysis topics. After discussing lessons from the SSA evaluations, the chapter discusses some topics about evaluation in practice that so far have garnered little attention in the SSA’s evaluations but are worth examining in future evaluations. These topics include alternative experimental designs (e.g., cluster randomization, staggered rollout designs, and factorial designs), rarely estimated effects (e.g., general equilibrium effects, entry effects, program components effects), and site representativeness.
L’exercice du travail social met en valeur une diversité d’approches et de modèles d’intervention. Parmi celles-ci, la notion de force a été intégrée à différents degrés au sein de la pratique. Reconnue pour permettre le développement personnel et favorisant le développement de l’autodétermination des personnes, la notion de forces recoupe différentes perspectives en travail social, ce qui constitue tant une preuve de son importance pratique qu’une source de confusion. Cet article a pour but de faire la lumière sur ces diverses perspectives, en exposant d’abord un bref historique du développement de la notion de force dans l’univers psychosocial ainsi qu’une définition. Ensuite, une mise en perspective des notions apparentées ainsi qu’une présentation des différents niveaux d’intégration de la notion de forces en travail social seront proposées. Finalement, un outil d’auto-évaluation de ses pratiques sera exposé. En conclusion, des enjeux reliés à l’implantation des pratiques orientées vers les forces seront mis en évidence, puis discutés.
Evidence-based practices are effective only when implemented faithfully. This paper explicates the history, standardization, and methods for developing and validating measures of fidelity. We overviewed the past 20 years of developing fidelity measures, summarized standardization of the development procedures, and described needed psychometric assessments. Fidelity assessment has become the sine qua non of implementation, technical assistance, and research on evidence-based practices. Researchers have established standardized procedures for scale development and psychometric testing. Widescale use of fidelity measurement remains challenging. The implementation of evidence-based practice and the development and validation of fidelity measures are interdependent. International improvements of mental health care will require attention to both.
La plupart des politiques dans le domaine de la santé mentale recommandent d’implanter les pratiques basées sur les données probantes. L’approche axée sur les forces est reconnue comme étant une pratique pouvant contribuer au rétablissement des personnes atteintes de troubles mentaux graves. Or, plusieurs études ont soulevé de nombreux défis d’implantation qui limitent sa portée. Une évaluation du processus d’implantation a été menée auprès d’intervenants ayant suivi une formation portant sur l’approche axée sur les forces. Les résultats indiquent que la formation n’est pas suffisante et qu’un engagement institutionnel est requis pour assurer la qualité de l’implantation.
L’intervention en contexte de nature et d’aventure (INA) est de plus en plus reconnue comme une méthode d’intervention pouvant contribuer à l’amélioration du bien-être général des personnes, autant dans les sphères physique, qu’émotive et psychologique. Les travaux qui en démontrent des effets positifs sont de plus en plus nombreux. Bien que cette modalité d’intervention soit généralement associée aux programmes en éducation, on peut la considérer en relation étroite avec les pratiques en travail social et particulièrement avec les interventions centrées sur les forces. L’objectif de cet article est de situer l’INA par rapport à celle-ci, telle qu’elle est présentée dans les écrits plus récents en travail social. Ces éléments sont mis en relief pour mieux circonscrire l’utilisation de l’INA en intervention psychosociale et en établir la proximité avec le travail social, en précisant en quoi cette modalité d’intervention rejoint les principes de l’approche centrée sur les forces.
I am a service user and academic working in a university social work department. My hybrid identity allows me to draw on different types of knowledge in all aspects of my work, including: academic, practice and experiential wisdom. Service user involvement is mandated across social work education but the scope and breadth of different kinds of participation is developed in diverse ways across university contexts. This article affirms the value of service user involvement in health and social care education, exploring its positive impact on students. When lecturers share personal experience of using services alongside practice and academic wisdom in the course of teaching, sometimes the value of experiential knowledge is doubted and its influence dismissed. I examine the importance of experiential wisdom in social work education, specifically when it is embedded in an academic role in a university social work department, and consider how it can be respected and valued. The parallel experiences of involving peer support workers in mental health services, who use their knowledge of recovery to mentor other service users, are then briefly examined, together with reflection of the concerns across mental health with professionals sharing their experiential wisdom with the people that they support.
The aim of this chapter is to provide a picture of the importance of vocational rehabilitation (VR) in supporting sick or injured people in keeping their job or in offering them another job. Many definitions have been proposed for VR. The definition proposed by the ICF seems the most comprehensive one. One of the key components of the ICF definition is the optimisation of work participation. VR is a complex activity since it is practised in varied organisational bodies and with the involvement of various countries, which can affect those who undergo VR, how the process is conducted, and what the outcomes are. VR can be seen as a process in its own right or as identical to the return to work (RTW) process. An important component in the RTW process is the assessment stage. The ICF core sets can play an important role as assessment tools. During the assessment phase, it is important to mobilise the person’s strengths and abilities rather than focusing on limitations and weaknesses. The strengths perspective in social work is well known in the case management field through Strengths Model case management. With regard to VR rehabilitation interventions, there is some support for the idea that workplace interventions have a certain effect on RTW. It is important to make use of individuals’ remaining working capacity, which is in line with the ICF biopsychosocial approach. It is important to rehabilitate people back to work instead of providing a disability pension. The visualisation of the ICF concept on the basis of benefits and limitations shows a number of significant benefits that can be used in the VR process.
