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

Roebuck, Maryann; Latimer, Éric; Bergeron-Leclerc, Christiane; Briand, Catherine; Durbin, Janet; Goscha, Rick; Krupa, Terry; Setliff, Alissa; Vallée, Catherine; Aubry, Tim

doi:10.1176/appi.ps.202100387

Cited by 7 publications

(12 citation statements)

References 30 publications

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“…Another line of investigation, not planned when the study was originally designed, involves applying ordinary least squares path analysis to test whether working alliance serves as a mediator variable between fidelity and outcomes. These analyses showed that higher fidelity was positively associated with clients’ QoL, hope, and community functioning outcomes, indirectly, through the client-case manager working alliance (Roebuck et al, in press).…”

Section: Discussionmentioning

confidence: 99%

Association between fidelity to the strengths model of case management and client outcomes: A quasi-experimental study.

Latimer¹,

Aubry²,

Barrett³

et al. 2022

Psychiatric Rehabilitation Journal

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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. Impact and ImplicationsImplementation of strengths model of case management (SMCM) was largely successful at seven sites in three Canadian provinces, but higher fidelity was not significantly associated with improved client outcomes. The sample size of 311 may have been insufficient. Given mixed findings from previous studies, and the compatibility of SMCM with a recovery orientation, further research, with strong designs and large sample sizes, is needed. This document is copyrighted by the American Psychological Association or one of its allied publishers.This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

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Section: Discussionmentioning

confidence: 99%

Association between fidelity to the strengths model of case management and client outcomes: A quasi-experimental study.

Latimer¹,

Aubry²,

Barrett³

et al. 2022

Psychiatric Rehabilitation Journal

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“…Studies conducted on patients with severe mental illness who attended community-based mental health programs showed that the working alliance with the case manager predicted fewer psychiatric symptomatology, better quality of life (De Leeuw et al, 2012;Roebuck et al, 2021Roebuck et al, , 2022Solomon et al, 1995), reduced health care use and mental health symptoms (Stergiopoulos et al, 2018), higher satisfaction with treatment (Sweeney et al, 2014), improved social functioning (Hopkins & Ramsundar, 2006), lower perceived stigma (Kondrat & Early, 2010), and greater life satisfaction (Chinman et al, 2000). In addition, users with a better relationship with their case manager might have greater levels of hope (Hicks et al, 2012).…”

Section: The Importance Of the Working Alliancementioning

confidence: 99%

Homeless people's recovery in Housing First and Traditional Services: The role of working alliance in Italian housing services

Curiale

Lenzi

Gaboardi

et al. 2023

Journal Community Psychology

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This study aims to investigate whether a working alliance could represent a potential mechanism that explains the effectiveness of housing services in terms of user recovery, comparing the Housing First (HF) model with Traditional Services (TS). This study included 59 homeless service users in Italy (29 = HF; 30 = TS). Recovery was assessed upon entering the study (T0) and after 10 months (T1). Results indicate that participants inserted in HF services were more likely to report stronger working alliances with social service providers at T0 that, in turn, was directly associated with higher levels of users' recovery at the beginning of the study and indirectly (through recovery at T0) with recovery at T1. Implications of the results are discussed with respect to research and practice on homeless services.

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“…This study was conducted as one component of a larger study that examined processes and outcomes related to fidelity to the strengths model of case management. [19][20][21][22] 2 | METHODS…”

Section: Strengths Model Researchers Have Reported Improvements In Cl...mentioning

confidence: 99%

“…In the present study, implementation took place within existing mental health programs, which entailed changing practices that could have been longstanding within the organization. This study was conducted as one component of a larger study that examined processes and outcomes related to fidelity to the strengths model of case management 19–22 …”

Section: Introductionmentioning

confidence: 99%

Implementation of strengths model case management in seven mental health agencies in Canada: Direct‐service practitioners' implementation experience

Briand

Roebuck

Vallée

et al. 2022

Evaluation Clinical Practice

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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.

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

Cited by 7 publications

References 30 publications

Association between fidelity to the strengths model of case management and client outcomes: A quasi-experimental study.

Association between fidelity to the strengths model of case management and client outcomes: A quasi-experimental study.

Homeless people's recovery in Housing First and Traditional Services: The role of working alliance in Italian housing services

Implementation of strengths model case management in seven mental health agencies in Canada: Direct‐service practitioners' implementation experience

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