Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Saturday, January 13, 2007: 4:00 PM-5:45 PM
Seacliff B (Hyatt Regency San Francisco)
The Client-Provider Relationship in Serious Mental Illness: Honing in on the Perspective and Role of the Case Manager
Organizer:Beth Angell, PhD, University of Chicago
Reconciling Expectations: How Case Managers Make Sense of Their Relationship with Their Clients
Patrice M. Gammon, MSS, Leslie Alexander, PhD, Page Walker Buck, MSS
Conceptualizing and Measuring the Case Management Relationship from the Provider Perspective: From Grounded Theory to Instrument Development
Beth Angell, PhD, Colleen Mahoney, MA
The Impact of Provider Attribution Characteristics on the Quality of the Client-Provider Relationship
Colleen Mahoney, MA, Beth Angell, PhD
Abstract Text:
Research suggests that the client-provider relationship may mediate the outcome of case management interventions for people with serious mental illness (SMI). In addition, surveys that assess important aspects of services from the perspectives of consumers with SMI indicate that relationships with providers are consistently identified as critical. Based on these developments, scholars in psychiatric rehabilitation have called for increased attention to the client-provider relationship as a vehicle for change, as a complement or counterpart to the contemporary focus on evidence-based practices. Since relationships have always been recognized as central to the effectiveness of social casework, social work research is well positioned to contribute to the pursuit of knowledge about the development and importance of the case management relationship in SMI.

In this symposium, we propose that research on the case management relationship may be enriched by honing in on the nature and contribution of the case manager perspective. That is, most previous studies focus almost exclusively on the contribution of client-level characteristics, such as psychiatric symptoms and client demographics, in predicting the client-provider relationship. Such a focus may potentially lead to an overemphasis on client pathology and consequent underattention to characteristics and behaviors of providers that may also differentiate high and low quality case management relationships.

The symposium brings together findings from three studies of the case management relationship that employ innovative approaches to the study of the provider contribution. The first paper takes as point of departure a finding of low congruence between client and provider-reported alliance (consistent with several previous studies) and uses a qualitative approach to explore areas of convergence and divergence between client and case manager perspectives. As the findings highlight, case managers and clients possess unique perspectives on the relationship which should be taken into account in both research and practice. The second paper follows upon this theme by presenting a grounded theory study of the ways that case managers conceptualize the client-provider relationship in assertive community treatment. The study finds that the key dimensions discussed by case managers are not well assessed by existing instruments, and thus, the paper details the use of this conceptualization in the development of a new instrument to measure the relationship from the case manager perspective. The third paper examines the contribution of the case manager's clinical reasoning processes to the relationship as perceived by clients. Findings show that when case managers think about the problem of medication nonadherence in a differentiated manner (as opposed to a more simplistic reasoning style), their clients report both a stronger positive relationship valence (e.g., more liking and trust) and a less negative relationship valence (e.g., less conflict and resentment).

As a set, the papers exemplify novel conceptual and methodological approaches to the study of the case management relationship. Taken together, the studies identify that the provider's contribution to the relationship is distinct from that of the client, and therefore warrants further study. These findings also carry important implications for the training of case management practitioners.

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