Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: Case management for people with psychiatric disorders has been widely researched and identified as an evidence based practice, but few studies have focused on process within the intervention. The black box aspects of interventions, the social interaction between consumers and providers, are highly valued by clients and strongly predictive of outcomes. Drawing on psychotherapy studies, researchers can identify methods to examine micro-level social interaction within clinical encounters. Fine grained analysis permits the study of changes in provider-client relationships over time, both positive and negative, in contrast to global measures of alliance. However, researchers must adapt these methods, which are designed for highly structured therapy sessions to the less controlled environments of field based settings. This federally funded study adapted methods from psychotherapy to measure engagement and relationships between case managers and homeless clients with psychiatric disorders.

Method: Replicating psychotherapy session-level analysis, the study measured 80 individual service interactions between case managers and clients. Immediately following a service interaction, clients and providers completed quantitative surveys measuring relationship, coercion, and quality of service interaction, yielding micro-level process data. Using parallel instruments for consumer and case managers enabled the study to capture both perspectives of the interaction.

Findings: The study found that the successful implementation of micro-level research in field based settings was dependent upon: 1) Modifying global measures of social processes, such as working alliance scales, for micro-level analysis and measures of therapeutic process for the broader activities of case management 2) Standardizing and sampling service interactions that varied widely according to location (home, street, community), time, activities, and participants involved 3) Addressing the difficulties of measuring more intense service interactions by building trust with clients and providers 4) Accommodating a nested design resulting from measuring dyadic interactions rather than individuals with statistical methods 5) Balancing the need for rigorous data collection with the need for flexibility in fluid service settings

Implications for Practice: By successfully adapting psychotherapy research methods to field based settings, researchers have the capacity to produce fine grained analysis of social interaction in unstructured service environments. Such research enhances the evidence base for practice by making it more reflective of important social processes that occur during front-line service provision. As a result, findings will be more translatable to the direct practice of social workers and mental health providers. Micro-level research yields insights into exactly how the most basic social work tool, the relationship, promotes positive change in our clients.