«Shadow accounting» in a crisis resolution home treatment team – about tacit knowledge and hidden practices.
Various models for crisis resolution and home treatment teams have been established as part of community services in recent years. The objective is to offer citizens available and accessible assessment and treatment, strengthen the person’s capacity to deal with their situation, as well as offer support for the family and the patient’s social network. This development of new services, in addition to demands for quality standards and evidence based practice, require comprehensive evaluation studies. In this paper we present a study based on registered telephone contacts to a crisis resolution/home treatment team over an 18 months period. The total number of telephone contacts as well as the cohort being registered as patients with medical case reports are included. A considerable number of telephone contacts did not result in patient status with medical case report. This material, here called «shadow accounting», is the focus of the present paper. Documentation like this is not an integral part of standard documentation in the public health system. In this study we explore and describe some of the characteristics of these telephone-contacts regarding 1) gender, age and contact body; 2) the problems and issues focussed on, and 3) the assessments and actions of the team.
Therapeutic practice in the prevention of violence
With this article we aim to highlight and develop concepts that describe milieu therapy in the prevention of violence. We conducted six semistructured individual interviews and one focus group interview with the staff in child welfare institutions. The transcribed material is analysed using a threestage structure analysis. The employee, regarded by colleagues and employer as good at preventing violence in situations in which the youngsters act threateningly and aggressively, seems to be able to detect frustration and aggression building up at an early stage. They are therefore able to intervene at an early stage of frustration. They provide alternative ways out of aggression and give the youth an opportunity to learn from previous behaviour by talking about incidences after they have occurred. Based on the analysis, we have developed three concepts that represent the major findings: (1) environmental sensitivity, (2) direction advice and (3) situation validation. The study also shows how the approaches are used at different stages of aggression in the adolescent.
Referral and discharge letters between primary and specialised mental health care services that contain the necessary patient information can help ensure that patients receive comprehensive and coordinated care. The content of 50 referral letters sent to and 50 discharge letters sent from the Mental Health Division in a Norwegian public health trust was examined. A checklist based on Integrated Care and existing literature concerning the recommended content in referral and discharge letters was used. The referral and discharge letters lacked information, most often in the areas of planning and follow-up of the care process. This study indicates that referral and discharge letters within mental health care for adults have severe limitations, and therefore do not always fulfil their important function. It is important to study the consequences of and the methods to improve this.
During ten years (1999–2008) of a national mental health escalation plan, Norwegian communities have received earmarked grants to finance mental health services. Disbursements were conditional on strict reporting routines to assure escalation in the right services. Despite earmarked grants being included in the general grants from 2009, leaving the communities more self-determined, reporting routines are still the same. This gives us the opportunity to follow the resource allocation in these services before and after the change of the funding scheme. In this article we follow the resource allocation (measured by man-labor-years) in Norwegian community based mental health services from 2007 to 2009. We use descriptive statistics, cross-sectional analysis and panel data analysis to study the variation in resource allocation between municipalities during this period.
A family group conference is a meeting in which the individual and his or her expanded social network meet to establish a plan addressing questions the individual wants to discuss. The aim of this article is to present main findings from a project, where family group conferences have been implemented among social assistance recipients in Oslo and Bergen. The purpose of the study was to generate complementary insights into how the family group conference functions in this context. A mixed method design was applied. 149 participants were included in an RCT-study and qualitative interviews with 15 informants and observations of 5 family group conferences were performed. The results show positive short-term effects on mental health, explained by improved family relations, a movement from loneliness towards a sense of community, and improved self-worth. Also the appreciative support from the social network was an important interactional process caused by the intervention. Family group conferences may thus have clinical implications for mental health work.
This article presents a project whose purpose was to investigate the possibility of combining the feedback system Client Directed Outcome Informed Therapy, CDOI, with the Open Dialogue Approach. CDOI in combination with the Outcome Rating Scale and the Session Rating Scale is adapted to, and in use within, individual therapy and family therapy, but it seems that it is not in the same way adapted to, and implemented within, networkoriented approaches. Our experience in the present study was that using CDOI did not inflict on the open dialogue in the meetings. When reflecting on the SRS score each participant got the opportunity to express their views of the meeting. The experience was that misunderstandings were discussed and the feedback system contributed to a joint understanding within the group. The reflections and feedback from the participants showed that it can be useful to apply the scales within Open Dialogue Approach. This project implies that using CDOI within an networkoriented approach makes this practice more client-directed and outcome-informed.
What about the children? A course for mothers with eating disorders
Parenting and children's situation as relatives of patients have become important foci in recent years. A psychoeducative program has been developed for mothers who suffer from eating disorders at the Unit for Eating Disorders, Modum Bad. The program has been developed in close cooperation with the mothers themselves. The program focuses on raising awareness of how illness can affect family life, and on strengthening parental competence and focus on prevention in relation to children. The psychoeducative program consists of five to six sessions with specific topics planned for each group meeting. The topics are relationships, help and support, eating disorders in everyday life and parental functioning. The course program has been systematically evaluated by approximately 20 mothers with very good feedback. The paper describes the implementation, content and experiences with the course. We propose that similar courses should be developed and tested among other groups of patients in mental health care and among patients with chronic somatic disorders.