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Accepted Manuscript

Implementing strengths model for youth in community mental


health: Impact on case managers' professional quality of life

Amy N. Mendenhall, Whitney Grube, Euijin Jung

PII: S0190-7409(19)30052-0
DOI: https://doi.org/10.1016/j.childyouth.2019.04.020
Reference: CYSR 4315
To appear in: Children and Youth Services Review
Received date: 19 January 2019
Revised date: 17 April 2019
Accepted date: 17 April 2019

Please cite this article as: A.N. Mendenhall, W. Grube and E. Jung, Implementing strengths
model for youth in community mental health: Impact on case managers' professional
quality of life, Children and Youth Services Review, https://doi.org/10.1016/
j.childyouth.2019.04.020

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Implementing Strengths Model for Youth in Community Mental Health: Impact on Case

Managers’ Professional Quality of Life

Amy N. Mendenhall, PhD, MSWa,* Amendenhall@ku.edu, Whitney Grube, MSWa


Whitney1@ku.edu, Euijin Jung, MAa ej.jung153@ku.edu
a
University of Kansas School of Social Welfare, 1545 Lilac Lane, Lawrence, KS 66045-3129
*
Corresponding author.

Abstract:

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Case management is a frequently offered service to children and families receiving community

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based mental health care. However, despite its frequent use, child and adolescent mental health

case management lacks formal structure leading to service ambiguity and poor outcomes, for

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both families being served, and the professionals serving them. This paper explores the

implementation of the Strengths Model for Youth, a recovery oriented case management model,
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at a community mental health center and its relationship with case managers’ professional
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quality of life. Researchers administered the Professional Quality of Life survey to child and

adolescent mental health case managers implementing the Strengths Model for Youth at baseline
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and at six months into implementation. Results indicate the Strengths Model for Youth has
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positive impacts on case managers’ feelings of compassion satisfaction and compassion fatigue

after six months of using the model.


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Keywords:
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case management, child and adolescent mental health, strengths

1. Introduction

Since the 1980s, the use of case management services within community mental health

contexts has grown exponentially (Rapp & Goscha, 2004). Mental health case management

connects clients to different services, with the case manager serving as a central person for
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individuals, families, and systems to contact and coordinate services. The use of case

management services has been shown to increase client participation in mental health services

(Bender, Kapp & Hahn, 2011), which in turn supports positive mental health outcomes (Karver,

2006).

The ability to connect clients to resources and services while improving outcomes has

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made case management services an important and fundamental component for both adult and

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youth mental health services. However, similar to other human service professions, providing

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case management services is often associated with high rates of staff turnover and burnout,

which negatively impact both agency and client outcomes (Sullivan, Kondrat & Floyd, 2015).

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The prevalence of burnout among mental health professionals has been reported to be as high as
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67% (Morse et al., 2012). Furthermore, mental health case managers often interact with

individuals experiencing significant amounts of trauma. Thus, case managers may be more
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susceptible to vicarious traumatization (Esaki & Larkin, 2013) and compassion fatigue (Craig &
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Sprang, 2010). Therefore, providing case managers with resources and tools to assist in effective

service provision, while simultaneously minimizing the likelihood of experiencing vicarious


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trauma and burnout is critical. This paper explores the implementation of the Strengths Model
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for Youth, a recovery oriented case management model, at a community mental health center and

its relationship with compassion satisfaction and compassion fatigue among case managers prior
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to implementing the model and at six months into implementation of the model.

1.1 Child and Adolescent Mental Health Case Management

A frequently offered outpatient mental health service to children and families with

emotional or behavioral difficulties is case management (Arnolds, Walsh, Oldham, & Rapp,

2007). Child and adolescent case management was developed in large part due to Jane Knitzer’s
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landmark study (1984), which found two-thirds of all children with serious emotional disorders

were not receiving appropriate services. In response to this, states and communities began

developing adolescent community-based programs, such as case management, in hopes to

increase the collaboration and coordination among the various child serving service sectors

(child welfare, juvenile justice, education, etc.), and to improve families’ access to mental health

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care (Green et al., 1996; Werrbach, 1996). Though it is a frequently offered service at

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community mental health centers, the research behind case management is limited. However,

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some research has found child and adolescent case management services, in a community mental

health setting, to be ambiguous and crisis driven (Grube & Mendenhall, 2016).

