Walking a Tightrope: Case Management Services and Outpatient Commitment

Effective case managers in community mental health are successful at forging a working alliance with recipients. This article explores one key aspect of case management practice, serving involuntary clients, specifically those on outpatient commitment orders. In 19 intensive interviews, a subset of a larger study, case managers shared their perceptions of the utility of outpatient commitment with a focus on how such orders impacted the professional relationship. We argue that the use of advance psychiatric directives and shared decision-making processes can reduce the need for coercive practice.     

Case management as a force for quality assurance and quality improvement in home care

To examine the extent to which case managers engage consciously in quality assurance activities for the services they purchase or arrange, semi-structured interviews were conducted with representatives of 75 case management agencies responsible for allocating home and community-based services with public funds, and 17 private, fee-for-service case management agencies. Relatively few agencies had developed formal criteria for defining quality, or systematic ways to assess it. Several types of quality oversight provided by case managers were identified: on-site review by case managers themselves, administrative review, and independent review by quality assurance staff. This article contains examples of best practices and discusses the policy implications of having case managers adopt a more explicit and rigorous role in assuring the quality of the services their clients receive.     

Worker skill and client outcome in child protection

The research in child protection and in work with other involuntary clients suggests that the use of certain skills by child protection workers is likely to be related to positive client outcomes. In particular, effective practice involves: helping clients and client families to understand the role of the child protection worker; working through a problem‐solving process which focuses on the client's rather than the worker's definitions of problems; reinforcing the client's pro‐social expression and actions; making appropriate use of confrontation; and using these skills within a collaborative client/worker relationship. This study attempts to identify the extent to which child protection workers make use of these skills and how these skills relate to client outcomes. Data were sought through 50 interviews with child protection workers and 282 interviews with family members. The child protection workers provided information about 247 client families. It was clear that when workers used the skills, their clients had better outcomes—the workers believed their clients showed better progress, the clients were more satisfied with the outcomes and the cases were more likely to have been closed 16 months later. Copyright © 2002 John Wiley & Sons, Ltd.     

Recognising Strategy and Tactics in Constructing and Working with Involuntary Social Work Clients

ABSTRACT

This paper reports on the author’s academic work on working with involuntary clients, which began with a knowledge exchange project in Scotland. I reflect back on this work and use it as a way to explore subsequent reflections on the field. These move beyond consideration of the skills required to undertake such work through locating the category of involuntary clients within wider, yet contradictory, governmental discourses on client engagement. These are identified as the strategy that sets the context for such work. But the strategy is enacted through the day-to-day tactics of social workers on the ground; such tactics, enacted in everyday encounters, are constitutive of effective but also ineffective engagement with clients. The discussion goes on to problematise the distinction between voluntary and involuntary clients and to suggest that effective social work practice, whatever the nature of that involvement, requires that clients are recognised at an ethical and relational level.

IMPLICATIONS

• The term involuntary client(s) cannot be taken for granted but is constructed and needs to be understood in particular and often contradictory policy and professional contexts.

• Effective but also ineffective ways of working with involuntary clients go beyond the acquisition or demonstration of particular skills but are embodied in the everyday relational practices of social workers.

• Ethical engagement with involuntary clients proceeds from a sense of mutual recognition.

     

A Case for the Case Study: How and Why They Matter

In this special issue we have asked the contributors to make a case for the case study. The guest editors, Jeffrey Longhofer, Jerry Floersch and Eric Hartmann, intergrate ideas from across the disciplines to explore the complexties of case study methods and theory. In education, Gary Thomas explores the importance of ethnographic case studies in understanding the relationships among schools, teachers, and students. Lance Dodes and Josh Dodes use the case study to articulate a psychoanalytic approach to addiction. In policy and generalist practice, Nancy Cartwright and Jeremy Hardie elaborate a model for a case-by-case approach to prediction and the swampy ground prediction serves up to practitioners. Christian Salas and Oliver Turnbull persuasively write about the role of the case study in neuro-psychoanalysis and illustrate it with a case vignette. In political science, Sanford Schram argues for a bottom up and ethnographic approach to studying policy implementation by describing a case of a home ownership program in Philadelphia. Eric Hartman queers the case study by articulating its role in deconstructing normative explanations of sexuality. In applied psychology, Daniel Fishman describes a comprehensive applied psychology perspective on the paradigmatic case study. Richard Miller and Miriam Jaffe offer us important ways of thinking about writing the case study and the use of multi-media. Each contributor brings a unique perspective to the use of the case study in their field, yet they share practical and philosophical assumptions.     

