The meaning of "strengths" for strengths-based mental health practice in Hong Kong Chinese culture: A qualitative exploratory study.

Background: Recovery-oriented, strengths-based intervention engages service users' strengths and resources to support their recovery process. This model was developed in an American context and has been applied in Hong Kong. It is important to formulate an understanding of strengths better fit to Hong Kong Chinese. Aims: This exploratory qualitative study examined Hong Kong Chinese service users' views on strengths and preferred translation for the word strengths, along with its cultural nuances. Method: Twenty-six people with serious mental illnesses were individually interviewed at a mental health center in Hong Kong, based on a photo-elicitation technique and reflection on Chinese terms related to strengths. Analysis of data employed the constant comparative method. Results: Participants reported that social factors, such as support by helping professionals and engagement in family roles, as well as spiritual beliefs and practices, are important for recovery. These insights and their preferred translations of strengths generate a culturally nuanced understanding of strengths. Conclusions & Implications for Practice: The strengths model applied in Hong Kong can be enhanced by a more culturally nuanced perspective, for example, including the importance of family-based identity and filial piety, beliefs related to harmony and fate, and practices such as a temple or church attendance. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Process research: compare and contrast the recovery-orientated strengths model of case management and usual community mental health care.

BACKGROUND: The strengths model of case management (SMCM), which was developed by Rapp and Goscha through collaborative efforts at the University of Kansas, assists individuals with mental illness in their recovery by mobilizing individual and environmental resources. Increasing evidence has shown that the utilization of the SMCM improves outcomes, including increased employment/educational attainment, reduced hospitalization rates, higher self-efficacy, and hope. However, little is known about the processes through which the SMCM improves outcomes for mental health service users. This study explores the views of case workers and service users on their experience of providing or receiving the SMCM intervention. METHODS: A qualitative design was employed using individual interviews with service users and case workers drawn from two study conditions: the SMCM group and the control group (treatment as usual). For both study conditions, service users were recruited by either centres-in-charge or case workers from integrated community centres for mental wellness (ICCMWs) operated by three non-governmental organizations (NGOs) in different districts of Hong Kong. Through purposeful sampling, 24 service users and 14 case workers from the SMCM and control groups joined the study. We used an inductive approach to analyse the qualitative data. RESULTS: We identified two overarching themes: service users' and case workers' (1) perceptions of the impacts of the interventions (SMCM and control group) and (2) experiences of the interventions, such as features of the interventions and the factors that facilitated the outcomes. The results showed that there were improvements in the functional recovery of the SMCM group in areas such as employment and family relationships, how self-identified goals were achieved, and how service users gained a better understanding of their own strengths and weaknesses. Regarding their experience of the interventions, participants in both the SMCM group and the control group reported that a good relationship between service users and case workers was vital. However, some concerns were raised about the use of SMCM tools, including the strengths assessment and the personal recovery plan (PRP) and the risk of case workers being subjective in the presentation of cases in group supervision sessions. CONCLUSION: The results were promising in terms of supporting the use of the SMCM, with some refinements, in mental health services for Chinese clients. TRIAL REGISTRATION: The Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12617001435370 , registered on 10/10/2017.

Study protocol for a randomised controlled trial evaluating the effectiveness of strengths model case management (SMCM) with Chinese mental health service users in Hong Kong.