1.2 The Strengths Model for Youth


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The Strengths Model for Youth (SM-Y; Mendenhall & Grube, 2016) is a solution-

oriented approach that focuses on empowering youth by emphasizing their strengths and working
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toward personalized goals. In the past, this model was used as a framework for adult case
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management services, and research has shown feasibility in adapting in adapting the model for

successful implementation with youth (Arnolds et al., 2007; Mendenhall & Grube, 2016). This
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adaptation allows case managers to work with youth to identify their strengths in multiple life
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domains, and then build on those strengths to create a personal, meaningful goal, as opposed to

clinical or mental health related goals. Implementation of the Strengths Model for Youth
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provides both case managers and supervisors with a formal practice model to guide their

meetings with clients (Mendenhall & Grube, 2016). This model also provides case managers

with tools, such as the Strengths Assessment, the Personal Plan, Group Supervision, and Field

Mentoring. A unique aspect of the Model is its focus on supervision, which can be a critical

piece to effective practice (Steiker & Malone, 2010). Both group supervision and field mentoring
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are supervisory tools that are implemented to ensure that direct practice workers are receiving

timely and effective supervision. These tools are used to assist with developing and achieving

youth centered goals, which become the weekly focus of case management sessions (Mendenhall

& Grube, 2016).

A qualitative study of SM-Y case managers and supervisors found the model provided

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workers with much needed structure for their work and had both intermediate and long-term

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impact on youth (Schuetz, Grube, & Mendenhall, 2019). According to case managers,

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intermediate impact included increased youth investment, motivation and self-esteem, and long-

term impact included reduction in service length and improved well-being outcomes, such as

socialization and school performance.


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1.3 Compassion Fatigue

Mental health case managers working with children diagnosed with an emotional or
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behavioral difficulty are likely to work with children and families experiencing trauma. As such,
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negative outcomes, like compassion fatigue, are likely to occur. Compassion fatigue has

previously been defined as “a state of tension and preoccupation with the individual or
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cumulative traumas of clients” (Figley 2002). It is a complex concept which consists of more
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than one construct. Utilizing the Professional Quality of Life Scale (Stamm, 2010), compassion

fatigue can be viewed as two constructs, secondary traumatic stress (STS) and burnout.
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Secondary traumatic stress has been defined as “the natural consequent behaviors and emotions

resulting from knowing about a traumatizing event experienced by a significant other. It is the

stress resulting from helping or wanting to help a traumatized or suffering person” (Figley, 1995,

pg. 7).
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For those experiencing STS, their symptoms mirror that of a person experiencing post-

traumatic stress disorder (PTSD) and can include symptoms such as feelings of intrusion,

avoidance, and arousal (Bride, 2004). Follette et al. (1994) conducted a survey with mental

health professionals and found that 24.2% of those completing the survey experienced STS and

utilized “withdrawing from others” as a coping strategy when working with child sexual abuse

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survivors. Rich (1997) conducted a survey with mental health therapists providing services to

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clients who identified as having experienced trauma. Rich (1997) found that 35.7% of

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participating therapists reported feeling “removed from friends and family” since obtaining

employment as a therapist working with traumatized clients. Ting et al. (2005) found nearly 53%

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of mental health social workers sampled felt STS negatively impacted their personal and
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professional life.

Burnout, a distinct and separate concept from STS, has been defined as feelings of
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exhaustion, cynicism, and inefficacy (Maslach et al., 2001) and can have substantial implications
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for professionals and their agencies. Higher rates of absenteeism and job turnover have been

found to be associated with burnout (Morse et al. 2012; Paris & Hoge 2010). Furthermore,
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burnout among mental health professionals is associated with various negative outcomes such as
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higher rates of depression, diminished sense of wellbeing, impaired emotional and physical

health, increased alcohol consumption, and impaired memory (Morse et al. 2012).
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Unfortunately, burnout among mental health professionals is common, and various studies have

found that 21–67% of mental health workers may be experiencing high levels of burnout (Morse

et al., 2012). Burnout also has negative implications for the worker-client relationship. Burnout

can damage the therapeutic relationship (Salyers et al. 2015), which in turn, results in poor client

outcomes, such as higher rates of hospitalization (Priebe, 2004).


