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Tool for mental health case workers to help clients become more independent

Case Western Reserve University : 26 January, 2007  (Technical Article)
Mental health case workers want to help their clients become as independent as possible and achieve a sense of well-being and self-mastery. Frequently, however, they lack a framework for thinking about how they can best help their clients do that. But a team of researchers led by Jerry Floersch, assistant professor at Case Western Reserve University
With funding from the Ohio Department of Mental Health, and in cooperation with the Cuyahoga County Community Mental Health Board, Floersch and his team spent two years carefully observing interactions, what they termed “problem-solving activities”, between individuals living with the consequences of severe mental illness and their case worker or other caregiver. Combining their observations with existing research on mental health recovery, they developed the ZRR. The ZRR, Floersch explained, enables case workers and their clients to identify how the client is feeling and the type of help that is appropriate to their stage of recovery.

In creating the ZRR, the researchers drew on language developed previously by the other members of the team during their research into what they and others have described as a process of “doing for,” “doing with,” “doing for oneself” and “standing by to admire.” These social relations make up one side of the ZRR model.

The other side consists of categories describing the emotional condition of the client. Here, Floersch explained, the team drew on language coming from a study of people who had recovered from schizophrenia: feeling overwhelmed by the disability, struggling with the disability, living with the disability and living beyond the disability.

Members of the research team included Lisa Oswald, with the Adult Recovery Network of Ohio; Paul Kubek with the Ohio Substance Abuse and Mental Illness Coordinating Center of Excellence; Tom Barrett, executive director of the Hanna Perkins Center for Child Development and associate professor at the Case School of Medicine; and Jeff Longhofer, visiting associate professor of social work and management at the Mandel School and Case’s Weatherhead School of Management.

With the tool assembled, they were able to classify the problem-solving activities they observed both in terms of the client’s emotional state and the nature of the service being provided. The theory behind the ZRR, Floersch explained, is that people with emotional and mental disabilities draw hope from seeing that someone who does for them also cares about them and is there to help.

“We’re theorizing that the next part of the recovery relationship is where the client and caregiver do something together and the client starts to take pleasure in the mutuality of the activity, a type of doing with,” Floersch explained. “Then they begin to move to doing the activity for themselves, which the caregiver can encourage by standing by to admire. The ultimate goal is self-mastery, which is not only being able to do something for yourself but feeling good that you did it. We’re speculating that when the client internalizes that process, first someone did for me, then we did it together, then I did it for myself, then they have self-mastery.”

An important aspect of the ZRR is that it provides clients and caregivers with language to describe what is happening between them. “If you can help your client say something even as simple as ‘will you do this for me?’ and ‘will you do this with me?’ and understand the difference, it changes the whole nature of the relationship because it brings to awareness what had been implicit and taken for granted,” Floersch explained.

Floersch said he and his fellow researchers have a contract with Columbia University Press to turn their findings into a book for case managers. “We want to show them how this tool has a sophisticated theory behind it, but they don’t have to use the theory in day-to-day work,” he explained. “The categories of relations and emotional states are described in practical language that’s easy to understand. We think it can make a tremendous difference in aiding the recovery process.”
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