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Inter-agency work in Open Dialogue: the significance of listening and authenticity
Abstract
Abstract The article explores what professionals regard as important skills and attitudes for generating inter-agency network meetings involving intra- and interprofessonal work. More specifically, we will examine what they understand as promoting or impeding dialogue and how this is related to their professional backgrounds. The professionals participated in a project using an open dialogue approach in order to increase the use of inter-agency network meetings with young people suffering from mental health problems. In this explorative case study, empirical data was collected through interviews conducted with two focus groups, the first comprising healthcare professionals and the second professionals from the social and educational sectors. Content analysis was used, where the main category that emerged was dialogue. To illustrate the findings achieved in the focus groups, observations of inter-agency network meetings are included. The findings describe the significance and challenges of listening and authenticity in the professionals' reflections. The healthcare workers expressed worries concerning their capacities for open and transparent dialogues, while the other professionals' emphasized the usefulness of particular techniques. Inter-agency network meetings may be improved if more awareness is placed on the significance of meeting atmosphere, dwelling on specific topics, dealing with silence and understanding how authentic self-disclosure in reflections can promote the personal growth of the participants.
... For the purposes of the present study, all professionals involved in network meetings will be referred to as "therapists. " Different professional backgrounds, with diverse ways of meaning making, may influence therapists' reflections with their co-therapist and their dialogue with the network (Holmesland et al., 2014). ...
... This might be related to the ability of dialogical practitioners to be themselves in meetings with families, which further creates a feeling of satisfaction (Sidis et al., 2020). Still, to be authentic in voicing the therapist's inner dialogue and emotions can be difficult for health care workers, as this might require an expansion of the professional role (Holmesland et al., 2014). Open Dialogue meetings often challenge practitioners, by demanding a role release and role expansion of their original professional training, i.e., as psychiatrists, psychiatric nurses, social workers etc. (Holmesland et al., 2014). ...
... Still, to be authentic in voicing the therapist's inner dialogue and emotions can be difficult for health care workers, as this might require an expansion of the professional role (Holmesland et al., 2014). Open Dialogue meetings often challenge practitioners, by demanding a role release and role expansion of their original professional training, i.e., as psychiatrists, psychiatric nurses, social workers etc. (Holmesland et al., 2014). Such Frontiers in Psychology 03 frontiersin.org ...
The present study aimed to explore co-therapists’ relationship and how therapists’ individual presence influences this relationship in Open Dialogue. Although co-therapy is key in Open Dialogue network meetings, the processes of that relationship remain largely understudied. The study applied thematic analysis to semi-structured interviews with 20 Open Dialogue trained therapists working in public and private sectors internationally. The results indicate that therapists are present in a meeting with their experiencing and professional self. Specific co-therapy processes allow co-therapists to attune to one another verbally and physically, creating a shared space that promotes new common understandings, shared responsibility and ultimately a transformation of each therapist’s self and practice. Trust between co-therapists seems to be a prerequisite for co-therapy to flourish. Results of the present study reveal a dynamic influence of co-therapy practice, in which co-therapy promotes a more dialogical personality and allows the therapists’ own transformation, which in turn enables common understandings and sharing of responsibility. Considering the growing interest in dialogical approaches and Open Dialogue trainings, trainers, supervisors, and practitioners need to be aware of and attend to the dynamics of co-therapy relationship in order to care for themselves, their team and ultimately the networks they collaborate with.
... These initiatives may be characterized as assertive and user involving (Eriksen, Sundfør, Karlsson, Råholm, & Arman, 2012;Hovish, Weaver, Islam, Paul, & Singh, 2012;Killaspy et al., 2009;Verhaegh, Bongers, Kroon, & Garretsen, 2009). Furthermore, they are collaborative, transdisciplinary (Holmesland, Seikkula, & Hopfenbeck, 2014;Ness, Borg, Semb, & Karlsson, 2014;Ness, Karlsson, et al., 2014), network-oriented (Piippo & Aaltonen, 2004;Ulland, Andersen, Larsen, & Seikkula, 2014) and health promoting (Herrman, Saxena, & Moodie, 2005). These lines of development in mental health care represent ways of helping people with mental health difficulties through contextual and interpersonal approaches rather than medical models for individuals. ...
... Holmesland and her colleagues Holmesland et al., 2014) also explored the open dialogue approach through interviews with professionals and observations of the network meetings. They found that this transdisciplinary approach called for a process of role transformation by the professional, a release from role by reducing the impact of therapeutic skills and allowing the help seekers to guide the communication with the aim of increasing their activity. ...
... They found that this transdisciplinary approach called for a process of role transformation by the professional, a release from role by reducing the impact of therapeutic skills and allowing the help seekers to guide the communication with the aim of increasing their activity. The professionals found that self-disclosure of thoughts, feelings and physical reactions seemed to promote dialogue and the growth of the participants (Holmesland et al., 2014). Larner (2009Larner ( , 2015 advocates dialogical practice and dialogical ethics in mental health approaches, yet he is critical of those who from a dialogical and ethical position reject therapeutic expertise or therapeutic methods and claim that such resources fall outside dialogical approaches because they are unethical and depersonalizing. ...
... Network dialogues initiated by mental health services to help adolescents with psychosocial difficulties in the southern part of Norway have been explored. In southern Norway dialogical and network-oriented practices have been implemented, developed and explored over the last two decades (Bjørnstad, 2013;Bøe et al., 2013;Gros as, 2010;Hauan, 2010;Holmesland, Seikkula & Hopfenbeck, 2014;Holmesland et al., 2010;Lidbom et al., 2014;Ropstad, 2010;Ulland, Andersen, Larsen, & Seikkula, 2013). Dialogical practices, in this context, refer to initiatives that include persons in the social network of the help-seeker through network meetings, where the aim is to facilitate change-generating dialogues. ...