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1.4 Compassion Satisfaction

While mental health case managers may experience compassion fatigue, they may also

experience compassion satisfaction. Compassion satisfaction (CS) is the feeling of satisfaction

one gets when helping other people (Stamm, 2010) and relates to a helping professional’s quality

of work life (Stamm, 2010). Compassion satisfaction is a stark contrast to the experiences of

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burnout or STS that helping professionals can experience. Professionals with high levels of

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compassion satisfaction experience a sense of achievement or inspiration, even when immersed

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in emotionally demanding work roles (Wagaman et al., 2015). Furthermore, compassion

satisfaction can be viewed as a protective influence against burnout and secondary traumatic

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stress due to feelings of achievement and motivation that compassion satisfaction instills in
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professionals (Bride, Radey, & Figley, 2007).

1.5 Study Aims


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The current study, while extremely exploratory, has two main aims. Using the
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Professional Quality of Life Scale (Stamm, 2010) as a measure of compassion satisfaction and

compassion fatigue, this study seeks to add to the current literature by presenting findings related
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to the compassion satisfaction and compassion fatigue of case managers working with youth
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diagnosed with an emotional or behavioral disorder in a community mental health center. While

there is a substantial amount of literature regarding compassion satisfaction and fatigue in mental
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health contexts, most literature focuses on clinicians or therapists. The first aim of this study is to

determine whether implementing the Strengths Model for Youth in a community mental health

center improves case managers’ levels of compassion satisfaction and compassion fatigue. The

second aim is to determine if case managers’ demographic and professional characteristics relate

to their levels of compassion satisfaction or compassion fatigue. Because the Strengths Model for
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Youth is a hope-inducing model of case management and re-directs work from being crisis

driven to goal driven, researchers hypothesized case managers using the model would experience

increases in compassion satisfaction and decreases in compassion fatigue. Researchers also

hypothesized case managers’ personal and professional characteristics would predict variation in

their levels of compassion satisfaction and compassion fatigue both prior to SM-Y

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implementation and after implementing SM-Y for six months.

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2. Methods

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2.1 Participants

All of the case managers implementing the SM-Y at one Midwestern mental health center

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were invited to complete the case manager survey at the time of the baseline and six month SM-
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Y fidelity reviews. The total sample includes 41 case managers, which represents every child

serving case manager employed at the community mental health center during this time period.
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Eight case managers identified as male and 33 identified as female. Most case managers
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identified as being between the ages of 20 and 34 (55.6%), and case managers were

predominantly White (82.9%). See Table 1 for complete demographic information.


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Table 1. Sample demographic information (N=41)

Variable N %
Gender
Female 33 80
Male 8 20
Race & Ethnicity
White 34 83
Black; Non-Hispanic 4 10
White; Hispanic 2 5
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Unreported 1 2
Age
20 to 34 years 28 68
35 to 49 years 9 22
50 to 64 years 3 7
65+ years 1 2
Education Level
Bachelor’s degree 29 71
Graduate degree 12 29
Years as a Case Manager

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Less than 1 year 3 7

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1 to 3 years 17 41.5
4 to 5 years 4 10

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More than 5 years 17 41.5
Years employed at this mental health center
Less than 1 year 11 27

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1 to 3 years 11 27
4 to 5 years 4 10
More than 5 years 15 36
Number of Case Managers on Teams
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Team 1 9
Team 2 7
Team 3 9
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Team 4 8
Team 5 8
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2.2 Procedures
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All procedures were approved by the [Redacted for Peer Review] Institutional Review
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Board. The Strengths Model for Youth (SM-Y) was implemented at a Midwestern community

mental health center serving youth ages 12 to 18 with emotional or behavioral difficulties. Five
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youth serving case management teams were trained on the model in a staggered implementation

approach.

Implementation spanned over three years, and as such, data was collected at various

points from 2015 and 2018. Each team/cohort underwent an initial training. Training cohorts

ranged in size (from 12 to 15 members) and included case managers, clinicians, and a team

supervisor. One training also included a parent support worker. In total, five initial trainings
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occurred, with all teams received the same training content. After the initial full day of training,

case management teams received ongoing consultation from an SM-Y consultant, who was a

member of the research team, until they reached model fidelity. Consultation occurred at the

mental health center or in the community and included support and education pertaining to all of

the tools and concepts of the model. Consultation varied by team need, but typically included

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one to two hours of group consultation with the case managers and supervisor, and an hour of

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one on one consultation with the supervisor. The consultation sessions occurred weekly for the

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first three months of implementation, biweekly for the second three months, and then monthly

until fidelity was reached.

