I grew up in a small town of about 10,000 residents. As a kid, the town felt like a massive, sprawling expanse of neighborhoods, businesses, and cars and people going who knows where. I didn’t worry too much about what 99.9% of the population was doing because I had my own little niche carved out within that community that seemed relevant to life. There was my family, our pets, my school classmates, sports teammates, and friends who lived in the neighborhood. And then there were all the things I did with those people and the places that gathered us together.
If I mapped out my childhood niche (my environmental habitat), it only covered a small portion of an already small town (my home, my friends’ homes, the school, the movie theater, the sports fields, the grocery store, the convenience store, the ice cream shop, a few fast-food places, and various hangouts). It didn’t matter about the size; I felt connected.
Helping people remain connected or increase their connections to their communities is at the heart of Strengths Model Case Management. Social isolation negatively affects anyone’s mental health, not just people receiving services. Prolonged isolation amplifies the internal and external life challenges we may be experiencing, affects sleep patterns, weakens our ability to manage stress effectively, and can lead to long-lasting neurochemical changes that affect our brain’s functioning (Bzdok & Zimmer, 2020; Cacioppo & Cacioppo, 2014).
Persistent social isolation has been linked to cardiovascular problems, increased depression and anxiety, and even increased mortality rates (Brown, Morgan, & Fralick, 2021). The consequences of isolation are so significant that the World Health Organization declared loneliness a major health concern in 2019 (Bzdok & Zimmer, 2020), and the US Surgeon General released an advisory denouncing the “epidemic of loneliness” in the United States in 2023 (Jaffe, 2023).
If we are serious about improving people’s overall health and wellbeing in behavioral health, then we must prioritize helping people strengthen existing connections and make new ones whenever possible. In this blog, I will use the term social and community connection versus community integration or community participation, which are related but distinct concepts.
I view social and community connection as a subjective experience in which a person feels a sense of belonging and connectedness through the social relationships they have and the social activities they engage in. Community integration, generally speaking, refers to the process of ensuring that all individuals have access to opportunities similar to those of others in a particular community. Important? Of course. If people only have access to housing, employment, education, and social activities that are primarily designed for a particular population being served, then it creates an artificial divide that can impede a person from being fully connected to their community. Community participation, generally speaking, refers to the things we do in the community. Isn’t this a good thing? Of course. Yet, people can be doing a lot of things in the community (e.g. going to the grocery store, walking in the park, talking to people, etc.) and still feel isolated or disconnected.
Social and community connection goes deeper than integration or participation. It is the meaning that we attribute to the network of people and places we intersect and interact with on a regular basis. It is our own personal and environmental niche embedded within the community we live. And though we may all live in the same community, our niches vary based on our interests, preferences, comfort level, and available opportunities. It hits at the level of deep-rooted values we may hold, including, but not limited to, values such as being included, accepted, belonging, and connected. It speaks to our identity and how we view ourselves. Not in terms of deficits or disabilities, but rather in terms of the valued social roles these community connections afford us: friend, family member, artist, gardener, mechanic, singer, mentor, writer, advocate, neighbor, worker, provider, student, etc. It is within these social and community connections that we have opportunities to express our creativity, capabilities, beliefs, culture, ideas, and our humanity.
An Intentional Focus on Developing Social and Community Connection
I think we can all agree on the importance of developing social and community connection. So why does it this aspect of health and wellbeing often seem to get put on the “back burner” in behavioral health programs? I think there are several reasons, though I will mention a few here:
The myopic focus on symptom reduction in many behavioral health programs.
When systems prioritize symptom reduction above all else (e.g., reducing anxiety, stabilizing mood, eliminating hallucinations), several unintended consequences can occur. One is that many aspects of the person’s life gets put on hold while efforts are made to decrease symptoms, primarily via medication management. People are often encouraged by their case managers to “get better first” before pursuing relationships, work, education, or community roles. This delays engagement in the very experiences that help to create meaning, purpose, and connection, which can also have an impact on improving symptoms (Weziak-Bialowlska et al., 2022; Wickramaratne et al, 2022; Alvarez, Mirza, Das-Munshi, & Oswald, 2025; Birrel et al., 2025).
Another is the risk of the person’s identity becoming problem-centered. When treatment revolves around symptoms, not only can case manager’s view of the person be skewed through a diagnostic lens, people receiving services may also begin to see themselves primarily through a diagnostic and problem-based lens. Conversations center on deficits instead of strengths, capabilities, interests, and aspirations and this directly undermines focusing on the development of valued social roles (friend, worker, neighbor, etc.).
High caseloads and administrative burdens
When case managers carry large caseloads, the work naturally shifts toward what is fast, measurable, and required. Staff therefore prioritize things like crisis management, medication adherence, addressing the problem of the day, and documentation deadlines. These are important—but they leave little time for things like relationship-building, community exploration, and strengths discovery. Work on reinforcing and developing social and community connection gets pushed aside because it takes time.
High caseloads also tend to focus the work on short-term, task-oriented interactions.With limited time per person: visits become brief and checklist-driven. Conversations focus on problems rather than possibilities. Building the working alliance and uncovering meaningful interests—a foundation of connection—requires time and presence, which high caseloads erode.
The view that there are always more pressing immediate needs to be dealt with
This perspective is very common—and on the surface, it’s hard to argue with. When someone is facing urgent issues like being unhoused, facing housing instability, medical needs, safety concerns, or lack of income, it seems obvious that those needs must come first. But here’s the tension: If we always prioritize immediate needs, social and community connection can get perpetually deferred—and sometimes never addressed at all.
