Strengths Model Case Management: Moving Strengths from Concept to Action

Social work has long acknowledged the importance of focusing on the strengths of people and their environments. From the early years of Jane Addams and the settle- ment house movement (1902) to Bertha Capen Reynolds (1951) to Charlotte Towle (1953) to Germain and Gitterman (1979), voices from within the social work profes- sion have repeatedly called for a focus on the capabilities, resilience, and empower- ment of people and communities that have been marginalized throughout history. The University of Kansas School of Social Welfare drew upon the voices of these early pioneers and articulated the strengths perspective in the 1980’s (Weick, Rapp, Sul- livan, & Kisthardt, 1989), challenging the field to put the strengths and resources of people, communities, and their environments at the center of the helping relation- ship. Yet, despite these calls for an emphasis on strengths, deficit-based approaches continue to dominate conventional social work practice (Saleebey, 2009). It was within this tension that Strengths Model Case Management was developed. The Strengths Model represented a significant paradigm shift for mental health, social work, and other helping professions. People with mental illnesses have his- torically been oppressed by the societies in which they live, and this has often been reinforced (albeit unintentionally) by professionals responsible for helping them. When the Strengths Model was developed, traditional case management approach- es often focused on pathology and diagnosis, held low expectations for what people with mental illnesses could achieve in their lives, and frequently used stabilization and maintenance as measures of success. The Strengths Model arose in response to this, viewing people not only as capable and possessing a unique array of personal and environmental strengths but also challenging and inviting professionals to focus their efforts and support toward helping people achieve life goals and roles that anyone else in the community might pursue. This chapter provides an overview and the philosophical underpinnings of Strengths Model Case Management. The principles, research, and tools will be presented, along with a case example to demonstrate how the philosophy and practice approach work together. The chapter will conclude with a view of the implementation process for Strengths Model Case Management within an organizational setting and implications for the model moving forward. The purpose of this chapter is to emphasize the impor- tance of taking strengths from a verbalized concept to an actionable set of practice and organizational behaviors designed to improve the lives of the people

Finding Common Ground: Exploring the Experiences of Client Involvement in Medication Decisions Using a Shared Decision Making Model

While shared decision making has gained more prominence in recent years in the field of general health care, few shared decision making models have been studied in the field of mental health. This constructivist study explores the experiences of twelve persons diagnosed with schizophrenia or other major thought disorder, along with their treatment providers (prescribers, nurses, case managers, and peer support workers), when introduced to a shared decision making model around psychiatric medications. Purposeful sampling, with an emphasis on achieving maximum variation, was used to better understand the interactive processes that contribute to as well as hinder client involvement in shared decision making. Multiple interviews with all participants over a one year period allowed for meaning making to unfold over time. Simultaneous involvement with data collection and data analysis was part of an emergent design that culminated in tentative constructions based on participant's experiences. Findings were subjected to a comprehensive member check for confirmability. Findings explore the multiple interacting factors that contribute to client's involvement in shared decision making, including agreement on a goal that is meaningful and important to the client to guide decisions, the relationship between the prescriber and the client, the presence of non-pharmaceutical alternatives that expand decision options, and behaviors by auxiliary supports (i.e. case management and peer support) that facilitate involvement. Findings also explore the complexity of thought behind client's decisions to use psychiatric medications and the dynamics that change when a new model of decision making is introduced. The findings became the basis of proposing a new tentative framework for shared decision making as well as a concept called activation points. While the findings are intended to improve the process at a specific mental health center, readers are invited to join the dialogue in regards to the transferability of the findings to other settings

Study protocol for a randomised controlled trial evaluating the effectiveness of strengths model case management (SMCM) with Chinese mental health service users in Hong Kong

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

Randomised controlled trial evaluating the strengths model case management in Hong Kong

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