Randomized controlled trial of Strengths Model Case Management with Chinese mental health service users in Hong Kong

The Strengths Model Case Management (SMCM, please see: Rapp CA, Goscha RJ. The strengths model: a recovery-oriented approach to mental health services. New York: Oxford University Press; 2011) has been developed to promote recovery through instilling hope and empowering the choices and autonomy of clients. Case management refers to the process of assessing needs, implementing a service plan, and monitoring progress to bring about positive outcomes The six fundamental principles of the Kansas SMCM are: (1) people with psychiatric disabilities can learn, grow, and change; (2) the focus is on individual strengths rather than deficits; (3) the community is viewed as an oasis of resources; (4) the client is the director of the helping process; (5) the worker-client relationship is essential; and (6) the primary setting is the community. SMCM comprises two primary tools that are used during sessions between case workers and clients: (1) Strengths Assessment, which appraises the client’s strengths, niches, and other attributes, such as self-efficacy and sense of hope, as well as the resources available in the family and community; (2) Personal Recovery Plan, which uses the information obtained from the strengths assessment to derive a plan comprising recovery goals that are meaningful for the client. Co-construction of recovery goals between clients and case workers poses challenges. Weekly strengths-based supervision (i.e., group supervision and field mentoring that helps workers improve their practice skills in an actual setting with a service user) will assure the use of the SMCM tools. Group supervision follows these specific steps: (1) The presenting staff hand out clients’ strengths assessments and specify the help needed from the group. (2) The team are to clarify the assessment and brainstorm ideas. (3) The presenting staff review the ideas and state the next steps. Field mentoring is a structured form of supervision where the supervisor and case worker meet together with a client for the specific purpose of the case worker learning, developing, and/or enhancing skills or use of tools related to the model. Field mentoring sessions most often occur in the client’s home or in the community but they can be conducted at the office in some circumstances as long as it is structured as a learning opportunity for the case worker. These implementation features will be monitored by the Fidelity Scale. The intervention period is 12 months. The clients allocated to the Intervention Group will receive individual sessions of approximately 30 minutes once about every 2 weeks, at the centre or in the community. The case workers delivering the SMCM intervention received training provided by Kansas University previously. The Strengths Assessment and Personal Recovery Plan will be used to guide the intervention sessions. During the intervention, case workers will help the clients identify recovery goals that are meaningful to them. Case workers will attend group supervision sessions with Goscha (i.e. Dr. Rick Goscha, the founder of Strengths Model, he is the present project's one of the named investigators. Please see: Fukui S, Goscha R, Rapp CA, Mabry A, Liddy P, Marty D. Strengths model case management fidelity scores and client outcomes. Psychiatric Services. 2012;63(7):708-10) via Skype on a regular basis (i.e. once a month over the 12 month intervention period) and will engage in a weekly strengths-based supervision (led by their own agency's supervisor[s])run at ICCMWs. Strengths-based supervision includes review case notes, case discussion and seeking advise from team members and supervisors. Fidelity Scale will be used every 6-month to monitor if these high-fidelity activities take place as expected. A leadership team has been established in each ICCMW to oversee the activities.