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SM-Y fidelity reviews for each team occurred prior to initial training and then every six
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months until a team reached fidelity. Once a team reached model fidelity, fidelity reviews only

occurred annually. These fidelity reviews served as a way to provide baseline information on
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current case management practices and then to determine how closely each case management
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team adhered to SM-Y’s standards of practice during implementation. The adapted fidelity scale

is largely the same as the fidelity scale utilized in adult Strengths Model case management (Rapp
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& Goscha, 2011) with the addition of an item on parent participation and a decrease in caseload
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size guidelines. The possible range on the fidelity scale is 9 to 45. To be considered at fidelity, a

team must average a score of four on the three fidelity subscales: structure, supervision, and
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clinical services. Table 2 includes fidelity scores prior to SM-Y implementation, after six months

of implementation and after twelve months of implementation for the five participating case

management teams. Three of the five teams reached model fidelity after implementing the model

for twelve months. All teams had improved fidelity scores from baseline to six months, and four
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of the five teams also had improved fidelity scores from six months to twelve months of

implementation.

Table 2. Strengths Model for Youth Fidelity Scores

Fidelity Scores Mean (SD)


Baseline 18.4 (0.8)
6 months 31.2 (3.0)
12 months 37.9 (2.8)

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Fidelity Score by Team Baseline 6 months 12 months

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Team 1 17 27 40*
Team 2 18 35 33

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Team 3 19 32 36
Team 4 19 29 40*
Team 5 19 34 40*

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* Indicates the team had reached model fidelity.

At the time of the baseline and six month fidelity reviews, case managers were invited to
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complete a case manager survey, which included demographic questions, the Professional
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Quality of Life Scale, and questions about the nature of their job. Case managers were assigned
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numeric IDs in order to track changes over time and to maintain confidentiality in responses.

Only the project coordinator and principal investigator had access to the key linking the case
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managers to their assigned numeric ID. Case manager surveys were not available for all five case
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management teams at twelve months of model implementation, and so analyses in this paper

focus on outcome data from baseline and after six months of implementation.
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Analyses were completed using paired-samples t-tests comparing case managers’

baseline Professional Quality of Life Scale scores to their scores after six months of model

implementation. Regression analyses were conducted to explore if personal, or professional case

manager characteristics predicted compassion satisfaction or compassion fatigue at baseline or at

six months of model implementation. Various methods for handling the missing data in this

small sample were explored, with each resulting in a similar pattern of results for the research
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questions. To maintain the sample size, data in the analyses presented in this paper utilized mean

imputation.

2.3 Professional Quality of Life Scale (PROQOL)

The Professional Quality of Life Scale (Stamm, 2010) is a 30 question measure that

examines helping professionals’ perceptions of positive and negative aspects of their

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employment (Howard et al., 2015). The PROQOL measures compassion satisfaction and

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compassion fatigue. In the PROQOL, compassion fatigue is an umbrella concept for burn-out

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and secondary traumatic stress. Thus, the measure reports on compassion satisfaction, burn-out,

and secondary traumatic stress. The PROQOL is a self-report measure and questions are scored

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on a five point Likert Scale. For burn-out and secondary traumatic stress, higher scores are more
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negative, whereas for compassion satisfaction higher scores are more positive. The subscales of

the PROQOL have demonstrated strong internal reliability and good construct validity based
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upon more than 200 peer-reviewed articles (Stamm, 2010).


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3. Results
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The results of the paired-samples t-tests comparing mean scores at baseline to the six

month implementation time point found a significant increase in case manager compassion
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satisfaction (t(40) = -2.39; p< .05) with a small effect size of .39. Results also demonstrated a
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significant decrease in burnout levels (t(40) = 4.05; p< .01) with a large effect size of .87.

Finally, the results revealed a decrease in secondary trauma (t(40) = 1.72; p= .09) with a small

effect size of .31. These results are included in Table 3.

Table 3. Comparison of Case Manager Professional Quality of Life Prior to Strengths


Model for Youth Implementation and Six Months into Model Implementation (N=41)
Baseline 6 Months Effect Size
Mean (SD) Mean (SD) t (Cohen’s d)
Compassion 36.56 (6.06) 38.32 (4.22) t(40)= -2.39* .39
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Satisfaction
Burnout 26.03 (6.19) 22.18 (3.68) t(40)= 4.05** .87
Secondary 21.59 (5.21) 20.33 (4.11) t(40)= 1.72§ .31
Trauma
§<.1, *<.05, **p<.01

As seen in Table 4 and Table 5, regression analyses were conducted to determine the

relationship between case manager personal and professional demographic characteristics and

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subscale scores prior to SM-Y implementation and after six months of implementing SM-Y.