... Holmesland and her colleagues (Holmesland et al., 2010(Holmesland et al., , 2014 also explored the Open Dialogue approach through interviews with professionals and observations of the network meetings. They found that this transdisciplinary approach called for a process of role transformation by the professional; a release of role by reducing the impact of therapeutic skills and allowing the help-seeker to guide the communication with the aim of increasing their activity. ...
... They found that this transdisciplinary approach called for a process of role transformation by the professional; a release of role by reducing the impact of therapeutic skills and allowing the help-seeker to guide the communication with the aim of increasing their activity. The professionals pointed to the way that self-disclosure of their own thoughts, feelings and physical reactions seemed to promote the dialogue and personal growth of the participants (Holmesland et al., 2014). ...
Studies exploring the experiences of recovering from mental health difficulties show the significance of social and relational aspects. Dialogical practices operate within the realm of social relations; individual perspectives are not the primary focus of attention. The present study is part of a series of qualitative studies from southern Norway, exploring dialogical practices and change from the perspective of lived experience and in relationship with network meetings. Two co-researchers, who themselves had experienced mental health difficulties, were part of the research team. Material from qualitative interviews was analysed through a dialogical hermeneutical process where ideas from Emmanuel L evinas and Mikhail Bakhtin were used as analytical lenses. Six interdependent dimensions emerged from our interpretative analysis, comprising three temporal dimensions (1. Dialogues open the moment, 2. Dialogues open the past, and 3. Dialogues open the future) and three dimensions of speaking, which operated across the three temporal dimensions (4. Ethical: Dialogues open through inviting attentiveness and valuing, 5. Expressive: Dialogues open for new vitality, and 6. Hermeneutical: Dialogues open for new meaning). These dimensions were incorporated into one main theme: Dialogues – beginning by others being invitingly attentive – open for moving and living. The way the findings point to change events as an opening for movement – 'moving in' as if from the outside, and 'moving on' as opposed to being stuck – are discussed in relation to other studies. We conclude by suggesting that the salient point of change-generating conversations is in the ethics of being invitingly attentive, and such conversations should take into account multidimensionality, that relates to the past and the future.
... Network dialogues initiated by mental health services to help adolescents with psychosocial difficulties in the southern part of Norway have been explored. In southern Norway dialogical and network-oriented practices have been implemented, developed and explored over the last two decades (Bjørnstad, 2013;Bøe et al., 2013;Gros as, 2010;Hauan, 2010;Holmesland, Seikkula & Hopfenbeck, 2014;Holmesland et al., 2010;Lidbom et al., 2014;Ropstad, 2010;Ulland, Andersen, Larsen, & Seikkula, 2013). Dialogical practices, in this context, refer to initiatives that include persons in the social network of the help-seeker through network meetings, where the aim is to facilitate change-generating dialogues. ...
... Holmesland and her colleagues (Holmesland et al., 2010(Holmesland et al., , 2014 also explored the Open Dialogue approach through interviews with professionals and observations of the network meetings. They found that this transdisciplinary approach called for a process of role transformation by the professional; a release of role by reducing the impact of therapeutic skills and allowing the help-seeker to guide the communication with the aim of increasing their activity. ...
... They found that this transdisciplinary approach called for a process of role transformation by the professional; a release of role by reducing the impact of therapeutic skills and allowing the help-seeker to guide the communication with the aim of increasing their activity. The professionals pointed to the way that self-disclosure of their own thoughts, feelings and physical reactions seemed to promote the dialogue and personal growth of the participants (Holmesland et al., 2014). ...
Studies exploring the experiences of recovering from mental health difficulties show the significance of social and relational aspects. Dialogical practices operate within the realm of social relations; individual perspectives are not the primary focus of attention. The present study is part of a series of qualitative studies from southern Norway, exploring dialogical practices and change from the perspective of lived experience and in relationship with network meetings. Two co-researchers, who themselves had experienced mental health difficulties, were part of the research team. Material from qualitative interviews was analysed through a dialogical hermeneutical process where ideas from Emmanuel L evinas and Mikhail Bakhtin were used as analytical lenses. Six interdependent dimensions emerged from our interpretative analysis, comprising three temporal dimensions (1. Dialogues open the moment, 2. Dialogues open the past, and 3. Dialogues open the future) and three dimensions of speaking, which operated across the three temporal dimensions (4. Ethical: Dialogues open through inviting attentiveness and valuing, 5. Expressive: Dialogues open for new vitality, and 6. Hermeneutical: Dialogues open for new meaning). These dimensions were incorporated into one main theme: Dialogues – beginning by others being invitingly attentive – open for moving and living. The way the findings point to change events as an opening for movement – 'moving in' as if from the outside, and 'moving on' as opposed to being stuck – are discussed in relation to other studies. We conclude by suggesting that the salient point of change-generating conversations is in the ethics of being invitingly attentive, and such conversations should take into account multidimensionality, that relates to the past and the future.
... Network dialogues initiated by mental health services to help adolescents with psychosocial difficulties in the southern part of Norway have been explored. In southern Norway dialogical and network-oriented practices have been implemented, developed and explored over the last two decades (Bjørnstad, 2013;Bøe et al., 2013;Gros as, 2010;Hauan, 2010;Holmesland, Seikkula & Hopfenbeck, 2014;Holmesland et al., 2010;Lidbom et al., 2014;Ropstad, 2010;Ulland, Andersen, Larsen, & Seikkula, 2013). Dialogical practices, in this context, refer to initiatives that include persons in the social network of the help-seeker through network meetings, where the aim is to facilitate change-generating dialogues. ...
