The Working Alliance as a Mediator Between Fidelity to Strengths Model Case Management and Client Outcomes.

Objective: The purpose of this study was to examine how the client­case manager working alliance in strengths model case management (SMCM) mediates the relationship between fidelity to the SMCM intervention and clients' quality of life, hope, and community functioning. Methods: In total, 311 people with severe mental illness, served at seven community mental health agencies in Canada, participated in the study. They were new to SMCM and participated in five structured interviews every 4.5 months for 18 months to measure the quality of the client­case manager working alliance and clients' quality of life, hope, and community functioning. The team-level SMCM fidelity scale was administered six times over 3 years. Ordinary least-squares path analysis was used to test simple mediation models. Results: Higher fidelity to SMCM was associated with better client outcomes indirectly through the working alliance. Higher SMCM fidelity predicted a stronger working alliance, which in turn predicted greater improvements in client quality of life (at 9 months and 18 months), hope (at 18 months), and community functioning (at 9 months). Conclusions: The results support the view that SMCM is an effective intervention. When the intervention was implemented as planned, it fostered stronger working alliances between clients and case managers and contributed to greater improvements in the quality of life, hope, and functioning of people with severe mental illness. The findings of this study highlight the value of ongoing monitoring of implementation fidelity to achieve high-fidelity interventions that may lead to positive client outcomes.

Association between fidelity to the strengths model of case management and client outcomes: A quasi-experimental study.

OBJECTIVE: Evidence concerning strengths model of case management (SMCM) remains mixed. This study aimed to test the hypotheses that higher fidelity to SMCM is associated with improved quality of life (QoL), hope, community participation, community functioning, more days of competitive employment and of independent living, and fewer days of hospitalization. METHODS: SMCM was implemented over a 3-year period, at seven sites in the Canadian provinces of Newfoundland and Labrador, Québec, and Ontario. Independent assessors visited 14 teams at the seven sites to evaluate fidelity at baseline and 6, 12, 18, 24, and 36 months later. Participants (N = 311) answered standardized questionnaires at 4.5-month intervals up to 18 months. Fidelity assessments were interpolated so they could be associated with questionnaire responses. Linear mixed-effects models and generalized linear models were estimated. RESULTS: Fidelity increased significantly, with all sites except one achieving or approaching good fidelity within 36 months. Fidelity was not significantly associated with any of the outcome measures, although all estimated directions of relationships were consistent with our hypotheses. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: In a pragmatic study of real-world implementation of the strengths model at seven sites, no statistically significant relationships between fidelity and outcomes were found. Low variation in fidelity across individuals, modest sample size, and limited ability to detect change over 18 months, may have contributed to these null findings. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Implementing the Strengths Model of Case Management: Assessing Practice Three Years After Initial Implementation.

While strengths approaches are important to recovery-oriented practice, implementation can be challenging. This study implemented the strengths model of case management (SMCM) in 11 CM teams and assessed the fidelity of delivery and staff perceptions of the model after 36 months using the SMCM fidelity scale and the Readiness Monitoring Tool. Paired sample t-tests assessed change in fidelity from baseline to 36 months. Adjusted regression analyses compared survey responses of direct and management staff. While fidelity ratings significantly improved across all domains, at 36 months they remained suboptimal in supervision practices and use of model tools. Staff perceptions were generally positive but consistently lower for front-line than management staff. Implementing SMCM into existing case management practice with good fidelity is feasible. However, clear support from management may strengthen staff motivation and delivery. A review of practice later in implementation can flag challenges for sustainability and guide implementation support.

What Do Patients with Chronic Spinal Pain Expect from Their Physiotherapist?

