Recovery In Mental Illness: The Relationship of Mental Health Case Managers' Perception of Consumers' Readiness to Work to Their Consumers' Active Movement Toward Employment

Background and Purpose: Research on recovery in mental illness has placed a premium on understanding consumer movement towards work. In addition, researchers are working to understand how case mangers/providers of mental health services directly or indirectly impact consumer movement towards recovery (Author, 2010a, 2010b). Part of this research enterprise has been to explore how case manager attitudes relate to consumer outcomes (O'Connell & Stein, 2010). The purpose of this study was: 1) to explore the relationship of community mental health case managers to their consumer's active movement toward employment; and 2) to determine if case managers' perceptions regarding what types of consumers are ready for employment relate to their consumers active movement towards employment. Methods: The researchers employed a cross-sectional design and recruited all case managers (n = 113) from 8 mental health agencies in one mid-western state. Case managers provided information about each of their consumers (n = 1556). Case managers also filled out a likert-type scale developed for this study – Perceptions of Employment Readiness Scale (PERS) – that explored the extent to which case managers believed consumers had to be in full recovery in order to work. The PERS had an alpha of .92. The dependent variable was active movement towards employment, and included filing out and/or turning in a job application, preparing for a scheduled job interview, attending a job interview, receiving supported employment referral, etc. Consumers were nested within case managers. In order to correct for potential autocorrelation issues associated with nested data structures, the researchers analyzed the data using a hierarchical generalized linear model with a Bernoulli distribution and logit link function. Results: The results indicated that case managers, themselves, accounted for almost 17 percent of the variance in consumer active movement towards employment. The probability by case manager that a consumer was actively moving towards work ranged from 11 percent to 77 percent. Of the 17 percent of variance in active movement towards employment, 25 percent was explained by the work stereotypes variable (β = -.76, t = -6.95, df =111, p < .01). Case managers with the lowest scores on PERS, which indicated less stringent ideas about what a consumer needed to look/behave like in order to work, had an consumers with a 308 percent increase in the likelihood of work. Case managers with the highest score had consumers with a 64 percent decrease in the likelihood of work. Conclusions and Implications: The results of this study point to the importance of frontline providers on consumer engagement in work related activities. Further, the results suggest that holding a view that a consumer needs to be nearly recovered does not foster consumer movement towards work. Further research is needed to determine the extent to which other case manager and even agency characteristics are associated with consumer movement towards employment. Finally research is needed to determine the practices that successful case managers use to help their consumers engage in employment based activities (Kondrat, 1992). Suggestions for interventions will be provided.

References

Author (2010a)

Author (2010b)

Kondrat, M. E. (1992). Reclaiming the Practical: Formal and Substantive Rationality in Social Work Practice. Social Service Review, 66, 237–55.

O'Connell, M.J., & Stein, C. (2010) The relationship between case manager expectations and outcomes of persons diagnosed with schizophrenia. Community Mental Health Journal. Advance online publication: DOI: 10.1007/s10597-010-9337