工作联盟作为坚持优势为本个案管理与客户结果之间的中介。

The Working Alliance as a Mediator Between Fidelity to Strengths Model Case Management and Client Outcomes.

机构信息

School of Psychology, University of Ottawa, Ottawa (Roebuck, Aubry); Douglas Mental Health University Institute and McGill University, Montreal (Latimer); Département des sciences humaines et sociales, Université du Québec à Chicoutimi, Chicoutimi, Saguenay, Quebec (Bergeron-Leclerc); Department of Occupational Therapy, Université du Québec à Trois-Rivières, Trois-Rivières, and Research Centre of Montreal Mental Health University Institute, Montreal, Quebec (Briand); Centre for Addictions and Mental Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto (Durbin); California Institute for Behavioral Solutions, Sacramento (Goscha); School of Rehabilitation Therapy, Queen's University, Kingston, Ontario (Krupa); Eastern Health, St. John's, Newfoundland and Labrador (Setliff); Faculté de médecine, Université Laval, Quebec City, Quebec (Vallée).

出版信息

Psychiatr Serv. 2022 Nov 1;73(11):1248-1254. doi: 10.1176/appi.ps.202100387. Epub 2022 May 3.

DOI:10.1176/appi.ps.202100387

PMID:35502516

Abstract

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.

摘要

目的

本研究旨在探讨客户-个案经理工作联盟在优势模型个案管理（SMCM）中如何调节 SMCM 干预的忠实度与客户生活质量、希望和社区功能之间的关系。

方法

共有 311 名患有严重精神疾病的患者参与了这项研究，他们来自加拿大的 7 个社区心理健康机构，是 SMCM 的新手，在 18 个月的时间里，每 4.5 个月接受 5 次结构化访谈，以测量客户-个案经理工作联盟的质量和客户的生活质量、希望和社区功能。团队层面的 SMCM 忠实度量表在 3 年内进行了 6 次评估。使用普通最小二乘法路径分析来测试简单的中介模型。