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Personal demographic characteristics include gender, age, and race. Professional demographic

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characteristics include education level, years as a case manager, years at the mental health center,

and case manager team. Prior to implementing SM-Y, analyses indicated that case manager

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personal and professional demographics did not predict compassion satisfaction, burnout, or
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secondary trauma, with two exceptions. In the compassion satisfaction model, membership on

Team 1, which was the first team at the center to implement the model, was related to higher
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levels of compassion satisfaction (B= 7.03, p= 0.03). In the burnout model, years as a case
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manager significantly predicted burnout (B= 1.87, p= 0.05) with higher number of years as a

case manager being associated with higher scores on the burnout subscale.
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Table 4. Regression Models for Compassion Satisfaction, Burnout, and Secondary Traumatic
Stress at Baseline Prior to Strengths Model for Youth Implementation (N=41)

Compassion Burnout Secondary Traumatic Stress


Satisfaction
Β p B p B p
Gender -3.64 0.19 2.74 0.25 3.04 0.23
Age 0.71 0.62 -1.49 0.23 0.11 0.94
Race (other) -1.01 0.78 2.48 0.43 0.78 0.82
Education (BSW) -0.30 0.91 1.87 0.39 1.03 0.66
Years as case manager -1.26 0.24 1.87 0.05 0.73 0.46
Years at agency 0.30 0.77 0.61 0.47 -0.33 0.72
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Team1 7.03 0.03 3.97 0.14 -4.28 0.14


Team2 5.26 0.11 -2.08 0.45 -1.47 0.62
Team3 2.71 0.44 -1.78 0.55 -3.09 0.34
Team4 3.97 0.20 -1.88 0.48 -3.39 0.24
Constant 38.55 0.00 16.93 0.00 19.13 0.00
R2 .33 .50 .56
Adj R2 .10 .34 .23
Note: () category refers to the reference category. Bolded values are significant at p < 0.1.

Additionally, regression analyses were conducted to determine the relationship between

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case manager demographic characteristics and subscale scores at the six-month implementation

time point controlling for the baseline subscale scores (see Table 5). Controlling for baseline

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scores, these analyses found that case manager personal and professional demographics did not

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significantly predict six-month scores for compassion satisfaction, burnout, or secondary trauma

with one exception. In the burnout model, membership on Team 2 was related to higher levels of
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burnout at six months into implementation of SM-Y (B= 3.62, p=.04). In the compassion
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satisfaction model, baseline scores for compassion satisfaction (B= .65, p<.01) and secondary

trauma (B= 0.28, p=.05) significantly predicted six month scores. In the secondary traumatic
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stress model, baseline scores for secondary traumatic stress significantly predicted six month
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scores (B= .30, p=.06). However, in the burnout model, baseline scores of secondary trauma

significantly predicted six month scores (B= .26, p = .04) rather than baseline scores of burnout.
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Table 5. Regression Models for Compassion Satisfaction, Burnout, and Secondary Traumatic
Stress at Six Month of Implementing Strengths Model for Youth (N=41)
Compassion Burnout Secondary
Satisfaction Traumatic Stress
Β P B p B p
Gender 0.64 0.69 0.11 0.94 1.32 0.48
Age -0.45 0.59 0.17 0.83 0.54 0.58
Race (other) 2.63 0.22 -1.75 0.36 -3.74 0.13
Education (BSW) 0.37 0.80 -0.02 0.99 0.36 0.84
Years as case manager 0.34 0.60 -0.66 0.26 -0.08 0.92
Years at agency -0.15 0.79 0.11 0.84 -0.35 0.60
Team1 -2.45 0.29 2.28 0.27 1.44 0.59
Team2 -2.30 0.23 3.62 0.04 1.77 0.43
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Team3 -0.12 0.95 2.56 0.17 2.11 0.37


Team4 -1.15 0.53 2.46 0.14 1.76 0.41
Baseline Compassion 0.65 0.00 -0.21 0.13 0.05 0.78
Baseline Burnout 0.10 0.53 -0.02 0.91 0.10 0.58
Baseline Secondary Trauma 0.28 0.05 0.26 0.04 0.30 0.06
Constant 3.85 0.68 25.05 0.01 10.57 0.34
R2 .51 .47 .68
Adj R2 .27 .21 .27
Note: () category refers to the reference category. Bolded values are significant at p < 0.1.