Three methods of accounting for case manager effects in tests of the efficacy of mental health services are explored. These methods include (1) treating the case manager as a fixed factor, (2) treating the case manager as a random factor, and (3) examining service effects within the case manager. They are demonstrated with data from a nationally known case management program serving individuals with serious and persistent mental illness. Specifically, 3 conceptually distinct types of services provided or brokered by case managers are identified: habilitation-rehabilitation, community support, and traditional psychiatric services. The effectiveness of each in improving clients' adjustment is then examined with multiple regression adjustment strategies and each of the 3 methods to account for case manager effects. The results provide strong support for effects attributable to case managers and some support for the efficacy of habilitation-rehabilitation and community support services beyond the effects of traditional psychiatric services. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Reports on the results of 12 replications of the Strengths model of C. A. Rapp and R. Chamberlain (see record
1986-25462-001). 88% of the 235 clients had a psychotic diagnosis, and 59% were diagnosed as schizophrenic. The range between projects was 53% to 100% of clients with a psychotic diagnosis. 92% of the clients had experienced at least 1 hospitalization before entering the case management projects, and 72% had multiple prior hospitalizations. Not only did the number of goals set by the client increase, but the rate of goal attainment increased from 60.4% in Year 1 to 82.2% in Year 6. Only 15.5% of project clients returned to the hospital while participating in the project. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Community-based treatments for persons with serious mental illnesses have consistently proven to be effective. While most studies evaluate assertive community treatment (ACT) programs collectively, distinct models offer different approaches to improving participant outcomes. This study specifically examined the Strengths model versus more traditional ACT programs. Multivariate analyses tested changes in utilization, symptomatology, and clinical outcomes. Both ACT and Strengths reduced inpatient days while increasing outpatient care. Though all patients improved clinically, Strengths demonstrated a significantly greater advantage with symptomatology reduced by half. Findings support both treatment models, but additional clinical gains may be obtained from the Strengths approach.
Three methods of accounting for case manager effects in tests of the efficacy of mental health services are explored. These methods include (a) treating the case manager as a fixed factor, (b) treating the case manager as a random factor, and (c) examining service effects within the case manager. They are demonstrated with data from a nationally known case management program serving individuals with serious and persistent mental illness. Specifically, 3 conceptually distinct types of services provided or brokered by case managers are identified: habilitation-rehabilitation, community support, and traditional psychiatric services. The effectiveness of each in improving clients' adjustment is then examined with multiple regression adjustment strategies and each of the 3 methods to account for case manager effects. The results provide strong support for effects attributable to case managers and some support for the efficacy of habilitation-rehabilitation and community support services beyond the effects of traditional psychiatric services.
The Strengths model of team case management was assessed relative to an existing high quality psychosocial rehabilitation program that informally provided many services typical of case management (e.g., service linkage, monitoring, and consumer advocacy). The experimental evaluation triangulated consumer and family member responses with mental health professional reports and consumer records of hospitalization and crisis center contacts. An analysis of data from these four sources revealed that one year after full program implementation, consumers who received case management in conjunction with psychosocial rehabilitation functioned at a higher level of competency and experienced significantly lower psychiatric symptomatology than consumers who received only psychosocial rehabilitation. Implications for the successful integration of case management into an existing community support program are discussed.
While formal Strengths case management appears to be efficacious as a community support—and perhaps as a psychiatric rehabilitation—intervention, a formal program of case management does not appear to be essential to CMHC preparation for Medicaid capitated financing. The Valley Mental Health case management program significantly increased consumers' residential autonomy and attendance at primary therapy, but improvements on these two Medicaid-related variables were nearly matched within the control group through the efforts of other program staff. Taken as a whole, the study findings demonstrate that a formal case management program can work effectively in league with other CMHC programs to achieve specific managed care-related administrative goals, but that these delineated administrative goals can also be attained through a CMHC-wide mobilization of dedicated front-line staff.
Case management services have enjoyed a rapid increase in prominence within the mental health system as a solution to a variety of social service problems. The authors discuss a successful demonstration project that used social work students as case managers for the chronically mentally ill. An exploratory design was used and the results were positive for clients, students, and the system.
This study reports the results of an experiment comparing a developmental-acquisition model of case management to usual case management services provided through a mental health center. This is the first study of case management with the chronically mentally ill to employ a true experimental design comparing two types of case management service. The statistically significant discriminant functions resulting from the analysis correctly classified 77% of the subjects based on the case manager's assessment of clients' socialization skills, assessment of community living skills by a significant other and the client, the client's tolerance of stress, use of leisure time, community behavior, and vocational training. Implications for research and service delivery are discussed.
The purpose of this study was to determine the effect on client outcomes produced by training case managers in a strengths model of case management. Outcomes of interest included client's quality of life, vocation/education, residential living, hospitalization rate, hospital days, and symptoms. It also compared the results obtained by the strengths model with results of a generalist model. Case managers at the experimental site were trained in the strengths model. Those at the control site received no training. Data were collected at both sites prior to training and three months later. Improvement in quality of life, symptoms, and vocational/educational outcomes were found in the experimental group. Quality of life and vocational/educational outcomes were better in the experimental group than in the control group.
The Strengths Model: A Recovery-Oriented Approach to Mental Health Services
- C A Rapp
- R J Goscha
Rapp CA, Goscha RJ: The Strengths Model: A Recovery-Oriented Approach to
Mental Health Services. New York, Oxford
University Press, 2011
An empowerment agenda for case management research: evaluating the strengths model from the consumers' perspective; in Case Management: Theory and Practice
- W Kisthardt
Kisthardt W: An empowerment agenda for
case management research: evaluating the
strengths model from the consumers' perspective; in Case Management: Theory
and Practice. Edited by Harris M,
Bergman H. Washington, DC, American
Psychiatric Association, 1993