EE Among Case Managers Serving Clients With Schizophrenia
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Leslie Alexander
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Graduate School of Social Work and Social Research
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Bryn Mawr College
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300 Airdale Road
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Bryn Mawr PA 19010
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610-520-2635
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lalexand@brynmawr.edu
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Phyllis Solomon
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Penn School of Social Work
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3701 Locust Walk
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Philadelphia PA 19104-6214
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215-898-5533
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FAX: 215-573-2099
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solomonp@ssw.upenn.edu
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Jeffrey Draine
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Penn School of Social Work
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3701 Locust Walk
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Philadelphia PA 19104-6214
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215.573.9298
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FAX: 215.573.2099
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jdraine@ssw.upenn.edu
The construct of Expressed Emotion (EE) assesses three components of the
family psychosocial environment, criticism, overinvolvement, and hostility.
It has consistently demonstrated a robust positive relationship with exacerbation
of psychiatric symptoms. This relationship has been found in a variety
of cultural contexts with varied disorders. EE has also been found to be
related to treatment dropout. This suggests a relationship between EE and
treatment adherence. While few studies have been conducted on non-family
caregivers, the limited research suggests that EE is a promising variable
to explore between providers and their clients with mental illness.
We studied EE among intensive case managers (CMs) to examine the relationship
between EE and CMs reported alliance with clients, with client attitude
toward medication compliance, and with the number and frequency of hospitalizations.
An exploratory prospective cohort design was used to enroll consecutive
dyads of clients and their CMs from a number of community mental health
agencies. Client eligibility criteria were age over 18, schizophrenia spectrum
disorder, new to intensive CM service. Each client and his/her CM had 5
in person interviews over the course of 9 months. The sample size for the
present analysis was 42 dyads.
Using GEE random regression models, with EE as a predictor, there was
no relationship between EE and number and frequency of hospitalizations
or worker alliance. However, those workers with high EE were more likely
to have clients with poorer attitudes toward medication compliance at 3,
6, and 9 months, with a small to medium effect size of .29.
This documents that there can be high EE among providers, with potentially
negative consequences for the client. EE is modifiable among families through
psychoeducational interventions resulting in a decrease in hospitalizations
for their ill relative. Consequently, these results offer direction for
the education of providers serving those with severe mental illness.