Case Manager Perspectives on the Role of Treatment in Supportive Housing for People with Severe Mental Illness.
Case Manager Perspectives on the Role of Treatment in Supportive Housing for People with Severe Mental Illness.
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DOI：
10.1086/687986
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发表时间：
2016
影响因子：
1.8
通讯作者：
Padgett DK
中科院分区：
文献类型：
--
作者：
Stanhope V;Choy-Brown M;Tiderington E;Henwood BF;Padgett DK
人们日益认识到住房是健康的一个社会决定因素，因此，保健改革举措正在将保健的范围扩大到传统环境之外。这种扩张的一个结果是增加了医疗补助基金，用于为患有严重精神疾病的人提供支持性住房项目。本定性研究探讨了在支持性住房项目中工作的案例管理人员的治疗方法，以及他们的方法如何受到项目要求和他们对精神疾病的信念的影响。这项研究是一项关于生活在支持性住房中的严重精神疾病患者康复的纵向定性研究的一部分。在18个月的时间里，研究人员对来自连续住宅支持住房项目的24名病例管理人员进行了多次访谈（n = 55）。为了提供案例管理者视角的深入视角，本研究使用了多个编码员的主题分析。总的来说，病例管理人员将支持性住房理解为一种治疗方案，但主要将治疗描述为药物管理。以下主题出现了：相信药物是项目成功的关键，说服住院医生服药，以及质疑该项目对不坚持服药的住院医生的效用。个案管理人员将支持性住房理解为一种治疗方案；然而，考虑到外部限制和他们自己对精神疾病的看法，病例管理人员往往将治疗等同于服药。研究结果表明，需要对个案管理人员进行心理健康康复和综合保健方面的培训。研究结果还对将住房与服务联系起来的政策产生了影响。
Growing recognition exists of housing as a social determinant of health, and thus, health care reform initiatives are expanding the reach of health care beyond traditional settings. One result of this expansion is increased Medicaid funds for supportive-housing programs for people with severe mental illnesses. This qualitative study explores the ways in which case managers working in a supportive housing program approach treatment and how their approach is influenced by both program requirements and their beliefs about mental illness. The study is part of a longitudinal qualitative study on recovery for people with severe mental illnesses living in supportive housing. Multiple interviews (n = 55) with 24 case managers from a residential-continuum supportive-housing program were conducted over 18 months. To provide an in-depth view of case manager perspectives, the study uses thematic analysis with multiple coders. Overall, case managers understand supportive housing as being a treatment program but predominantly characterize treatment as medication management. The following themes emerged: believing medication to be the key to success in the program, persuading residents to take medication, and questioning the utility of the program for residents who were not medication adherent. Case managers understand supportive housing to be a treatment program; however, given the external constraints and their own beliefs about mental illness, case managers often equate treatment with taking medication. Study findings demonstrate the need to train case managers about mental health recovery and integrated health care. The findings also have implications for policies that tie housing to services.