[Processes and Outcomes of Work-Oriented Case Management during and after Medical Rehabilitation for Substance Use Disorders: A Workshop Report from the BORA-TB Project].

Abstract

Case workers in a vocational support program for persons with addiction disorders ("BORA-TB") accompanied rehabilitants for up to 12 months after rehabilitation treatment. Positive return-to-work (RTW) effects were not statistically verifiable using survey data from the evaluation study. This raises the question of methodological adjustments to the assessment of outcomes. The work summarized here sought to identify and analyze the different paths along which consultation interactions progressed, including the different forms of outcomes they terminated in, to reach an understanding of how these can be influenced by or understood through individual and contextual factors.For the analysis of n=50 individual consultations, data taken from the primary documentation of services received by clients as reported by case managers were combined with statistical measures and free-hand text notes from clients' self-report questionnaires. These data were reiteratively compared within and between cases following the principles of Grounded Theory.Eleven types of consultation processes were differentiated. Each represents a specific pattern of case manager tasks and methods, forms of (possible) outcomes, and prognoses for disease management in relation to the client's situation at the start of consultation and to personal characteristics. The wide range of reported case management tasks included praise for independently achieved vocational successes, legal support, and analyses of clients' personality characteristics for (change) motivation. Outcomes differed depending on client´s life situation and needs, yet is always defined as greater participation in vocational and social environments. Prognoses for each type taking into consideration variation in consultation processes and forms of outcomes suggest hypotheses about suitable disease management.Alternative approaches to the evaluation of outcomes in caseworkers' support of persons with addiction disorders appear feasible with available data on consultation processes. They also seem appropriate given the heterogeneity of affected persons' situations. A validation of the approach used here and a quantitative analysis of type distributions could yield more suitable instruments for measuring treatment outcomes in addiction research.