Motivating Russian workers: analysis of age and gender differences

What motivates Russians to work? Two hypotheses govern this analysis. First, worker motivation is positively correlated with organizational commitment, where organizational commitment is captured by a series of statements related to the employee’s perception of their workplace and the satisfaction expressed about the workplace and job. Second, worker motivation is positively correlated to the expectation that a desired reward will be received in exchange for doing the job well. Using survey data collected in May/June 2000 from 1200 employees in three regions of Russia, this paper: (1) documents the nature and scope of organizational commitment among Russian workers as the transition process draws to a close; (2) identifies the relative importance of select job motivators, as well as the expectation that these motivators will be received in exchange for a job well done; and (3) analyzes the extent of gender and generational differences in organizational commitment and worker motivation. The results can be used not only to begin filling a gap in the motivation literature by extending previous analyses based on US workers, but also to inform Russian and foreign managers about monetary and non-monetary factors to include in designing an effective reward structure. The results also are suitable for use in management training programs in Russia and elsewhere which focus on developing ways to construct more effective teamwork at the workplace.     

Transforming Into Men Who Matter: Increasing Empathy in Domestic Abuse Treatment

ABSTRACT

Men referred to domestic abuse treatment are typically involuntary clients, ranging from being legally mandated to being under significant pressure from others to attend. Such treatment programs have mixed results in achieving change in abusive behaviours. Most programs emphasise taking responsibility for abusive behaviour by examining the precursor thinking beliefs and values, with less attention paid to learning new interpersonal skills that replace antisocial behaviours with prosocial alternatives. Empathy provides a measurable moderator of moving beyond simply acknowledging responsibility for past abuse into learning and applying prosocial relationship enhancement skills with their treatment cohort, families, and significant others. This paper describes a program that builds empathy skills through a series of program and mentalisation tasks that include routine client feedback using the Partners for Change Outcome Management System (PCOMS). Evidence of increased retention and statistically significant changes in empathy using the Social Empathy Index are provided from a previous study examining the same program. The practice and research implications for domestic abuse clients and other involuntary populations are discussed.

IMPLICATIONS

• Involuntary clients continue to have high dropout rates across a range of client populations and are a challenge to engage in the change process. With the application of the client feedback tools and relationship enhancement skills described in this paper professionals can more effectively engage other types of involuntary clients in their change efforts.

• The focus on empathy and relationship enhancement skills can lead to reduced treatment dropout across involuntary client populations referred for substance use, domestic violence, or other offender behaviours.

     

A comparative analysis of Norwegian and American social workers’ views about inclusion of religion and spirituality in social work

ABSTRACT

This article presents results from a comparative analysis of national surveys of Norwegian and American social workers’ views and practice with regard to inclusion of religion and spirituality in their professional work with clients. Findings include views about professional values, educational preparation, raising the topics of religion and spirituality with clients experiencing oppression, and use of related interventions. Overall, American social workers are more likely to address religion and spirituality than Norwegians. International comparative statistical and conceptual analyses consider influences of differences in practice settings, respondents’ age and length of experience, and cultural contexts.     

Role of Relational Case Management in Transitioning from Poverty

One-off financial assistance through emergency relief provides a short-term intervention to immediate material crisis. However, recurrent instances of clients accessing this type of assistance points to the ineffectiveness of managing financial hardship without addressing the causes of long-term poverty. This article presents findings from an external process evaluation of the Salvation Army relational case management model known as Doorways. A mixed-method design was implemented, consisting of semistructured interviews, observations, and document analysis, as well as Client Satisfaction and Wellbeing Survey. Across the seven research sites semistructured interviews were conducted with 45 clients and nine case managers, and 30 client surveys were completed. Three themes will be discussed: the Doorways philosophy; the flexible service delivery approach; and client capacity building and continuity of care. Findings illustrated the effectiveness of a relational case management approach and reaffirm the central role of relationships in transforming the lives of people experiencing poverty.

IMPLICATIONS

• The quality of relationship between case managers and their clients plays an integral role in transforming the lives of people experiencing long-term or situational financial disadvantage.

• Service delivery requires a relational and flexible approach to adequately tailor support to the individual and contextual needs of clients.

