CLINICAL HANDBOOK OF SCHIZOPHRENIA

320 V. SYSTEMS OF CAREents receiving strengths case management do worse. The strengths model research resultshave also been remarkably resilient across settings. Consistency has been shown evenwithin studies. Three of the studies had multiple sites with different case managers, supervisors,and affiliations, with a total of 15 different agencies.The two outcomes areas in which results have been consistently positive are reductionin symptoms and enhanced quality of community life. The three studies (two experimentaland one nonexperimental) using symptoms as a variable all reported positive outcomes.This included findings that people receiving strengths model case managementreported fewer problems with mood and thoughts and greater stress tolerance and psychologicalwell-being than the control groups. Although the studies used a variety ofmeasures, which we term enhanced quality of community life (e.g., increased leisure timein the community, enhanced skills for successful community living, increased social supports,decreased social isolation, and increased quality of life), people receiving strengthsmodel case management had enhanced levels of competence and involvement in terms ofcommunity living. Eight of the nine studies using these types of measures reported positiveoutcomes that were statistically significant.Other outcomes that seem to be strong indicators of the effectiveness of strengthsmodel case management include reduced hospitalization (three out of six studies showingpositive outcomes), vocational (two out of two showing positive outcomes), and housing(two out two showing positive outcomes).THE PURPOSE AND THEORY OF STRENGTHSThe purpose of case management in the strengths model is to assist people to recover,reclaim, and transform their lives by identifying, securing, and sustaining the range ofresources—both environmental and personal—needed to live, play, and work in a normalinterdependent way in the community. A case manager works to “identify, secure, andsustain” resources that are both external (i.e., social relations, opportunities, and resources)and internal (i.e., aspirations, competencies, and confidence) rather than to focusonly on external resources (brokerage model of case management) or internal resources(psychotherapy or skills development). It is the dual focus that contributes to the creationof healthy and desirable niches that provide impetus for achievement and life satisfaction.The strengths theory posits that a person’s quality of life, achievement, life satisfaction,and recovery are attributable in large part to the type and quality of niches that heor she inhabits. These niches can be understood as paralleling a person’s major life domains,such as living arrangement, work, education, recreation, social relationships, andso forth. The quality of the niches for any individual is a function of his or her aspirations,competencies, and confidence, and the environmental resources, opportunities andpeople available.Recovery as an outcome is a state of being to which people aspire. It comprises twocomponents, the first of which concerns an individual’s self-perceptions and psychologicalstates. This includes hopefulness, self-efficacy, self-esteem, feelings of loneliness, andempowerment. The second component closely resembles community integration. Inshort, people should have the opportunity to live in a place they can call home, to workat a job that brings satisfaction and income, to have rich social networks, and to haveavailable means for contributing to others. It also means avoiding the often spirit-breakingexperiences of forced hospitalization, homelessness, or incarceration.Recovery as an outcome involves achieving certain psychological states and a degreeof community integration. In life, the two are closely entwined. An increased sense of