... Holmesland and her colleagues (Holmesland et al., 2010(Holmesland et al., , 2014 also explored the Open Dialogue approach through interviews with professionals and observations of the network meetings. They found that this transdisciplinary approach called for a process of role transformation by the professional; a release of role by reducing the impact of therapeutic skills and allowing the help-seeker to guide the communication with the aim of increasing their activity. ...
... They found that this transdisciplinary approach called for a process of role transformation by the professional; a release of role by reducing the impact of therapeutic skills and allowing the help-seeker to guide the communication with the aim of increasing their activity. The professionals pointed to the way that self-disclosure of their own thoughts, feelings and physical reactions seemed to promote the dialogue and personal growth of the participants (Holmesland et al., 2014). ...
Studies exploring the experiences of recovering from mental health difficulties show the significance of social and relational aspects. Dialogical practices operate within the realm of social relations; individual perspectives are not the primary focus of attention. The present study is part of a series of qualitative studies from southern Norway, exploring dialogical practices and change from the perspective of lived experience and in relationship with network meetings. Two co-researchers, who themselves had experienced mental health difficulties, were part of the research team. Material from qualitative interviews was analysed through a dialogical hermeneutical process where ideas from Emmanuel Lévinas and Mikhail Bakhtin were used as analytical lenses. Six interdependent dimensions emerged from our interpretative analysis, comprising three temporal dimensions (1. Dialogues open the moment, 2. Dialogues open the past, and 3. Dialogues open the future) and three dimensions of speaking, which operated across the three temporal dimensions (4. Ethical: Dialogues open through inviting attentiveness and valuing, 5. Expressive: Dialogues open for new vitality, and 6. Hermeneutical: Dialogues open for new meaning). These dimensions were incorporated into one main theme: Dialogues – beginning by others being invitingly attentive – open for moving and living. The way the findings point to change events as an opening for movement – ‘moving in’ as if from the outside, and ‘moving on’ as opposed to being stuck – are discussed in relation to other studies. We conclude by suggesting that the salient point of change-generating conversations is in the ethics of being invitingly attentive, and such conversations should take into account multidimensionality, that relates to the past and the future.
... However, the impact on service users has been little researched. In some studies, researchers have identified aspects that are key to effective interprofessional working, for example, role-understanding and appreciation, listening and authenticity (Holmesland, Seikkula, & Hopfenbeck, 2014;Suter et al., 2009). While highlighting the potential of interprofessional working (Hudson, 2007;Reeves, Lewin, Espin, & Zwarenstein, 2010), this literature has also identified pitfalls. ...
... This situation was exacerbated by the sheer volume of national and local services and organisations, and a constantly changing service landscape. Thus fostering qualities and working methods that have been linked to effective inter-agency working, such as understanding and appreciation of roles, information sharing and communication (Suter et al., 2009;Holmesland et al., 2014), presented a considerable challenge. While some practitioners were nonetheless prepared to go the extra mile and, for example, take time to explain things and point the bereaved person in the right direction, more often responses were unhelpful to the extent of being experienced by the bereaved as undermining and alienating. ...
This article reports findings from the first two stages of a three-stage qualitative study which considered the role of services, including public, private and charitable organisations, in responding to the needs of adults bereaved following the drug and/or alcohol-related death of someone close. The study, the first of its kind to explore the landscape and role of services in substance use deaths, was conducted over two sites: south west England and Scotland. In stage 1 of the research, adopting both convenience and purposive sampling, data were collected via semi-structured interviews on experiences and support needs of bereaved individuals (n = 106). In stage 2, six focus groups were conducted with a purposive sample of practitioners (n = 40), including those working for the police, coroner’s service, procurator fiscal depute (Scotland), health service, funeral service, press, clergy, Public Health England, Drugs Policy Unit, bereavement counselling/support and alcohol and drug treatment services, to investigate how services may better respond to this bereavement. Thematic analysis from both data-sets identified two overarching themes. The first, focusing on practitioner responses, captures how these bereaved people may meet with inadequate, unkind, and discriminatory responses from services. Having to navigate unfamiliar, fragmented, and time-consuming procedures compounds the bereaved’s distress at an already difficult time, illustrated by a ‘mapping’ of relevant services. The second relates to challenges and opportunities for those responding. Service failures reflect practitioners’ poor understanding of both substance use bereavement and the range of other practitioners and services involved. Those bereaved are a poorly understood, neglected and stigmatised group of service users. There is a need for services to respond without judgement or insensitive language, and provide information about, communicate and work closely with, other services despite differences in working practices and cultures. These recommendations could positively affect bereaved peoples’ experiences, alleviating stress and overwhelm at a particularly vulnerable time.
... Research on the effectiveness of OD has been reported in patients with psychosis (Gordon et al., 2016;Holmesland et al., 2014), particularly schizophrenia (Bergström et al., 2018;Seikkula et al., 2003), although it has been pointed out that methodologically rigorous research methods have not been established . However, quantitative studies, including randomized controlled trials (RCT), as well as qualitative studies on OD (Sunthararajah et al., 2022) have attempted to compare the experiences of usual care, peer support, and OD approach for patients with mental health crises. ...
Purpose
Parenting support is a pressing issue in Japan. The application of open dialogue (OD)—an alternative treatment for mental illnesses—to parenting support has generated considerable interest. This study aimed to describe the participants’ experiences shared during a dialogic group session based on OD principles for mothers of young children facing parenting challenges.
Methods
Five mothers with parenting concerns participated in five continuing group sessions over a half-year at a parenting support centre in Japan. The data comprised participants’ utterances and feedback in each session, along with semi-structured individual interviews conducted after all sessions.
