The role of process: Examining consumer -provider service interactions

Abstract

Objective. The recovery movement has affirmed the importance of consumer-provider relationships for people with severe mental illness (SMI). This naturalistic study examined the process of providing Assertive Community Treatment (ACT) services to homeless persons with SMI. ACT is an intensive case management model targeted towards hard-to-engage consumers. Although there has been extensive research on the structure of case management models, the actual process of engaging and maintaining consumers in services remains an understudied aspect of case management that may have considerable impact on consumer outcomes. The study examined consumer-provider relationships, coercion, and their impact on quality of services from both the provider and consumer perspective. Methods. Two focus groups were conducted with consumers and providers to explore consumer-provider relationships. Seventy individual service contacts were sampled for the quantitative part of the study. Case managers and consumers completed interviews measuring socio-demographic characteristics, service contact characteristics, consumer-provider relationships, utilization of coercive strategies, perceived coercion, and quality of service contact. Parallel measures distinguished between case manager and consumer perspectives. Multivariate regression analyses examined the effect of consumer-provider relationships and coercion on quality of service contact. Results. Consumer-provider relationships and perceived coercion, rather than utilization of coercive strategies, were strongly associated with quality of service contact. Consumer and case manager perspectives diverged, with consumer measures explaining the variance in outcomes more than case manager measures. Focus group findings illustrated the differences between the case manager and consumer perspectives, with case managers viewing the relationship as a means to obtain service goals, whereas consumers valued these relationships for their own sake. Conclusion. Findings demonstrate that, for consumers, quality of service is associated with positive consumer-provider relationships and not feeling coerced. With consumers whose connection to services is tenuous, immediate positive response to service interactions is vital to maintain engagement. Case managers need to have the clinical skills to understand the consumer perspective and prioritize the relationship within service provision. More evidence related to the process of service provision will facilitate translation of research to practice and promote recovery oriented services