Using Ethnographic Methods to Explore Team Culture and Recovery Orientation

Background and Purpose: A recovery orientation is imperative in mental health services. Recovery-oriented services embrace the philosophy that service users have choice and providers work with service users towards self-identified goals. Housing First (HF) is a recovery oriented housing program in which services users determine treatment and services. While structural aspects of a program like HF can influence service providers’ orientation to recovery principles, staff attitudes, values, and beliefs are central to the incorporation of recovery principles in every day practice. These attitudes, values, and beliefs are shaped by day-to-day interactions with each other and make up an important but rarely examined aspect of team culture.  Team culture has been examined predominately as a product of organizational and agency structures, but interactions among staff members are an important component of team culture that has been studied rarely. This study examined how case managers approached recovery-oriented work through an analysis of the discursive process within team meetings focusing on how language was used to represent service users.

Methods:  Over the course of a year, researchers followed 14 case managers from two treatment teams within a Housing First program. Researchers observed team meetings and took field notes on the social interaction between case managers. In-depth semi-structured interviews were also conducted with each study participant. Data analysis was guided by symbolic interactionism theory (Blumer, 1969). Open coding identified categories indicating discursive processes and higher level coding derived intersubjective themes related to representation of service users and meaning making. 

Results: Team meetings allowed a space for staff members to translate and understand service users’ behaviors.  The interactions showed discursive processes that accentuated the positive and softened the negative situations.  Team members used techniques such as giving benefit of the doubt, normalizing behavior, avoidance of medical model terminology, employing humor, and being non-judgmental as alternate ways to frame what could be perceived as perplexing or difficult behaviors among service users.  Small successes were celebrated and language served to heighten service user strengths. These discursive processes oriented providers to a recovery-oriented approach, representing service users as holistic individuals and creating a shared frame of reference for the team.

Conclusions and Implications: Through these discursive processes, case managers understood the life situations, hopes, goals, and needs of service users. The co-construction of narratives had a recursive quality:  shaping a team culture that in turn influenced their future interactions with service users. While structural aspects of mental health programs can incorporate recovery principles, the essence of recovery-oriented practice is often embedded in team culture.  Understanding the underlying processes that contribute to team culture can inform the implementation of recovery-oriented practice beyond structural reforms.

 Blumer, H. (1969). Symbolic Interactionism: Perspective and Method. Englewood Cliffs, NJ: Prentice-Hall