What are the important elements of case management to young persons with early psychosis?

The Singapore Early Psychosis Intervention Programme (EPIP) was launched in April 2001 to offer holistic, integrated care to young persons with first-episode psychosis. Case management is the key linchpin of EPIP. Using the... [ view full abstract ]

The Singapore Early Psychosis Intervention Programme (EPIP) was launched in April 2001 to offer holistic, integrated care to young persons with first-episode psychosis. Case management is the key linchpin of EPIP. Using the phase specific recovery model, case managers conduct bio-psycho-social assessments and provide necessary interventions for our clients for a period of 3 years. Although our clients’ satisfaction rate has been 80% or more (Verma, S., Poon, LY., Subramaniam, M. Abdin, E., Chong, SA, 2012), we do not know what component of case management work has been impactful for our patients. Hence, a team of case managers initiated a study to evaluate if the clients find our case management model beneficial.

A qualitative study was conducted to avoid pre-determined assumptions and to focus on the meaning of key issue for participants (Griffin, 2004). There were 6 focus group discussions of 47 young persons with a mean age of 27.4. Thematic analysis was adopted with the help of Nvivo software. An inter-rater reliability of kappa 0.79 was achieved. The first 5 common themes were: counseling & guidance, holistic monitoring, therapeutic alliance, collaborative role with other care providers, and crisis management. The participants commented that they wished their case managers could be contactable 24 hours, 7 days a week and to have the same person working with them on their entire recovery journey.

The results informed the team that the young persons appreciated therapeutic intervention and not just brokerage services and coordination. This is similar to what the team has been working towards in focusing on drawing out clients’ strengths and anchoring positive interactions with clients. Their wish of having the same case worker being available 24 hours daily is not feasible due to institutional guidelines. Pulling in other external resources might be a way to close this gap.