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

The Strengths Model in Hong Kong

Mental health practice involves the continuous process of learning and refinement, especially when practitioners focus on the strengths and aspirations of individuals who are coping with serious mental illnesses (Tse et al., 2016). Cross-cultural considerations include beliefs, language, the role of social support, and the distinctive characteristics of specific communities that require localization in designing and offering mental health services. In this chapter, we describe the experience of adopting the Strengths Model in Hong Kong, starting with an introduction to the mental health system in the city. We then illustrate the development and implementation of the Strengths Model for the Chinese population in Hong Kong. We also briefly review research studies focusing on the Strengths Model in mental health practice in this cultural context (Tsoi et al., 2018; Tsoi, Tse, Canda, & Lo, 2019; Tse et al., 2019). The process of localization described in this chapter required the building of complex relationships among Strengths Model founders, scholars, organizations, caseworkers, and people facing mental health challenges

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