     

A National Study of Involuntary Protective Services to Adult Protective Services Clients

ABSTRACT

A questionnaire was sent to state administrators of Adult Protective Services Programs (APS) to learn about involuntary protective services provided by APS to vulnerable adults at risk of abuse, neglect, or exploitation. Data were obtained on criteria used to assess the need for involuntary services, types of services provided, sources of authority for involuntary intervention, the nature and extent of public concern about involuntary services, and the protection of the rights of incapacitated clients. Based on responses from 43 states, less than 10 percent of APS recipients receive services without their consent; and all states providing services involuntarily take steps to ensure the protection of rights. Available information from the study does not support the general belief that adults who self-neglect are more likely than other APS clients to have protective services imposed.     

The Challenge of Leadership in Front Line Clinical Teams Struggling to Meet Current Policy Demands

Teams, and their managers, working at the interface between government policy and service to clients are subject to high levels of anxiety arising out of the persecutory manner in which well-intended policy demands are delivered and cost efficiencies imposed. Informed by Bion's ideas about group behaviours, these responses can be understood as a form of defensive behaviour and identified as Basic Assumption Me-ness. Basic Assumption Me-ness in team managers takes the form of managerialism at the expense of leadership, developing a shell that acts as a protection for the lonely, overburdened, vulnerable and soft inside. This hardness, evident through increased unavailability and a rather sadistic use of boundaries, is communicated to staff, who in turn pass it onto clients. In this manner, it infects all relationships thus stifling emotional engagement, creative thinking and practice. This paper then explores ways in which team leaders, courageous enough to take up their authority in an emotionally engaged manner, can reverse these dynamics to the relief and benefit of all concerned. Leaders need to insist on attendance at meetings and supervision where cases can be properly considered; demonstrate an ability to think about risk as ever present in the work because, as all are well aware, no amount of form filling can eliminate this; and acknowledge that the work requires constant assessment and judgement as well as an ability to stay with the unknown. The aim is to be responsive to the daily struggles of team members working face-to-face with clients and to remain aware of ‘the reality on the ground’ when engaging in an equally lively way with senior management.     

An integrative approach to threat assessment and management: security and mental health response to a threatening client

Workplace violence threat assessment and management practices represent an interdisciplinary approach to the diversion of potentially dangerous employees and clients. This case study illustrates such an intervention in a complex situation involving a social service agency and its client. Following a curtailment of services and an arrest, the client developed an escalating homicidal anger toward the agency administrator. Once a Tarasoff warning was received, the agency contacted a security company who organized a threat assessment and management plan involving interdisciplinary collaboration. Information developed in the course of the assessment was presented to prosecutors, who facilitated the client's arrest and involuntary psychiatric commitment until he was judged to be no longer dangerous. This case ultimately involved an integration of the services of security, law enforcement, mental health professionals, prosecutors, the courts and the state mental health system in leading to a successful diversion of the client from a path of intended violence.     

A Mandate for Honesty: Jeff Young's No Bullshit Therapy

Jeff Young talks about having been trained to be formal with clients, and his gradual realisation that he could return to the more direct ways of speech he learned as a child, and combine that with warmth. He found that clients and fellow professionals welcomed a therapist who did not ‘beat around the bush’. Together, Jeff and Ron talk about when directness is appropriate, and how directness needs to be modified for particular clients.     

Dealing with Resistance: Working with Involuntary Clients in Community-Based Drug Treatment Programs in China

ABSTRACT

This study explores strategies for dealing with client resistance that are commonly used by a group of selected counsellors who work closely with illicit drug users in the community-based compulsory treatment programs in China. Through semistructured in-depth interviews with 16 counsellors, this study finds that different forms of client resistance were experienced in their day-to-day practice, encompassing passive and active behaviours. Five typical strategies are used by Chinese counsellors in this study to deal with client resistance: showing respect and caring and expressing empathy; attending to the needs of the clients; making effective use of peer influence; altering clients’ unwillingness to change; and strategically enhancing clients’ self-determination. Considering these strategies can also be seen as general principles for dealing with involuntary clients in other fields of social work services, the findings of this study may have broader impact.

IMPLICATIONS

• Effective ways that can be used by counsellors for reducing illicit drug users’ resistance during treatment include: showing respect and caring, and expressing empathy; attending to the needs of the clients; making effective use of peer influence; altering clients’ unwillingness to change; and strategically enhancing clients’ self-determination.

• Professional social work training is urgently needed among community-based drug treatment social work practitioners in China, to achieve efficient practices and better outcomes.

