LAYING THE FOUNDATION FOR SELF-MANAGEMENT SUPPORT IN A RECOVERY FRAMEWORK

Abstract

<p><strong>Introduction</strong></p> <p>Despite international pressure to implement self-management support for individuals living with chronic illnesses, little direction is available for integration into specialized mental health services. The premise of the dissertation is that self-management support can be provided and be beneficial within a recovery framework for individuals living with serious mental illnesses.</p> <p><strong>Methods</strong></p> <p>A large regional service was studied as an exemplar of specialized service delivery. Using a van Manen phenomenological study through an occupational therapist lens, the meaning of clients’ experiences with self-management learning events in a diverse sample was examined. Conditions shaping clinicians’ experiences and actions enabling self-management across eight varied settings were identified in a Yin case study with embedded units. Provider triads (occupational therapist-nurse-social worker) from each setting, allowed an examination of patterns by individual, discipline and practice environment. With an integrated knowledge translation approach, both studies informed the strategic creation of an innovation and implementation plan for organizational change.</p> <p><strong>Results</strong></p> <p>Findings created a rich picture of clients’ lifeworlds learning self-management and conditions and mechanisms influencing clinician self-management support practices. Client self-management needs were not routinely addressed by services. Clients experienced eight tasks shaped by contextual structures represented in a model of the work of learning self-management. Self-management was enmeshed in recovery and a personal resource for self-determination and living well. Another model illustrated the complex dynamic relationships underpinning clinicians’ intentions and actions, and key features of clinicians enabling client self-management. A structured approach to delivering self-management support and a learning and embedding initiative were generated.</p> <p><strong>Conclusions</strong></p> <p>The dominance of practice environments offers an opportunity for organizational change. Direction is given to customize self-management support in a conventional mental health service. The conceptualization of self-management support within a recovery framework may benefit all client groups with long-standing conditions.</p>