Although case management is crucial to the delivery of mental health services to the seriously mentally ill, there is little understanding of what case managers actually do. The conventional view of the case manager role as an organizational linchpin is narrow and neglects the reciprocal and processual nature of the case manager role. In an effort to go beyond these limitations, a role-contingency approach is offered that assumes case managers perform a variety of therapeutic, interventive, and integrative functions for their clients along with the organizational-linchpin function. The frequency that each function is performed is dependent on service system, organizational, and client contingencies. Data from a study of 49 case managers in eight, countywide care systems in a northwestern state system based on the Community Support Program model provide support for the role-contingency approach. Additionally, the data show that the role most frequently performed by case managers is that of "therapist/crisis manager." The organizational-linchpin function is performed infrequently and not viewed by case managers as extremely important. Implications for the effectiveness of mental health service delivery are discussed.

Family members of seriously mentally ill persons were interviewed to determine their satisfaction with services received through a countywide service system based on the community support program (CSP) model developed by the National Institute of Mental Health. Interviews with 56 family members indicated that a majority were dissatisfied with various aspects of the service system. Multiple regression analysis revealed that significant contributors to family satisfaction were sex of respondent, type of relationship to family member, age at onset of illness, and time since onset of illness. Interaction with a case manager, specifically interaction involving emotional support for families, was the strongest factor explaining family satisfaction. That finding confirms the central role of the case manager in the delivery of CSP services.

(1986). Descriptive Evaluations of Community Support Programs. International Journal of Mental Health: Vol. 15, The Future of the Mentally Ill in Society, pp. 26-43.

Deux modeles theoriques destines a rendre compte de l'adaptation sociale et de l'utilisation des services sociaux par un echantillon de 971 adultes malades mentaux chroniques sont exposes, compares et commentee. Les malades mentaux dont il s'agit participent au NIMH Community Support Program mis sur pied a l'echelon federal pour aider les grands handicapes mentaux a «fonctionner» en dehors des institutions

On a soutenu qu'en milieu familial les coalitions se forment en vue de maintenir le systeme de pouvoirs existant. Une nouvelle methode de reperage des coalitions intrafamiliales est proposee pour tester cette hypothese. Quarante-huit familles de 4 personnes appartenant aux classes moyennes (deux parents+deux enfants) ont ete etudiees. Trois a quatre heures d'entretien ont ete conduites dans chaque foyer

The main purposes of this exploratory study were to encourage greater interest in studying family physical contact and in using photographic analyses. New measures of attraction and a new photographic technique for recording and quantifying physical contact were developed. Forty-eight middle-SES families, each with two parents and two children, participated in the study. There were 12 families of each type of sibling composition: two sons; two daughters; older son, younger daughter; and older daughter, younger son. Two hypotheses derived from the literature on nonfamilial physical contact were tested: (a) within the family, higher status members initiate more and receive less physical contact than those of lower status, and (b) the more preferred family members are more likely than the less preferred to be contacted physically by other members. The first hypothesis received moderately strong, consistent support: initiation of contact was greater and receipt of contact was lower for parents than for children, lower forfathers than for mothers, and lowerfor older than for younger children. The second hypothesis was not supported: more contact did not occur between children and the parents whom they preferred. Two possible explanations of this finding are advanced, one concerning the methodology used and the other the nature of family functioning.