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.

Ruminative and catastrophizing cognitive styles mediate the association between daily hassles and high anxiety in Hong Kong adolescents.

This study assessed rumination, catastrophizing and daily hassles as predictors of anxiety when controlling for depressive symptoms in a community sample of adolescents reporting high anxiety. Adolescents aged 12-18 (N = 2,802, mean age of 14.9) completed the Screen For Child Anxiety-Related Emotional Disorders. With a total score of 30 as the cutoff, a group of high anxiety adolescents was identified (a prevalence rate of 28.02%). Path analyses results showed that amongst the high anxiety boys, catastrophizing but not rumination was a positive predictor of anxiety and it mediated the effects of daily hassles on anxiety. In the high anxiety girls, both rumination and catastrophizing predicted anxiety but only catastrophizing was the mediator between daily hassles and anxiety. It is suggested that such gender differences in cognitive responses styles should be considered in cognitive-behavioral therapeutic approaches designed to help adolescents showing high anxiety.

Quality of life of caregivers with relatives suffering from mental illness in Hong Kong: roles of caregiver characteristics, caregiving burdens, and satisfaction with psychiatric services.

BACKGROUND: The study attempted to explore the quality of life (QoL) of Chinese caregivers with mentally ill relatives. It also aimed to examine the differential roles of caregiving burdens, caregiver characteristics, and satisfaction with psychiatric services in caregivers' QoL. METHODS: 276 caregivers with relatives attending community psychiatric facilities in Hong Kong were invited to fill out a questionnaire. One sample t-tests were conducted to compare the results of this study with that of other Chinese populations in Hong Kong, Taiwan, and mainland China. A hierarchical regression analysis was performed to examine the relative influence of different factors on caregivers' QoL. RESULTS: Our sample of caregivers had significantly lower QoL scores than other Chinese populations. Results also suggest that Chinese caregivers who had chronic illness, younger in age, a lower education level, experienced more difficulties in handling negative symptoms, and were more dissatisfied with mental health services had poorer quality of life. Indeed, caregiver characteristics displayed a much stronger association with caregivers' QoL than did caregiving burdens and satisfaction with psychiatric services. CONCLUSIONS: This study supports the strong association of caregiver characteristics and the QoL of caregivers and establishes the nature of the relationship between satisfaction with mental health services and caregiver QoL. Implications for future research and practice are discussed.

Nine-Month Longitudinal Impact of Peer Support Workers' Recovery Attributes on Service Users' Recovery in Hong Kong.

OBJECTIVE: In this study, the authors investigated the longitudinal effect of the recovery attributes of peer support workers (PSWs) on users of mental health services in Hong Kong over a 9-month period. METHODS: Recovery attributes were measured among PSWs (N=26) employed by four local nongovernmental organizations before their commencement of service. The recovery-related outcomes of regular service users (N=181) were measured every 3 months for 9 months. Multilevel mixed-effects linear regression analyses with restricted maximum likelihood were used to analyze the possible association of PSWs' qualities on service users' recovery outcomes. The Holm-Bonferroni method was used to adjust for p values to account for multiple comparisons. RESULTS: Results showed that levels of hope and self-esteem among PSWs were statistically significantly associated with improvements in hope and empowerment among service users over time. CONCLUSIONS: PSWs' recovery attributes may benefit service users' personal recovery. Future exploration on the specific pathways of recovery attributes of PSWs on service users' recovery is suggested.

A one-year longitudinal qualitative study of peer support services in a non-Western context: The perspectives of peer support workers, service users, and co-workers.

This study explored the changing views of key stakeholders (peer support workers, their co-workers, and service users) about peer support services in a non-Western community, using a longitudinal qualitative approach. Five trainee peer support workers (PSWs), 15 service users, and 14 co-workers were interviewed over a 12-month period, under the auspices of the Peer Support Workers Project (also known as the Mindset project) in Hong Kong. A total of 77 interviews were transcribed and thematic analyses were conducted across the participant groups at three different time points (training, work placements, and employment). During the initial implementation of the services, uncertainty about the role of the PSWs were reported. However, trusting and beneficial relationships with service users were gradually built, showing growing resilience and confidence over time. The participants realized that PSWs' experiences of mental illnesses were a unique asset that could help service users to alleviate their own somatic symptoms and improve their connections with others. Our findings highlight that the perceptions of peer support services changed from confusion to viewing PSWs as an asset, to an awareness of the importance of family support, and to the belief that implementing such a program will benefit both service users and PSWs.