Results
Qualitative descriptive analysis revealed six themes: “From initial surprise to growing ease with dialogue without a theme,” “Talking and listening without interruption or judgement,” “Reflections by the facilitators: insightful or uncomfortable?,” “Learning to talk about difficult things,” “Offering empathic advice without imposing opinions,” and “Multiple voices helped deepen their thoughts and reflections.”
Conclusions
The participants discovered how to listen to others without judgement and verbalize thoughts that would otherwise have remained unvoiced. The sessions also enabled them to understand their families and themselves better. The dialogical group sessions demonstrated new possibilities for more open, mutually supportive communication.
... Additionally, efforts to define 'good listening' often equate it with active listening, particularly within dialogue contexts (e.g. Holmesland et al., 2014). Key components of active listening include conveying (nonverbal) engagement, paraphrasing a speaker's message, and asking questions (Weger et al., 2014). ...
... Mutual reliance means familiarity with each other as persons and with each other's professional responsibilities (Holmesland et al., 2010). Developing a transdisciplinary professional role focusing on shared goals (Holmesland et al., 2014;Holmesland et al., 2010;Seikkula et al., 2011) might have strengthened the dialogue in the meetings we explored. ...
... Preliminary evidence suggests that OD may be more effective than standard care in reducing relapse and the use of antipsychotic medication (Seikkula et al., 2001bHartman and De Courcey, 2015;Bergström et al., 2018). Additionally, OD might help equip mental health staff with additional skills necessary to engage service users and their families across the broad spectrum of care needs (Holmesland et al., 2014). However, although promising, there is no high-quality evidence to date to support an NHS-wide adoption of this model of care. ...
Open dialogue (OD) is a multi-component therapeutic and organizational intervention for crisis and continuing community mental health care with a therapeutic focus on clients’ social networks. The development and implementation of this model of care in the United Kingdom requires considerable contextual adaptations which need to be assessed to support effective implementation. Program fidelity–the extent to which core components of an intervention are delivered as intended by an intervention protocol at all levels–is crucial for these adaptations.
Aims
To develop, pilot, and implement a program fidelity measure for community mental health services providing OD and ‘treatment as usual’ (TAU) or standard NHS crisis and community care.
Methods
Measure structure, content, and scoring were developed and refined through an iterative process of discussion between the research team and OD experts. Measure was piloted in the 6 OD and 6 TAU services participating in a large-scale research program.
Results
Initial data suggests that the Community Mental Health Team Fidelity Scale (COM-FIDE) is a potentially reliable and feasible measure of the fidelity of community mental health services and specific OD components of such services.
... Open Dialogue supports self-disclosure, with ideas of openness and authenticity seen as important elements (Holmesland et al., 2014) Encouragement of self-disclosure in Open Dialogue (Hopfenbeck, 2015) (Hill et al., 1989) ...
Presentation of the results of my masters dissertation. A qualitative analysis of practitioners experiences with self-disclosing in Peer-supported Open Dialogue (POD). You can find the full presentation here:
https://event.miodrc2020.exordo.com/session/38/oral-12
... The Parachute Program is no exception. 4 Some qualitative literature has also examined the experiences of professionals (health care and other) within network meetings based on the Open Dialogue model (Holmesland et al. 2010(Holmesland et al. , 2014. ...
Guided by the principles of Open Dialogue and Intentional Peer Support (IPS), Parachute NYC was designed to provide a “soft landing” for people experiencing psychiatric crisis. From 2012 to 2018, Parachute’s teams of clinicians and peer specialists provided home-based mental health care to enrollees and their networks (family, friends), seeking to engage and improve their natural support networks. This qualitative study examined the experiences of enrollees and network members who participated in Parachute. Participants reported that they valued the accessibility and flexibility of Parachute as well as their relationships with, and the lack of hierarchy within, the Parachute team. Responses to the structure of network meetings and Parachute’s approach to medication were mixed, with a few participants struggling with what they felt was a lack of urgency and others experiencing the approach as holistic. Many enrollees and network members reported that Parachute improved their self-understanding and relationships with each other.
... Clinicians reported that discussions and decisions needed to be more open and transparent, and that the concerns of team members needed to be voiced and heard. In previous studies outside of Western Lapland, 22 open dialogue challenged the traditional working roles and hierarchies that were already in place. ...
Background
Open dialogue is an integrative approach to the organisation of specialist mental health services and therapeutic meetings.
Aims
This qualitative study sought to explore service users' and clinicians’ experiences of network meetings during the implementation of open dialogue in a modified version, for a UK-based mental health service.
Method
In total 19 participants were interviewed (8 service users and 11 clinicians) and an inductive thematic analysis of the data was conducted.
Results
Four dominant themes were identified: (1) open dialogue delivery, (2) the impact of open dialogue principles; (3) intense interactions and enhanced communication, and (4) organisational challenges. Clinicians considered open dialogue as a preferred, but challenging way of working, while being therapeutic. The data indicated that service users' experiences of network meetings were mixed. There was a wide variety of service user views as to what the purpose of a network meeting was and for some witnessing reflective conversations felt strange. However, the majority described feeling listened to and understood, excluding one service user who described their experience as distressing. Clinicians expressed an authentic self in their interactions with service users and both service users and clinicians described network meetings as emotionally expressive, although this was described as overwhelming at times.
Conclusions
The results of this thematic analysis indicate that service users' and clinicians’ experiences of open dialogue warrant further investigation. The intensity of interactions in network meetings should be carefully considered with service users before gaining consent to commence treatment. Implementation of open dialogue should be monitored to assess clinician- and service-level adherence to the principles of the approach.
Declaration of interest
None.