An “Immediate Needs First” approach can become a trap for case managers and in many ways reinforce a continual focus on problems and crises. In behavioral health case management, an immediate need is always on the horizon. Case managers can find themselves in a continual reactive, transactional approach where appointments become dominated by housing, benefits, health, symptoms, behavior, or daily life concerns. Focusing only on urgent problems can unintentionally keep conversations centered on what’s wrong and position the person as someone who is constantly “in need”.
This reactive and transactional approach misses a powerful lever for stability that can support the person with their over health and wellbeing in the longer term. Social and community isn’t something separate from immediate needs, problems, and challenges that people face —it supports them in their efforts to address them and keep moving forward in life even despite them. Helping people build strong social and community ties can help people maintain housing, provide informal support during crises, reinforce motivation to keep taking steps toward health and wellbeing, and reduce reliance on formal services over time.
The view that some people are too ill to develop meaningful social and community connections.
Sometimes, the hesitancy to support people around developing and strengthening social and community connections is based on our perceptions of the people we serve. We worry about negative consequences that may arise from interactions in communities where stigmatizing views of the people we serve are held. While this is often based in good intentions (e.g. not wanting people to get rejected, risk setting people up to fail, etc.), it also reinforces stigma by turning people’s need for connection inward to the formal system of care (agency-run groups, wellness centers, day programs, agency sponsored events and activities, etc.). While often supportive in nature, these environments don’t always translate into authentic belonging. These types of services can unintentionally create “parallel communities” that limit exposure to broader, naturally occurring community spaces.
So how can Strengths Model Case Management help?
For starters the structural elements of SMCM are designed to support case managers establish a strong working alliance with the people they serve and take time to help them develop social and community connection, including the emphasis on lower caseload sizes (maximum of 25:1, and even lower when serving populations with higher support needs), community-based contact (75% or more), weekly strengths-based group supervision, a prescribed set of supervisory support behaviors to help case managers move toward proficiency using Strengths Model tools and interventions, and a focus on improvement of life outcomes that support health and wellbeing (housing, employment, education, supportive relationships, and community involvement).
In addition, the overall philosophical orientation of the model has an explicit focus on supporting people with connecting with people, places, and involvements in their community that bring purpose, meaning, hope, and valued roles. These are the drivers of connection. The model asks everyone on the team to focus on possibilities, not just problems; capabilities, not just deficits; opportunities, not just obstacles; and what is takes to help people thrive, not just cope. The view we hold of the people we serve shapes our engagement approaches, the questions we ask, the goals we support people with, and the interventions we use in practice.
Finally, the Strengths Model tools (the Strengths Assessment and the Personal Empowerment Plan) are key drivers in supporting people around social and community connection. The Strengths Assessment invites people to explore possibilities. It’s not just a descriptive tool…it’s directional, because it helps people explore what they hope to move toward, even amid the current challenges they are experiencing. The seven domains (housing, key assets, employment/education, supportive relationships, wellness/health, leisure/recreation, and spirituality/culture) and three temporal orderings of the Strengths Assessment (past, present, and future) allow the case manager to begin systematically mapping potential opportunities to reinforce existing social and community connections, explore interest in re-establishing past connections/involvements, or explore new connections based on the persons interests, aspirations, talents, skills, and preferences. Every Strengths Assessment has the potential of becoming a personalized map of where social and community connection might occur for the person.
The Personal Empowerment Plan (PEP) is used to invite people to act on something meaningful and important from aspirations column of the Strengths Assessment. While people can cognitively desire having more social and community connection, the most difficult part is getting started. The PEP focuses on movement, not just the final outcome. So whether the person wants to take steps toward employment, taking classes in the community, getting involved in a community activity, getting to know more of their neighbors, inviting someone to go do something with them, or just doing something in the community that puts them in proximity to other people, it all starts with a small value-driven step. Steps on the PEP are iterative, which just means that the outcome of the first steps leads to a decision about what the second step will be, and so forth. It allows the person to try or experience something, evaluate it, then decide what to do next. Small successes build confidence and increase willingness to take another step forward.
We can’t guarantee that people are going to feel connected once they achieve any goal, what we can do is create opportunities. We can help people engage in activities that increase the likelihood of social and community connection being made.
Final Thought
When I think back to my childhood, what stands out isn’t the size of the town or the number of places I went to. It was the feeling of belonging within a small slice of it. That’s what we’re really working toward in Strengths Model Case Management—not just participation, not just access, but meaningful connection. Because at the end of the day, it’s not about being in the community. It’s about feeling like you’re part of it.
References
Alvarez, C.V., Mirza, L., Das-Munshi, J., & Oswald, T.K. (2025). Social connection interventions and depression in young adults: a systematic review and meta-analysis. Social Psychiatry, 60, 549-562.
Birrell, L., et al. (2025). Social connection as a key target for youth mental health. Mental Health & Prevention, 37.
Brown, E. E., Morgan, R., & Fralick, M. (2021). Isolation and mental health: The impact of loneliness on cardiovascular disease, depression, and mortality. Journal of the American Heart Association, 10(1)
Bzdok, D., & Dunbar, R. I. M. (2020). The neurobiology of social distance. Trends in Cognitive Sciences, 24(9), 717–733.
Cacioppo, J. T., & Cacioppo, S. (2014). Social relationships and health: The toxic effects of perceived social isolation. Social and Personality Psychology Compass, 8(2), 58–72.
Jaffe, S. (2023). U.S. Surgeon General declares loneliness a public health epidemic. Lancet, 401(10388), 1787.
Weziak-Bialowolska, D., et al. (2022). The role of meaning and purpose in life for mental health and well-being. Journal of Positive Psychology, 17(4), 456–468.
Wickramaratne, P. J., et al. (2022). Social connectedness as a determinant of mental health outcomes. American Journal of Psychiatry, 179(5), 1–10.
