The Research
Funded by the Ohio Department of Mental Health (# 021150), we studied the types of mental health relationships that facilitated recovery. In one research (client) group, three clients (i.e., one living with major depression and two living with schizophrenia) were followed for twenty-four months while they lived in the community and engaged informal and formal caregivers in everyday problem solving; Marilyn, the focus of this book, was one of the participants in this group. In the second (case manager) group, three case managers and their clients (i.e., two living with schizophrenia and one living with schizo-affective disorder) were observed for twenty-four months while they engaged in case management. Participant-observation methods were used to collect the data in both groups; a total of 628 management events were observed and studied (i.e., 401 events among the first group and 227 events among the second).
Recruitment
Supervisors of six mental health agencies were asked to identify case managers willing to participate. Once identified and consented (the study was approved by the Institutional Review Board of Case Western Reserve University), we asked managers to identify clients that might be willing to consent to our accompaniment as they received help or services from them; we consistently collected data on three manager/client relationships. Through meetings at client operated drop-in centers and from a community-based housing program we approached clients directly without case manager introductions. These efforts resulted in consistent data collection on three individuals living with mental illness in the community.
Data Collection
Case managers, clients, psychiatrists, doctors, and supported employment specialists were observed as they engaged in relationships to negotiate the acquisition of community goods and services. We were immersed in the everyday lives of clients and managers and we recorded the oral narratives among participants (for more on methods, see Floersch 2008; 2004; 2002; 2000). In short, we sought to observe actual case management and routine mental health service delivery. We became participant-observers. First, in the client group, we participated as case managers in transporting clients (like Marilyn) to appointments, helping access resources (e.g., grocery shopping) and staying in continuous contact with their experiences of everyday life; second, we observed their service providers and informal caregivers as they interacted with the clients. And third, in the manager\client group we observed managers conduct routine case management in community settings.
Data Analysis
The data analytic strategy was a synthesis of thematic and grounded theory techniques (Boeije 2002; Braun & Clarke 2006; Charmaz 2006; 1990; Floersch et al., 2010; Glaser, 1967; Muhr 1993; Sivesind, 1999). Analysis of the client group data relied solely on written field notes collected in daily journals chronicling who did what, when, and where; however, analysis of manager\client data depended on audio recorded client and case manager interaction. Our analysis began two and one-half years into data collection by applying a coding strategy to the field notes and the transcriptions. The data were read and wherever interactions referenced a problem-solving event, it was highlighted; we identified 628 distinct events. Next, we contrasted and compared the events and grouped them by their problem-solving characteristics. This effort divided the events into four categories of problem-solving activity: (1) doing for, (2) doing with, (3) standing by to support, and (4) doing for oneself/letting go. (The coding was partially influenced by Floersch’s (2002) previous study of case managers, where he had identified a practical manager language of “doing for” and “doing with.”) The last analytic step contrasted and compared all the events within a problem-solving category; each category was associated with a unique life domain of the client’s everyday life: feeling, thought, and action.