... Clinicians reported that discussions and decisions needed to be more open and transparent, and that the concerns of team members needed to be voiced and heard. In previous studies outside of Western Lapland, 22 open dialogue challenged the traditional working roles and hierarchies that were already in place. ...
... Clinicians reported that discussions and decisions needed to be more open and transparent, and that the concerns of team members needed to be voiced and heard. In previous studies outside of Western Lapland, 22 open dialogue challenged the traditional working roles and hierarchies that were already in place. ...
Background:
Peer-supported Open Dialogue, (POD) is a treatment that embraces a network perspective, bringing together both social and professional networks, to provide continuity of psychological care across the boundaries of services.
Aims
To better understand the experiences of service users receiving POD in an early intervention service.
Method
Eight service users were recruited and took part in semi-structured interviews, the data was analysed using thematic analysis.
Results
Two superordinate themes formed around implementation issues and communication within meetings. The first - ‘Adjusting to a new way of working’, contained the subthemes; old approach as unhelpful, purpose of meetings unclear and new approach as strange. The second theme of ‘Communicating in new ways’, included the subthemes of openness Vs. Privacy, feeling listened to and understood, sharing multiple perspectives and increase in emotional expression. The results suggested that participants experienced the network meetings as different from usual care in that they were unusual but positive. The data indicated that feeling listened to was the main explanatory factor in the positive responses to network meetings.
Conclusions
POD advocates for both a way of being and a way of organising services. The data suggested clinicians were being with service users in new and different ways, the potential of which is hard to evaluate within the existing service structure as it had not been re-organised due to the early phase of implementation. A number of recommendations have been made.
... Simply said, professionals are expected to be resonating as fellow human beings (Seikkula & Olson, 2003;Seikkula & Trimble, 2005). Being transparent and sincere has been highlighted as another fundamental principle for the therapist's attitude during the meetings (Homesland, Seikkula, & Hopfenbeck, 2014;Seikkula & Arnkil, 2014). This also means that the therapist can responsibly rely on her role as a professional. ...
In this paper we focus on the Open Dialogue (OD) approach to acute psychosis with the aim of better understanding and clarifying the principles underlying its efficacy. To do this, we do a conceptual analysis of the OD literature. We introduce the basic principles of the OD approach and focus on the dialogical process, which stands out as a core healing factor of this practice. In particular, we shed light on one element that yields and sustains dialogue: the dialogical therapeutic stance. We systematise and disentangle different descriptions of the dialogical therapeutic stance and derive some of its essential properties. Based on this, we finally propose a clear-cut definition of the dialogical therapeutic stance as comprising two necessary and constitutive aspects: openness and authenticity. We believe that this conceptualisation might usefully inform the OD practice and theory, and eventually contribute to advance research on the treatment of schizophrenia.
Full text available at: http://www.tandfonline.com/eprint/9djU44KHWbWeYCrndXRd/full
... In her doctoral work, Holmesland (2015) also explored the experiences of the healthcare professionals working in Joint Development, 2003-05. Data for three analyses were based on multi-stage focus groups, observations/audio recording of network meetings, and interviews with help-seekers (Holmesland, Seikkula, & Hopfenbeck, 2014;Holmesland, Seikkula, Nilsen, Hopfenbeck, & Erik Arnkil, 2010). Through content analyses, Holmesland found that: i) The healthcare professionals were able to develop a transprofessional identity and role, ii) It was challenging to foster the professionals' ability to genuinely listen, iii) Professionals without formal therapeutic training were able to integrate Open Dialogue skills into their practices, and iv) healthcare professionals adapt to each other during network meetings (Holmesland, 2015). ...
Open Dialogue is a resource-oriented mental health approach, which mobilises a crisis-struck person's psychosocial network resources. This scoping review 1) identifies the range and nature of literature on the adoption of Open Dialogue in Scandinavia in places other than the original sites in Finland, and 2) summarises this literature. We included 33 publications. Most studies in this scoping review were published as "grey" literature and most grappled with how to implement Open Dialogue faithfully. In the Scandinavian research context, Open Dialogue was mainly described as a promising and favourable approach to mental health care.
Mental health challenges do not only involve the person but, moreover, the entire family and other social networks. Family-focused care has developed during the last decades to become more evidence based and humanistic, but still there is a need to increase true collaboration with families in mental health settings. In this chapter, the history, development and rationale for family-focused care are described briefly. There are a variety of theoretical approaches and empirical models on how to collaborate with families and networks. A few of these are introduced to encourage all advanced practice mental health nurses (APMHNs) to work with families. Although the values of family-focused care are important for all professionals to apply, there is a special demand for the APMHNs to increase their understanding on family’s importance in care. APMHNs also have an important interdisciplinary role in developing inclusive and collaborative practices in relation to families and networks, as well as developing their own competence on working with families.KeywordsFamilyNetworksFamily-focused careFamily systemsFamily-focused approachesMental health problemsInvisible children
Open Dialogue approaches fall broadly into the area of systemic psychotherapeutic practices. They encourage active participation of families and social networks, and emphasize genuine collaboration within highly integrated systems of health-care service delivery. These approaches are currently being implemented in a growing number of services across the globe, and in this review, we summarize and discuss insights from papers concerned with the implementation of Open Dialogue. We used a scoping review method, which included systematic literature searches and summarizing data extraction as well as consultation with eight Open Dialogue implementation stakeholders who were invited to comment on preliminary review findings and a draft paper. We included 18 studies in the review and present their content under four thematic headings: 1. Training, 2. Family and network experiences, 3. Staff members’ experiences, and 4. Structural and organizational barriers and resistance to implementation. In general, the studies did not include rich descriptions of the implementation contexts, which made it difficult to draw conclusions across studies about effective implementation practices. The discussion draws on Jamous and Peloille’s (Professions and professionalisation, 1970, Cambridge University Press, 109-152) concepts of “indeterminacy” and “technicality,” and we argue that the indeterminacy that dominates Open Dialogue is a challenge to implementation efforts that favor specific and standardized practices. We conclude by encouraging the development of implementation initiatives that theorize Open Dialogue practices with higher levels of technicality without corrupting the fundamental spirit of the approach.
