The strengths model is not just a philosophy or perspective, although it is that. It is rather a set of values and principles, a theory of practice, and explicit and rigorous practice methods that have been developed and refined over the last 25 years (Rapp & Goscha, 2006). The empirical testing of the case management model has shown consistent results that are superior to traditional approaches to serving people with severe psychiatric disabilities. The purpose of this literature review is to critique the effectiveness of the strengths model of case management when working with people with psychiatric disabilities.
Introduction (history and scope of the “problem”):
Case management as a concept first appeared as a response to massive deinstitutionalized movement of mentally ill persons that began in the mid-1950s (Salfi & Joshi, 2003). The deinstitutionalization of the chronically mentally ill has exposed serious inadequacies in the community mental health system (Rapp & Winersteen, 1989). Several unfortunate consequences of the shift have been reported: the increase in the homeless population (Cohen, Putnam, & Sullivan, 1984); the hospital revolving door, where in some places readmissions approximate 70% (Goldman, Adams, & Taube, 1983); and the heavy burden placed on families who often do not have the personal or financial resources that come with demands (Hatfield, fierstein, & Johnson, 192). Case management is the most frequently proposed solution to assisting the chronically mentally ill in obtaining benefits and services within the community. Helping activities that contributed to positive outcomes for people, such as service coordination and client empowerment, became a critical component in the delivery of health and social services people with persistent mental illnesses (Rapp & Kisthardt, 1996; Salfi & Joshi, 2003). The growth in popularity of case management has resulted in numerous models and frameworks (Salfi & Joshi, 2003). Case management is defined as a process or method for ensuring that consumers are provided with whatever services they need in a coordinated, effective, and efficient manner (Salfi & Joshi, 2003). The definition is consistent with the Broker or “generalist” model, which focuses on assessing the needs of individuals, identifying appropriate services, and ensuring availability of these services (Salfi & Joshi, 2003). Some say the model stops short of coaching the client or taking responsibility for making sure the client gets the service and places much of the responsibility for obtaining services on the client or identified family members (Rapp & Kisthardt, 1996; Salfi & Joshi, 2003). The primary role of the Broker model of case management is assessment, linkage, and referral (Smith, 1980; Salfi & Joshi, 2003). Case management can also be defined as “a service that links and coordinates assistance from both paid service providers and unpaid help from family and friends to enable consumers…to obtain the highest level of independence consistent with their capacity and their preferences for care” (Geron & Chassler, 1994; Salfi & Joshi, 2003). This definition is consistent with the Strengths model, which was articulated as an alternative to the Broker style of case management (Salfi & Joshi, 2003). It was developed in response to concerns that case management tended to emphasize pathology, limits, and impairments negating the personal strengths, resources, gifts, and abilities that an individual can draw upon for achieving personal goals (Rapp & Chamberlain, 1985; Salfi & Joshi, 2003). A focus on client strengths and instilling hope is not new to social work but is the heart of the social work profession (Russo, 1999). The roots of the strengths perspective lie in...