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4. Discussion & Conclusions

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4.1 Discussion

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This exploratory study provides preliminary or initial evidence suggesting the Strengths

Model for Youth may positively impact aspects of child and adolescent mental health case

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managers’ professional quality of life. While not every result had large effect sizes, these initial
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findings indicate the model could help improve compassion satisfaction, burnout, and secondary

trauma.
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In regards to compassion satisfaction, statistically significant increases were found


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among the case managers after implementing Strengths Model for Youth for six months. For

social service agencies, specifically community mental health centers, this finding is particularly
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relevant. Helping professionals, such as social workers and frontline community mental health
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staff, are often guided by compassion and desire to help struggling individuals and improve

societal conditions (Radey & Figley, 2007). However, as Radey & Figley (2007) highlight, as
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compassionate as helping professionals can be, their compassion level can eventually dwindle

due to fatigue or stress connected to working with individuals struggling with a plethora of

challenges. For professionals working with youth, these challenges are only amplified because of

the complex family dynamics they are often forced to navigate. However, findings indicate the

Strengths Model for Youth may improve compassion satisfaction over time. Key principles of

the Strengths Model for Youth state professionals should involve the caregiver/parent in a youth-
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directed plan, and professionals should always approach services with the notion that youth are

capable of continual growth and transformation (Mendenhall & Grube, 2016). It is possible that

because of these positive principles embedded in the model, case managers begin to have a more

positive view of their caseload, improving their compassion satisfaction. Compassion satisfaction

has been found to be a protective factor against elements of fatigue (Bride, Radey, & Figley,

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2007), thus, social service agencies and organizations, such as community mental health centers,

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should continually incorporate practices that increase workers’ levels of compassion satisfaction,

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such as the Strengths Model for Youth.

Study findings also indicate statistically significant decreases in burnout after six months

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of implementation of the Strengths Model for Youth. This finding is extremely promising as
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burnout has long plagued social service agencies and is pervasive throughout mental health

professional literature (Sullivan, Condrat, & Floyd, 2015). While there are a multitude of factors
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associated with turnover, such as pay or workload (Sullivan, Condrat, & Floyd, 2015), burnout is
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a key factor associated with staff turnover. Turnover should be of utmost concern for agency

leaders as prior studies suggest turnover at organizations can cost an agency over $100,000 a
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year (Sullivan et al., 2015; Selden, 2010). In a time of limited resources, having a model that
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reduces staff members’ feelings of burnout, and thus potentially reduces turnover, can be critical

for agencies.
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Furthermore, decreases were evident in case managers’ feelings of secondary traumatic

stress after six months of implementation . For professionals working with children and

adolescents, this is particularly important. Unfortunately, estimates indicate 25% of U.S. children

and adolescents experience a “high magnitude event” by age 16 (Costello, Erkanli, Fairbank, &

Angold, 2002). Thus, it is likely professionals working with this population are going to
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encounter youth who have experienced trauma, exposing the professional to secondary trauma. A

case management model, such as SM-Y, that reduces feelings of burnout and trauma can

positively impact an agency’s workforce.

The regression analyses conducted largely yielded insignificant results, with a few

notable exceptions. Prior to SM-Y implementation, years as a case manager did significantly

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relate to case managers’ level of burnout, with higher number of years being associated with

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higher levels of burnout. This result is unsurprising as case manager positions can be extremely

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stressful with high caseloads and limited resources and training (Grube & Mendenhall, 2016),

and longer periods of time working under those conditions may intensify those feelings of

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exhaustion, cynicism, and stress. In investigating professional quality of life at six months of
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model implementation, none of the case manager personal or professional characteristics were

significant predictors when controlling for baseline levels of professional quality life. These
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finding suggest that implementing SM-Y had similar impact on professional quality life for all of
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the case managers regardless of personal and professional differences.