INTRODUCTION: Strengths-based approaches mobilise individual and environmental resources that can facilitate the recovery of people with mental illness. Strengths model case management (SMCM), developed by Rapp and Goscha through collaborative efforts at the University of Kansas, offers a structured and innovative intervention. As evidence of the effectiveness of strengths-based interventions come from Western studies, which lacked rigorous research design or failed to assure fidelity to the model, we aim to fill these gaps and conduct a randomised controlled trial (RCT) to test the effectiveness of SMCM for individuals with mental illness in Hong Kong. METHODS AND ANALYSIS: This will be an RCT of SMCM. Assuming a medium intervention effect (Cohen's d=0.60) with 30% missing data (including dropouts), 210 service users aged 18 years or above will be recruited from three community mental health centres. They will be randomly assigned to SMCM groups (intervention) or SMILE groups (control) in a 1:1 ratio. The SMCM groups will receive strengths model interventions from case workers, whereas the SMILE groups will receive generic care from case workers with an attention placebo. The case workers will all be embedded in the community centres and will be required to provide a session with service users in both groups at least once every fortnight. There will be two groups of case workers for the intervention and control groups, respectively. The effectiveness of the SMCM will be compared between the two groups of service users with outcomes at baseline, 6 and 12 months after recruitment. Functional outcomes will also be reported by case workers. Data on working alliances and goal attainment will be collected from individual case workers. Qualitative evaluation will be conducted to identify the therapeutic ingredients and conditions leading to positive outcomes. Trained outcome assessors will be blind to the group allocation. ETHICS AND DISSEMINATION: Ethical approval from the Human Research Ethics Committee at the University of Hong Kong has been obtained (HRECNCF: EA1703078). The results will be disseminated to service users and their families via the media, to healthcare professionals via professional training and meetings and to researchers via conferences and publications. TRIAL REGISTRATION NUMBER: 12617001435370; Pre-results.

Fidelity of a strengths-based intervention used by dutch shelters for homeless young adults.

OBJECTIVE: In a cluster randomized controlled trial, this study aimed to investigate the effectiveness of and fidelity to Houvast (Dutch for "grip"), a strengths-based intervention to improve the quality of life for homeless young adults. METHODS: Fidelity was measured six months after professionals and team leaders at five Dutch shelters for homeless young adults finished their training in Houvast. Fidelity was measured with the Dutch version of the strengths model fidelity scale, which consists of ten indicators distributed across three subscales: structure, supervision, and clinical practice. A total fidelity score was composed by averaging the ten indicator scores for each facility. During one-day audits by two trained assessors visiting each facility, a file analysis (N=46), a focus group with homeless young adults (N=19), and interviews with the team leader and supervisor (N=9) were conducted. Professionals, supervisors, and team leaders completed questionnaires two weeks before the audit (N=43). In addition, an evaluation of the audit was conducted six months later. RESULTS: Although none of the five shelters achieved a sufficient total model fidelity score, median scores on caseload, group supervision, and strengths assessment were satisfactory. Each facility received a report with a set of recommendations to improve model fidelity. The evaluation showed improvements in use of the strengths assessment and personal recovery plans and in supervision. CONCLUSIONS: Facilities face several challenges when implementing a new intervention, and implementing Houvast was no exception. Learning experiences and possible explanations for the insufficient total fidelity scores are reported.

Enhanced consumer goal achievement through strengths-based group supervision.

PURPOSE: This article seeks to enhance and support consumer-centered care in psychiatric rehabilitation through the use of strengths-based group supervision (SBGS). SOURCES USED: The article is based on social science research findings, 30 years of experience with the model, and the literature on supervision. Relevant findings from research on the model are included. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: SBGS is a promising approach for improving consumer goal achievement and centeredness. It warrants further implementation and research.

Evidence-based practice implementation in Kansas.

Over the last 8 years, Kansas has been successful in the implementation of evidence-based practices. This paper describes the strategies used at multiple levels of the mental health system including: state policy, provider agency management, fidelity and outcome monitoring, supervisor training and support, and practitioner training. The challenges going forth are described.

The principles of effective case management of mental health services.

This paper identifies ten principles or active ingredients of case management that are common to interventions that produced statistically significant positive outcomes for people with serious psychiatric disabilities. Twenty-two studies employing experimental or quasi-experimental designs were selected for inclusion in this review. The use of the principles for systems design is briefly discussed. The term case management is used throughout this article because it is the term that is used in the studies reviewed. We acknowledge that this term is considered pejorative to many people with psychiatric disabilities. People with psychiatric disabilities are not "cases" and they do not need to be "managed." A more accurate reflection of what this service entails is that it is the services or resources that are managed in order to help people reach their goals. Until a more appropriate title becomes globally recognized, the term should be used with sensitivity to the negative connotations it carries.

The Kansas Excellence in Client-Centered Supervision Program: design and initial results.

Supervisors in community support services are perceived as important to the performance of their teams or programs. Research on training as a means of improving skills has been discouraging. This paper describes a program designed to improve outcomes by providing multiple supports, including training, to CSS supervisors. Results after one year of operation are reported.