Understanding and evaluating strengths model case management in Hong Kong mental health services

Abstract

The recovery paradigm in mental health posits that individuals can recover through regaining hope and engaging in meaningful life roles and goals, and achieve personal recovery despite living with their symptoms. In Hong Kong and around the world, the practice of recovery-oriented innovations has become increasingly popular. Strengths Model Case Management (SMCM), sometimes known as the Kansas Model, is a widely practiced recovery model in the U.S. There is a lack of comprehensive understanding and evaluation of the SMCM in Hong Kong. This study sought to achieve three research aims: (1) Understanding the meaning of strengths in the context of mental health, according to local Hong Kong Chinese affected by mental illnesses; (2) Evaluating SMCM through the perspectives of service users; and (3) Evaluating SMCM through the perspectives of practitioners. To address these objectives, four studies were undertaken through engagement with a number of local non-governmental organizations. Study 1 was a qualitative study that looked at the ways in which service users define, identify and strengths and regain strengths, as well as to establish a Chinese translation for the word strengths. Results showed that family and work roles were highly regarded by participants as their personal strengths, whereas resources and opportunities in society were seen as the biggest environmental strengths. The agreed Chinese translations for the word strengths (ability (能力), and strong point (專長), have prompted four signature motifs that challenge the current conceptualization of human strengths in positive psychology literature. Study 2 was a 12-month controlled before-and-after trial. Results indicated that SMCM was effective in helping the participants to progress towards their recovery goals, as well as helping staff to alleviate burnout (emotional exhaustion). A high fidelity of the intervention was also associated with positive outcomes. Study 3 was an evaluative study conducted with staff that have participated in Study 2, or supervisors that oversaw the implementation of the intervention. Results revealed inadequate staffing was a challenge in implementation success, but the self-agency of users facilitates implementation; partnership between the practitioner and user and hope were seen as the critical ingredients of SMCM for positive impact. Study 4 used individual interviews to assess changes following SMCM for nine selected participants. Results revealed that participants experienced changes in their social self and experiences of self (seeing themselves as capable of making changes in life, increasing awareness of their emotions and the illnesses, regaining a sense of purpose). Participants suggested more flexibility in the frequency of contact hours, and a more innovative mode of delivery of SMCM. In summary, SMCM seemed to be effective in enacting changes in clients’ goals achievement as well as enhancing subjective dimensions of personal recovery. There is also some evidence that SMCM is beneficial for frontline practitioners. Judging from the findings, it is hoped that future efforts can be directed at achieving high fidelity to maximize effectiveness, coupled with participatory elements in the research design, implementation and evaluation phase such that effective, recovery-oriented practices can be achieved in Hong Kong.