MEASUREMENT OF ALLIANCE IN CASE MANAGEMENT SERVICES

案件管理是服务的一个重要组成部分， 在过去的二十年里，严重精神障碍的人。 已经阐明了几种案件管理模式。 所有这些 重点关注案件经理需要的任务和职能， 代表客户执行，以及这些活动的执行 在很大程度上依赖于发展令人满意的合作关系 案件经理和委托人之间的关系 这一形成的重要性 联盟是隐式确认的，或在所有 主要型号。 然而，客户-案例经理关系本身 没有得到充分的研究和研究。 的概念和措施 帮助关系在心理治疗中的适用性有限 的服务. 个案管理的适当定义和衡量 联盟将加强监测和改进执行工作的能力 服务干预，其中案件管理发挥核心作用， 重要的角色。 拟议工作的目标是制定和 验证用于服务研究的措施，将改善这一点 衡量和优化客户个案管理联盟的能力， 为了更快地稳定社区中的客户， 长期的结果。 拟议的研究将包括几个主要组成部分。 一是 案例管理联盟的构建将被仔细定义， 在一个初步的项目集量化。 定义将借鉴一系列 定性和定量资料来源，包括以前和初步的 利用现有的工具。 概念化协商， 仪器开发将来自临床医生和服务研究人员 在定义和测量病例方面具有丰富的经验 管理层，以及消费者。 第二，项目将在 一项对500名病例管理者-客户对的横断面研究，以及一项可靠的 案例管理联盟的衡量标准将被推导和评估， 结构和判别有效性。 第三，将对该措施进行评估 对比两年的预测有效性， 180对儿的纵向研究。 农村地区的消费者和供应商 新罕布什尔州和华盛顿，华盛顿特区的城市环境将提供以下数据： 仪器开发和验证。 最终分析将评估 案件管理联盟对重点、中等范围 结果，如住房稳定、物质使用、破坏性 症状的后果，以及参与治疗和社区， 并将讨论联盟的发展时间及其 与其他成果领域的相关性。

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.