Understanding the Role of Individual Consumer–Provider Relationships Within Assertive Community Treatment

Abstract

The widespread adoption of assertive community treatment has resulted in a shift from an individual model to a team model of case management. The shift has had implications for individual relationships between case managers and consumers, but still little is known about how these relationships develop in teams. This exploratory mixed methods study looked at how case managers and consumers negotiate individual relationships within a team model. Quantitative methods identified high and low service intensity relationships between consumers and case managers and qualitative methods explored and compared these relationships. Consumers in high service intensity relationships described a preference for certain case managers and the burden of working with multiple people. Case managers invested high service intensity relationships with special therapeutic value, articulated the challenges of coordinating care across the team, and utilized team limit setting techniques. In contrast, low service intensity relationships were more likely to reflect integration with the entire team. Findings suggest that teams need to consider how individual relationships enhance care for their consumers and how to nurture these relationships while maintaining the support necessary for case managers and consumers.

Aging in place within permanent supportive housing

“…The finding that providers believe older adults prefer to live in congregate settings is at odds with previous research that found people who have experienced homelessness would prefer to live independently in their own apartment (Tsemberis et al, 2004;Nelson et al, 2007) and is inconsistent with research that suggests most Americans express wanting to live independently regardless of age (Katz, 2011;Klinenberg, 2012). Although this may accurately reflect the preferences of some older adults who have experienced homelessness, provider misperception is also a likely explanation given documented discrepancies between the views of providers and homeless consumers (Stanhope and Matejkowski, 2010). An important distinction that neither the quantitative nor qualitative data differentiated between is that independent apartment living can be part of both single-site and scatter-site PSH (Tsemberis et al, 2004;Collins et al, 2012).…”

Users’ choice and change of allocated primary mental health professional in community-based mental health services: A scoping review

“…Accordingly, a qualitative study on 10 service users of mental health centres showed that changes in the allocated PMHP were experienced as setbacks in treatment, giving rise to negative feelings (Biringer, Hartveit, Sundfør, Ruud, & Borg, 2017). Even in team-based mental health services, the continuity of the individual relationship with one case manager seemed to play an important role for users' comfort level; users often expressed their preference for working with a particular case manager over others (Stanhope & Matejkowski, 2010). 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 F o r P e e r R e v i e w 11 Self-reports and questionnaires by 371 users of an Italian Community Mental Health service showed that users with the least education and those who spoke only Italian had a strong preference for a therapist of their own nationality (Lorefice & Borus, 1984).…”

Hjelpsomme relasjoner. En kvalitativ undersøkelse av samarbeidet mellom brukere med alvorlige psykiske lidelser og rusproblemer og fagpersoner i to oppsøkende team

“…Til tross for at betydningen av relasjonen er viet økende oppmerksomhet i forskningen, foreligger det relativt få studier som har involvert brukere med alvorlige psykiske lidelser, og spesielt ikke de med både psykiske lidelser og rusproblemer (Denhov and Topor, 2012). Ikke minst mangler det fortsatt utdypende beskrivelser som viser hvorfor brukerne og ansatte opplever de generelle kvalitetene ved relasjonen og arbeidsformene som hjelpsomme og hva disse generelle kvalitetene består i. Det finnes også relativt få studier som ser på relasjonens betydning i desentraliserte tjenester utenfor den psykoterapeutiske behandlingsrammen eller institusjonskonteksten, selv om det er noen unntak (Hørberg, Brunt og Axelsson, 2004;O'Brian, 2001;Stanhope andMetejkowski, 2010, Sommer, Strand, Borg og Ness, 2013). I I denne artikkelen vil vi derfor beskrive betydningen av relasjonene slik de utvikler seg innenfor rammen av lokalbaserte tjenester, og utdype begrunnelsene til ansatte og brukere for at visse relasjonskvaliteter og arbeidsformer er hjelpsomme.…”