MEASUREMENT OF ALLIANCE IN CASE MANAGEMENT SERVICES

案例管理是已开发的服务的关键组件 在过去的二十年里，为患有严重精神障碍的人提供了帮助。 已经阐明了几种病例管理模式。所有这些都是 重点关注案件经理需要完成的任务和职能 代表客户执行，并执行这些活动 严重依赖于发展令人满意的协作关系 在案件经理和委托人之间。形成这一现象的重要性 联盟是隐含承认的或明确指定的 大牌模特。然而，客户-案例经理关系本身具有 没有得到充分的定义和研究。的理念和措施 心理治疗中的帮助关系对此的适用性有限 服务。案例管理的适当定义和衡量 联盟将加强监测和改进执行情况的能力 在服务干预中，案例管理发挥着核心和 重要的角色。拟议工作的目标是开发和 验证在服务研究中使用的将改善这一点的度量 衡量和优化客户-案例管理联盟的能力，两者 更快地稳定社区中的客户，并最终实现 长期的结果。 拟议的研究将涉及几个主要组成部分。首先， 构建案例管理联盟将被仔细定义并 在一个初步的项目集中进行量化。定义将利用一系列 定性和定量来源，包括以前的和初步的 使用现有的仪器。咨询概念化和 仪器开发将由临床医生和服务研究人员进行 在案例的定义和衡量方面有丰富的经验 管理，也来自消费者。第二，项目将在以下方面进行评估 一项对500名病例管理者-客户二人组的横断面研究 将对案例管理联盟的衡量标准进行推导和评估 结构效度和判别效度。第三，将对措施进行评估 对照前瞻性预测有效性的两年结果， 180个二联体的纵向研究。农村地区的消费者和供应商 新罕布夏州和华盛顿特区的城市环境将为 仪器的开发和验证。归根结底，将评估 病例管理联盟对重点、中程的贡献 结果，如住房稳定、物质使用、破坏性 症状的后果，以及对治疗和社区的参与， 并将讨论联盟的发展时间和其 与其他结果领域的相关性。

Case management is a critical component of services that have developed over the past two decades for people with severe mental disorders. Several models of case management have been articulated. All of these focus significantly on the tasks and functions that case managers need to perform in behalf of the client, and performance of these activities relies heavily on development of a satisfactory collaborative relationship between case manager and client. Importance of the formation of this alliance is acknowledged implicitly or specified explicitly across all major models. However, the client-case manager relationship per se has not been adequately defined and studied. Concepts and measures of the helping relationship in psychotherapy have limited applicability to this service. Adequate definition and measurement of the case management alliance will enhance the capacity to monitor and improve implementation of service interventions in which case management plays a central and significant role. The goal of the proposed work is to develop and validate a measure for use in services research that will improve this capacity to measure and optimize client-case management alliances, both for more rapidly stabilizing clients in the community and ultimately for long-term outcome. The proposed study will entail several major components. First, the construct of case management alliance will be carefully defined and quantified in a preliminary item set. Definition will draw on a range of qualitative and quantitative sources, including previous and preliminary work with existing instruments. Consultation for conceptualization and instrument development will come from clinicians and services researchers with significant experience in the definition and measurement of case management, as well as from consumers. Second, items will be evaluated in a cross-sectional study of 500 case manager-client dyads, and a reliable measure of case management alliance will be derived and evaluated for construct and discriminant validity. Third, the measure will be evaluated against two-year outcomes for predictive validity in a prospective, longitudinal study with 180 dyads. Consumers and providers in both rural urban settings in New Hampshire and Washington, D.C. will provide data for instrument development and validation. Final analysis will evaluate the contribution of case management alliance to focal, intermediate-range outcomes, such as stabilization of housing, substance use, disruptive consequences of symptoms, and engagement in both treatment and community, and will also address the time of development of alliance and its relevance to other outcome domains.