The Mental Health Act (MHA) 1983, is the primary legislation by which people can be assessed, detained and treated on the grounds of mental disorder in England and Wales. This paper is a scoping review of the existing qualitative literature relating to the most common participants within MHA assessments, including the person assessed, friends and relatives, Approved Mental Health Professionals (AMHPs) and doctors. It does so with a view to reflecting on how power relationships within these assessments have been understood, drawing on a wide range of studies, given that little existing research has explicitly focussed on power. It argues that MHA assessments and their wider contexts are often deeply unequal and experienced as such, at odds with a broader policy rhetoric of collaboration and recovery. Looking across research it concludes that the main preoccupations of the different groups of people at MHA assessments are often significantly different. The article considers the implications of these different perspectives in relation to the contemporary context of MHA assessments.
This paper reviews the literature on human relational factors and their impact on complex care systems for a highly vulnerable population of children and young people in out‐of‐home care (OOHC). Factors contributing to the functioning of collaborative OOHC systems are reviewed from theoretical and contextual perspectives. The authors posit that secondary traumatic stress and vicarious trauma are central to understanding the impact of relational trauma and the experience of individuals, families, teams, and the wider ecology of collaborative care systems. Given the challenges of working collaboratively across interpersonal, family, and systems boundaries to support traumatised children in OOHC, further research is required.
Objectives
Current service organization is not adapted for youth with or at risk of mental illness. Access, engagement and continuity of care are notorious challenges, particularly during transition from adolescence to adulthood, when youths are transferred to adult services. An HTA was initiated to evaluate the efficacy of programs for which admission is not a function of the legal age of majority.
Methods
A systematic review of systematic reviews identified literature published between 2000 and 2017 in 4 databases. To be selected, studies had to focus on specialised mental healthcare early intervention (EI) programs targeting both adolescents and young adults. Contextual and experiential data were collected through interviews with local leading experts. Article selection and quality assessment using ROBIS were conducted with inter rater agreement. The analytical framework developed includes 4 domains: access, engagement and continuity, recovery as well as meaningfulness and acceptability.
Results
1841 references were identified. Following inclusion/exclusion criteria, 5 studies were selected, 3 of which focused on EI for psyschosis. EI programs alone do not seem to decrease duration of untreated psychosis. EI including a multi focus campaign were more successful. EI does, however, seem to decrease hospitalisation for psychosis. The experience of service users and professionals with inter agency collaboration and person-centred care models were analysed to identify facilitating and inhibiting implementation factors.
Conclusions
Healthcare policies need to support further research and development of EI where admission is not a function of the legal age of majority and diagnostic, particularly for youths at risk.
Método:
As bases utilizadas neste artigo de revisão foram: PubMed (365), PsycInfo (134) e Lilacs (nehuma publicação encontrada), além de 2 livros, incluídos por referência cruzada. Foram selecionadas 34 publicações que atendiam ao objetivo proposto. A busca foi realizada em outubro de 2015. Os descritores selecionados foram: open dialogue, crisis, first episode psycosis, schizophrenia, terapy family, need adapted approach.
Resultados:
Foram encontrados 3 artigos de revisão, 5 estudos teóricos, 21 estudos qualitativos e 5 estudos quantitativos. Destes, 2 foram escritos em italiano, 1 em francês e 31 em inglês. Com relação ao país de origem dos autores temos: Noruega, Estados Unidos, Finlândia, Austrália, Reino Unido, Bélgica, Canadá e Polônia. As produções foram agrupadas para análise em: Concepções e princípios do Diálogo Aberto; Contribuições do diálogo Aberto; Desafios para implementação do Diálogo Aberto em outros países, realidades e contextos.
Objective::
Emerging evidence for Open Dialogue (OD) has generated considerable interest. Evidence comes from a range of methodologies (case study, qualitative, and naturalistic designs), which have not been synthesized as a whole. The objective of this review was to synthesize this literature.
Methods::
A systematic search of the databases PubMed, CINAHL, Scopus, Web of Science and PsycINFO included studies published until January 2018. A total of 1,777 articles were screened. By use of a textual narrative synthesis, studies were scrutinized for relevance and quality.
Results::
Twenty-three studies were included in the review; they included mixed-methods, qualitative, and quantitative designs and case studies. Overall, quantitative studies lacked methodological rigor and presented a high risk of bias, which precludes any conclusions about the efficacy of OD among individuals with psychosis. Qualitative studies also presented a high risk of bias and were of poor quality.
Conclusions::
Variation in models of OD, heterogeneity of outcome measures, and lack of consistency in implementation strategies mean that although initial findings have been interpreted as promising, no strong conclusions can be drawn about efficacy. Currently, the evidence in support of OD is of low quality, and randomized controlled trials are required to draw further conclusions. It is vital that an extensive evaluation of its efficacy takes place because OD has already been adopted by many acute and community mental health services.