As expected in the six months implementation analyses, baseline levels of secondary


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trauma significantly predicted later levels of secondary trauma, and baseline levels of
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compassion satisfaction significantly predicted later levels of compassion satisfaction. However

surprisingly, the initial level of burnout among the case managers did not predict level of burnout
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six months later but initial level of secondary trauma did, with higher levels of secondary trauma

at baseline predicting higher levels of burnout at six months. This finding is interesting

especially given that secondary trauma did not seem to be as greatly impacted by model

implementation. These findings suggest that having high levels of secondary trauma may lead to

higher levels of burnout at a later time point if left unaddressed.


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The potential effect of team membership, or who the supervisor is, on professional

quality of life emerged within both regression models, with one team showing higher

compassion satisfaction at baseline and another team showing higher burnout at six months.

These results highlight the critical nature of the supervisor role in case management, and

emphasize the need to provide supervisors with training and tools, such as SM-Y, to effectively

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support case managers on their team.

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4.2 Implications

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The results of the study, while very exploratory, are promising, and there are implications

in terms of future practice, policy, and research. In regards to policy and practice, this study

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shows that the Strengths Model for Youth could be a promising model of case management for
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community mental health centers. By providing case managers with a strengths-based, goal-

oriented framework, the model appears to better equip them for their job, which is leading to
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improved professional quality of life. Additionally, this Model provides supervisory tools, like
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Group Supervision and Field Mentoring, which can also positively impact direct service workers

or case managers. Future research into SM-Y should continue to explore how supervision within
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the context of the Model changes and thus, influences case managers’ performance and job
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satisfaction.

In a field where compassion fatigue and turnover are high, practice models that address
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positive impacts for not just the client, but also for the professional providers, are invaluable.

Community mental health needs to invest in more models like SM-Y in order to better equip ill-

prepared and highly stressed workers for work with youth and families who have complex needs

and histories. SM-Y should continue to be explored on a larger scale and in other community

mental health settings. Furthermore, implementation of the model in various child-serving

systems could prove beneficial. Similar to community mental health workers, child welfare
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workers or juvenile justice workers experience the same kinds of workplace challenges and

client stressors. Thus, the model could have similar positive effects if implemented in those

systems.

This study leads to several directions for future research. First, research should examine

the relationship between the Strengths Model for Youth, professional quality of life, and youth

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outcomes. It is logical to assume when a professional has a higher level of compassion

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satisfaction, the clients he or she serves might positively benefit. Future research should examine

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whether or not there is a relationship between the model’s impact on case managers and

subsequent client outcomes. Finally, the longitudinal effect of the model on professionals’

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quality of life needs to be examined. The current study only examined professional quality of life
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after implementing the Strengths Model for Youth for six months, and so research needs to

determine if the effects of the model remain constant or change at later points of implementation.
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4.3 Limitations
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While the study addresses a gap and adds significantly to the literature, there are
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limitations that must be addressed. First, this study is extremely exploratory, and there are
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limitations regarding the sample. The sample size is small limiting the generalizability of the

findings. Research was conducted at only one community mental health center. Thus, future
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research should be conducted with additional participants and locations to determine if findings

can be replicated. Also, the sample was recruited from only one agency and agency level

variables were not included in any of the analysis. While individuals characteristics were

controlled for, it is plausible agency-level factors played a role in case managers’ feelings of

compassion satisfaction and fatigue. There are many other plausible confounding variables, such

as caseload size or personal stress or dysfunctional team dynamics, which may play a role in
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determining a case manager’s level of compassion satisfaction and compassion fatigue at a given

time point. As such, future research should utilize a control group and employ more rigorous

experimental designs.

4.4 Conclusions

The Strengths Model for Youth is a recent adaptation of an adult case management model

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(Mendenhall & Grube, 2016) and as such, there is a dearth of research pertaining to its

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effectiveness. This study begins to address this gap in the literature by studying how this new

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framework affects the professionals who are utilizing it. These preliminary findings are

promising, and suggest that the Strengths Model for Youth may positively affect the professional

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quality of life of case managers in community mental health settings.
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Declarations of interest: none
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Funding: This work was supported by the Health Care Foundation of Greater Kansas City.
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Highlights

 Case management services in community mental health often lack formal structure and goals.
 The lack of structure and stressful work environment can lead to case manager burnout and
secondary trauma.
 Strengths Model for Youth (SM-y) case management is a youth-driven, strengths focused formal
model of case management which builds on client strengths to reach goals.
 Results in the current study indicate that implementation of SM-Y may lead to increases in case
manager compassion satisfaction and decreases in compassion fatigue after six months of
implementation.