Purpose: Evidence has suggested that patients' expectations influence the clinical course when they present with low back pain (LBP). However, little empirical evidence has outlined the nature of these expectations. The aim of this study was to describe LBP patients' expectations of physiotherapy. Method: Seventy-nine adult patients who had LBP for more than 16 weeks and were referred for physiotherapy at two hospital physiotherapy departments in St. John's, Newfoundland and Labrador, were included. They filled out a questionnaire detailing their expectations of treatment. Results: Before treatment, more than 90% of patients expected a physical examination, tests or investigations, a diagnosis, reassurance and advice, and clear explanations of causation, symptom management, and benefits and risks of treatment. Approximately half hoped for a prescription or referral to a specialist, and about 60% hoped to discuss problems in their life. Conclusions: The findings of this study indicate that patients attend physiotherapy with clear expectations about what information should be provided. Most expected tests or investigations leading to diagnosis and an explanation of causation; this presents a challenge for clinicians, given the current understanding of LBP reflected in international practice guidelines. The fact that more than half of the patients wanted to discuss problems in their life points to the need for physiotherapists to consider LBP from a bio-psychosocial perspective.

Objectif : selon certaines données probantes, les attentes des patients influencent l'évolution clinique lorsqu'ils consultent pour des douleurs lombaires (DL). Cependant, peu de données empiriques exposent la nature de ces attentes. La présente étude visait à décrire les attentes des patients ayant des DL vis-à-vis de la physiothérapie. Méthodologie : au total, 79 patients adultes atteints de DL depuis plus de 16 semaines, qui avaient été dirigés vers l'un des deux départements de physiothérapie des hôpitaux de St. John's, à Terre-Neuve-et-Labrador, ont participé à l'étude. Ils ont rempli un questionnaire détaillant leurs attentes en matière de traitement. Résultats : avant le traitement, plus de 90 % des patients s'attendaient à subir un examen physique, des tests ou des investigations et à recevoir un diagnostic, des paroles rassurantes et des conseils ainsi que des explications claires sur la cause de leur douleur, la prise en charge des symptômes et les avantages ou les risques du traitement. Environ la moitié espérait recevoir une prescription ou être dirigée vers un spécialiste, et environ 60 % souhaitaient parler de leurs problèmes personnels. Conclusion : d'après les résultats de cette étude, les patients ont des attentes claires quant à l'information qu'ils devraient recevoir en physiothérapie. La majorité s'attendent à subir des tests ou des examens qui permettront de poser un diagnostic et d'expliquer la cause de leurs problèmes. Compte tenu des connaissances des DL énoncées dans les lignes de pratique internationales, c'est un défi pour les cliniciens. Puisque plus de la moitié des patients souhaitaient parler de leurs problèmes personnels, les physiothérapeutes devraient aborder les DL d'un point de vue biopsychosocial.

Background Television and Infants' Allocation of Their Attention During Toy Play.

The effect of background television on 6- and 12-month-olds' attention during 20 min of toy play was examined. During the first or second half of the session, a clip from a variety of commonly available television programs was presented. The duration and frequency of infants' looks to the toys and to the television indicated that regardless of age or program content, background television frequently got, but did not hold the infants' attention. An order effect indicated that infants looked longer at the television when it was available in the second half of the session. Examination of infants' focused attention to the toys showed a reduction in the mean length of focused episodes when the television was on. A follow-up of the infants at 24 months indicated greater resistance to distraction by the television during play. Data from the three ages showed that individual differences in the amount of viewing were moderately stable across age and across home and lab contexts.

When the television is on: the impact of infant-directed video on 6- and 18-month-olds' attention during toy play and on parent-infant interaction.

The pattern of 6- and 18-month-old infants' and their parents' attention to toys, a commercially available infant-directed video, and each other were examined in a 20 min free-play context as a function of whether the television was on or off. The results indicated that infants at both ages directed significantly more of their attention to the toys than the video when the toys were novel. Attention to the parent was low across the session. Parents directed most of their attention to the infants and the toys and relatively little to the video. They also talked to and played with their infants less when the video was on than when it was off. These results are discussed in terms of Cohen's (1972) model of attention-getting and attention-holding and the implications of this for learning and distractibility.