This article positions safety' and risk' as key public health problems in mental health. I demonstrate that discourse about safety occurs extensively in relation to mental health, but it does not occur in a way where the mental health system gets any safer for the key actors involved. Ongoing unproductive discourse occurs because the different actors involved are speaking at cross purposes and about different things against the background of a public' discourse focused on safety crises. I map the general interests of the main set of actors to demonstrate the conflicted and complex nature of discourse around mental health safety. In response I outline a dialogical approach to safety and risk based on the work of Habermas and values of recovery. This is presented as a framework from which to assess whether discourse is occurring effectively to develop shared meanings. Shared understandings of safety will mean that the safety needs of relevant actors can be understood and negotiated rather than giving way to an actuarial process which does not take into consideration the context of a person's life.
Background:
In the UK and internationally, there have been increasing calls for interagency collaboration across mental health services for children and young people. However, it is not clear whether such practices do, indeed, have a positive impact and, if so, what factors facilitate and inhibit collaboration across agencies.
Methods:
Electronic searches were carried out on seven key computerized bibliographic databases. For inclusion in the review, studies needed to report on close working by two or more services that provided mental health support for children and/or young people and that had some systematic collection of qualitative and/or quantitative data. Outcomes were analysed narratively, and facilitating and inhibiting factors were examined using thematic analysis.
Results:
A final sample of 33 studies was identified from 4136 initial records. Outcomes were mixed, with some findings indicating that interagency collaboration was associated with greater service use and equity of service provision, but other suggesting negative outcomes on service use and quality. However, interagency collaboration was perceived as helpful and important by both service users and professionals, and collaborative initiatives were evaluated positively. The factors most commonly identified as facilitating interagency collaboration were good interagency communication, joint trainings, good understandings across agencies, mutual valuing across agencies, senior management support, protocols on interagency collaboration and a named link person. The most commonly perceived barriers to interagency collaboration were inadequate resourcing, poor interagency communication, lack of valuing across agencies, differing perspectives, poor understandings across agencies and confidentiality issues.
Conclusions:
The results are consistent with findings from previous reviews of interagency collaboration across adult and child services: there were some indications of benefit; and facilitating and inhibiting factors involved working relationships and multi-agency processes, resources and management. The identification of these factors has implications for practitioners, service managers, trainers, commissioners and researchers.
In order to maintain relationships effectively humans must communicate with each other. In everyday life, there are many types of communication including with work colleagues, family, neighbors, and friends, some efficient and some inefficient.
Non-verbal communication is defined as not involving words of speech: voluntary or involuntary non-verbal signals, such as smiling or blushing. The present research deals with non-verbal communication among humans, evaluating biblical verses associated with this topic from a viewpoint of contemporary perspective.
Achieving safe, quality health care is highly dependent on effective communication between all members of the healthcare team. This study explored the attitudes and experiences of recent healthcare graduates regarding interprofessional teamwork and communication within a clinical setting. A total of 68 pharmacy, nursing, and medicine graduates participated in 12 semi-structured focus group discussions in clinical workplaces across three Australian states. Discussion focussed on graduates' experiences of interprofessional education and its impact on their capacity for interprofessional teamwork and communication. The Social Identity and Realistic Conflict theories were used as a framework for qualitative data analysis. A consistent pattern of profession-focussed, rather than patient- or team-focussed goals was revealed along with reports of negative stereotyping, hierarchical communication, and competition for time with the patient. Graduates acknowledged the importance of communication, teamwork, and patient-centred care and felt a better understanding of the roles of other health professionals would assist them to work together for patients' wellbeing. Identifying workplace identities and differential goals has uncovered possible motivations underlying health professionals' behaviour. These insights may help improve interprofessional collaboration by focusing attention on common team goals, increasing feelings of worth and being valued among different professionals, and decreasing the need for competition.
This paper aims to identify the dominant types of team organization in cross-professional Swedish human service organizations and the relationship between team type and perceived efficiency as well as team climate as an aspect of work satisfaction. A questionnaire was responded to by 337 individual professionals from 59 teams, mainly from psychiatric care (50.7%) but also from social, neuropaediatric and vocational (re)habilitation, school health care and the occupational health service. The interprofessional model of team organization was the most frequent (62%), followed by the transprofessional (33%), and the multiprofessional team, (5%). A moderate positive correlation was found between team type and perceived efficiency as well as team climate. The greater the interdependence and the closer the cooperation , the higher the efficiency and the better the climate. No differences were found between professions or organizational domiciles with respect to team type. This paper suggests (1) a more consistent vocabulary with 'cross-professional' as the generic term covering different team types and (2) that a contingency approach to teamwork is tested in future research.
The open dialogue (OD) family and network approach aims at treating psychotic patients in their homes. The treatment involves the patient's social network and starts within 24 hr after contact. Responsibility for the entire treatment process rests with the same team in both inpatient and outpatient settings. The general aim is to generate dialogue with the family to construct words for the experiences that occur when psychotic symptoms exist. In the Finnish Western Lapland a historical comparison of 5-year follow-ups of two groups of first-episode nonaffective psychotic patients were compared, one before (API group; n = 33) and the other during (ODAP group; n=42) the fully developed phase of using OD approach in all cases. In the ODAP group, the mean duration of untreated psychosis had declined to 3.3 months (p=.069). The ODAP group had both fewer hospital days and fewer family meetings (p
An open dialogue need-adapted approach was applied in Finnish Western Lapland by organizing three-year family therapy training for the entire staff, and by following the outcomes. Three inclusion periods of first-episode psychotic patients were compared. In a two-year follow-up of two consecutive periods during the 1990s (1992–3 and 1994–7) it was found that 81% of patients did not have any residual psychotic symptoms, and that 84% had returned to full-time employment or studies. Only 33% had used neuroleptic medication. A third inclusion period, covering 2003–2005, was organized to determine whether the outcomes were consistent 10 years after the preliminary period. Fewer schizophrenia psychotic patients emerged, and their mean age was significantly lower. Duration of untreated psychosis had shortened to three weeks and the outcomes remained as good as for the first two periods. It is therefore suggested that the new practice can be related to profound changes in the incidence of severe mental health problems. This is supported by the large number of local inhabitants participating in treatment meetings for crises. Professionals had learned to make early contact in the event of crisis, and by this means prevent problems from developing into more severe cases.
