CLINICAL HANDBOOK OF SCHIZOPHRENIA

32. Strengths-Based Case Management 325This is the situation into which a new case manager was assigned. The case managerhas recently been trained in the strengths model of case management and felt conflictedrelative to what he learned in training about starting where the person was at the time, allowingthe person to direct the helping process, building upon a person’s strengths, andthe prevailing consensus of program staff that David was “decompensating” and neededan immediate involuntary intervention.The strengths model, while not ignoring problems, shifts the focus to a more holisticview of the situation and the person. Problems are placed in a context of what might begetting in the way of individuals achieving what they want in life, or what they find particularlydistressing or disabling from their experience.The new case manager decided to begin a strengths assessment with David. He gotpermission from the program to take David out of day treatment for part of the day andto hang out at the mall, where they also shopped for shoes together. The strengths assessmentwas not conducted by sitting down in an interview, but through casual conversationas the case manager and David went about the morning activities at the mall. Figure 32.1is the actual initial strengths assessment (later versions continued over time).The case manager’s decision was to engage David around an area that was most importantand meaningful to him: his desire to go to work. “I want a job” was David’s passionstatement. Focusing in on David’s passion for wanting a job does not mean the casemanager needs to ignore any problems, difficulties, barriers or challenges. Problems,though, are put in their place within the context of something that David has motivationto pursue. What is defined as a problem is anything that is getting in the way of David beingable to achieve his goal in life. David is part of defining what is problematic for himand what course he wishes to pursue. This is the essence of creating a hope-inducing environmentin which David is the director of his own helping process.Over the next few weeks, the case manager and David looked for jobs instead of goingto day treatment. The strengths assessment was used to generate several employmentoptions that might fit with David’s strengths, interests, desires, and aspirations (jobs relatedto fishing, movies, Mexican food, etc.). David eventually got a job taking tickets ata local movie theater. What he liked most about this job was that one of the benefits wasgetting to go to movies free when he was not working and eating all the popcorn andsoda he wanted. David found a niche in which he thrived.As of this writing, David has now been employed continuously for 17 years, thoughhe has had a few job changes in between (better pay, nicer theater, etc.). After spendingyears in the state hospital, David was only hospitalized once after getting a job, and thatwas for physical reasons. He did not work on improving his reading and writing skillsuntil several years after he started working. He could read enough to recognize whatmovies were on people’s tickets and where to send them. His motivation for eventuallylearning to read and write was to be able to pay his own bills. He is now his own payee.David and Tony, his roommate from the Transitional Living Apartments, eventually gottheir own place together. Instead of learning daily living skills from the mental health center,they learned from each other and through experience. David never attended an angermanagement class. His anger was never a problem outside of the day treatment program,and working and living on his own seemed to be the best medicine or therapy he couldhave.Contrasting the information contained in the psychosocial assessment and thestrengths assessment, one might not think it refers to the same person. What is writtencomes from the perceptual framework being used. In one framework, all of David’s deficitsand shortcomings are the focus, and interventions by staff are centered around “fixing”David. In the other, David’s strengths are brought to the forefront, even in the midst