Examining the Experience of Change to Funding and Service Length: A Multi-method Study of Community Mental Health Services

This PhD Thesis explored the connections between community mental health interventions, service user needs, outcomes, funding and stakeholder engagement. Specifically, the overarching question “How are changes to community mental health funding and service length connected to stakeholder engagement and outcomes in the literature and practice?” was addressed using four different research studies. The first study used a realist synthesis approach to address the question “How does stakeholder engagement impact outcomes when there is a change in public funding allocation models within community mental health settings?” The findings demonstrated that funding change does not necessarily influence outcomes, but that stakeholder engagement is an essential mechanism that can support positive outcomes. The second study asked, “How do short term case managers reflect on the principles of a time restricted case management intervention?” Short-term case management is modeled after Intensive Case Management and Critical Time Intervention; however, the new change limits service to three months. A principles-focused evaluation (P-FE) methodology with focus groups was used to gather perspectives of short-term case managers. The results indicated that case managers adhering to the short-term case management (STCM) process as it was conceptualized, however they are more often embracing “broker case management” models of care instead of an Intensive Case Management approach. Following the investigation with case managers, the third study sought perspectives from clients who were recipients of STCM services. Specifically, the question for this study was “What are the experiences with services of individuals who received short term case management?” This qualitative study used individual in-depth interviews and found that clients predominantly reported a positive experience with having a therapeutic relationship with a case manager, however, some clients conveyed concern that this relationship had to come to an end or a desire to interact more frequently with their case manager. Lastly, the fourth study focused on measuring the needs of clients who had participated in STCM and asked, “What are the needs of clients before and after short term case management services as rated by both the client and the case manager?” Based on an analysis of the program’s Ontario Common Assessment of Need (OCAN) data, psychological distress, company and physical health were the most common unmet client needs at the start of service. Findings indicate that STCM can have a positive impact of psychological distress and daytime activities. Additionally, it appears to decrease total need and total unmet need scores. This new evidence has demonstrated that the constructs of funding, service delivery model, engagement, client needs and outcomes are complex. Additionally, stakeholder engagement is an essential construct when considering how funding and services are structured within community mental health settings.

Keywords: change
Community
funding
mental health
outcomes
service length
Advisor: Wodchis, Walter P
Dainty, Katie