     

Recovering Heritage and Homeland: Ethnic Revival Among Fourth‐Generation Japanese Americans

In recent years, fourth‐generation Japanese American youth have been attempting to recover their ethnic heritage and reconnect with their ancestral homeland. This ethnic revival is a response to their continued racialization as “Japanese,” which has caused them to become concerned about their overassimilation to American society in an era of multiculturalism where cultural heritage and homeland have come to be positively valued. As a result, they are studying Japanese, majoring in Asian studies, living in Japan as college exchange students, and participating in Japanese taiko drum ensembles in local ethnic communities. Although this return to ethnic roots is a more serious commitment than the symbolic ethnicity observed among white ethnics in the past, it indicates that ethnicity remains involuntary for racial minorities, even after four generations. The case of later‐generation Japanese Americans demonstrates that cultural assimilation does not preclude the continuation and active production of ethnic difference.     

A Program Evaluation of Los Angeles ACORN's Welfare Case Advocacy

SUMMARY

Bureaucratic confusion and client dissatisfaction since the 1996 changes in welfare policy opened opportunities for third party advocacy on behalf of welfare clients. This paper evaluates Los Angeles ACORN's case advocacy program for welfare clients. Outcomes analyzed include client satisfaction with ACORN's advocacy and effects of the program on welfare clients who later became ACORN members. Ninety-one percent of clients surveyed (N = 99) stated they were satisfied with the resolution of their welfare case complaint. Eighty-eight percent of respondents stated ACORN did a better job resolving their problem compared to the welfare department. Unique aspects of the program include peer advocacy and opportunities for welfare recipients to join ACORN and work on welfare policy changes among other issues.     

Social and family responsibility or self-interest?

Mothers’ increasing labour market participation is posed as a key aspect of a growing trend towards individualization — both for ill and for good. In ‘for ill’ versions, mothers’ employment is regarded as undermining commitment to family relationships and leading to a loss of community. In ‘for good’ versions, family and community relationships become contingent upon values of equality and respect. ‘Preference theory’ modifies the individualization thesis, with a posited distinction between mothers in full-time employment with ‘work-centred’ identities and those with part-time work who want ‘adaptive’ or ‘home-centred’ identities. This paper examines such issues, drawing on qualitative case study research on mothers employed full and part time in a hospital and an accountancy firm in the UK. It considers how the variable work ethos of organizations, and the ways mothers engage with these, can interact with their engagement in family and community relationships. In particular, it suggests that employment can be as much about social obligation in a local community, and commitment and obligations to family, as about individualized self-provision and options.     

Using Social Work Theory and Values to Investigate the Implementation of Community Treatment Orders

Abstract

This paper establishes the value of a social work investigation of good practice with people on Community Treatment Orders in the context of social work's longstanding interest in the ethical challenges of working with involuntary clients. The emancipatory values of social work were used to guide this research, thereby ensuring the participation of consumers and their families or carers. Critical social work theory provided an important theoretical base. A mixed methods approach was undertaken, including a cluster analysis and case studies. Five principles of good social work practice emerged from the qualitative data: (a) use and develop direct practice skills; (b) take a human rights perspective; (c) focus on goals and desired outcomes; (d) aim for quality of service delivery; and, (e) enhance and enable the role of key stakeholders. These principles are briefly presented along with recommendations for practice and service development.     

Technostress: Implications for Adults in the Workforce

The use of technology can enhance workplace efficiency, productivity, and flexibility; yet, technological tools can have negative effects on individuals’ cognitive, psychological, and physical health, as well as on organizations (e.g., lowered employee satisfaction, decreased employee commitment). The use of information and communications technologies (ICT) adds to existing work stress. The authors reviewed recent literature to identify ICT trends, define key terms, and gain insights to improve awareness of ICT issues related to career development, health and wellness, and job security. The potential for inquiry as it relates to career exploration, development, and advancement is relevant to counselors and clients in today's workplace. Research is needed to examine the effects of technostress across different industries, to identify workers at greatest risk of adverse effects, to explore the impact on career decision making, to help clients develop personal coping resources, and to determine strategies for career professionals to collaborate with workplace managers.     

A Judicial Menu:

An "incapacitated" elderly person may be brought to probate court in proceedings to impose adult protective services, involuntary commitment for mental illness, or guardianship. If the person or agency bringing the petition has chosen a remedy the criteria of which do not fit the respondent, the case is likely to be dismissed without assuring assistance to the elderly person. Suggesting that judges take a global view, the article encourages them to ask, "What remedy is appropriate for this person, in this situation?" Key to choosing the remedy is comprehensive, functional evaluation of the respondent by a qualified human services professional. The article discusses content of the evaluation, available resources, and implications of the judicial menu approach for the respondent and the court.