Aims and objectives. We aimed to discover the significance of the participation of relatives in the treatment process using the principles of the Need-Adapted Approach. The study is based on joint interviews with 10 psychiatric patients, their relatives and a multiprofessional treatment team.
Background. The Need-Adapted Approach was developed in Finland for difficult psychiatric problems in public sector psychiatry. The central feature of the approach is the active participation of patients and their relatives in planning the treatment and in the treatment process. It emphasises horizontal expertise and open discussions between the patient, relatives and professionals.
Design. A qualitative method based on the grounded theory approach was used.
Method. The main focus in the analysis was on how the informants experienced the significance of the participation of their relatives in the treatment process.
Results. Seven categories and one core category were identified. Primary categories which increased safety were: (1) shared understanding, (2) a new kind of relationship opens up and (3) being able to cope with life. Secondary categories were: (4) exclusion and (5) need for a one-to-one relationship. Ambivalent categories were: (6) whom or what one can believe and (7) keeping the illness secret. One core category, safety, was identified among the categories. A theoretical model was created for clinical purposes.
Conclusions. When practiced correctly, the Need-Adapted Approach makes it possible to create circumstances in psychiatric treatment where the patient and his/her relatives can experience increased safety in spite of the anxiety connected to the psychiatric difficulties.
Relevance to clinical practice. Clinical workers and nursing personnel can use our findings in their practical work with psychiatric patients and their relatives. Our findings support further theoretical considerations concerning safety and can be used as guidelines for nursing personnel in their work.
After birth the first thing we learn is becoming a participant in dialogue. We are born in relations and those relations become our structure. Intersubjectivity is the basis of human experience and dialogue the way we live it. In this paper the dilemma of looking at dialogue as either a way of life or a therapeutic method is described. The background is the open dialogue psychiatric system that was initi-ated in Finnish Western Lapland. The author was part of the team re-organizing psychiatry and afterwards became involved in many different types of projects in dialogical practices. Lately the focus has shifted from looking at speech to seeing the entire embodied human being in the present moment, especially in multifarious settings. Referring to studies on good outcomes in acute psychosis, the contribu-tion of dialogical practice as a psychological resource will be clarified. I was invited to write a paper on open dialogues or a related subject for the ANZJFT, which I was delighted about. The editor's proposal was to write about how to become a dialogical therapist. I was enthusiastic about the possibility, but at the same time a bit confused, because speaking of dialogism as a form or method of psychotherapy makes me feel uneasy. I have come to see dialogue or dialogism as a way of life that we learn straightaway after birth: First we learn to breath — inhal-ing and exhaling, and immediately afterwards we learn to be an active participant in dialogical relations, where we respond to the expressions of those around us and actively initiate their responses to our expressions (Bråten, 2007; Trevarthen, 2007). How could I see this ordinary, everyday process as a therapeutic method? With the risk of sounding a bit hypocritical, I see dialogue simply as something that belongs to life, not as a special therapeutic method. And this means all psychotherapies have to be dialogic if they are to be successful in bringing about the positive changes that psychotherapists seek.
This paper aims at exploring and discussing the possibilities of applying qualitative content analysis as a (text) interpretation method in case study research. First, case study research as a research strategy within qualitative social research is briefly presented. Then, a basic introduction to (qualitative) content analysis as an interpretation method for qualitative interviews and other data material is given. Finally the use of qualitative content analysis for developing case studies is examined and evaluated. The author argues in favor of both case study research as a research strategy and qualitative content analysis as a method of examination of data material and seeks to encourage the integration of qualitative content analysis into the data analysis in case study research.
URN: urn:nbn:de:0114-fqs0601211
The aim of this article is to explore the challenges connected to the transformation and emergence of professional identity in transdisciplinary multi-agency network meetings and the use of Open Dialogue.
The empirical findings have been taken from a clinical project in southern Norway concerning multi-agency network meetings with persons between 14 and 25 years of age. The project explores how these meetings are perceived by professionals working in various sectors.
Data was collected through three interviews conducted with two focus groups, the first comprising health care professionals and the second professionals from the social and educational sectors. Content analysis was used to create categories through condensation and interpretation. The two main categories that emerged were 'professional role' and 'teamwork'. These were analysed and compared according to the two first meeting in the two focus groups.
The results indicate different levels of motivation and understanding regarding role transformation processes. The realization of transdisciplinary collaboration is dependent upon the professionals' mutual reliance. The professionals' participation is affected by stereotypes and differences in their sense of belonging to a certain network, and thus their identity transformation seems to be strongly affected. To encourage the use of integrated solutions in mental health care, the professionals' preference for teamwork, the importance of familiarity with each other and knowledge of cultural barriers should be addressed.
To identify the factors that make trust within the context of public mental health possible. We also consider the question of patients' trust in the whole caring system. The study is based on individual interviews with 22 psychiatric patients, who were also users of social services.
There are theoretical studies concerning trust between human beings in several disciplines within psychiatry and social services but few studies investigate how trust can be created and what makes it possible. The literature reveals that there is need for research concerning trust in psychiatry. In this study we examined two different caring contexts and investigated what makes trust possible in these contexts. The contexts are termed the Integrated Network and Family Model and the Traditional Model.
A qualitative method based on the grounded theory approach was used.
The main focus in the analysis was on how the patients had experienced the contexts of the caring systems and how trust was created or not within them.
Three categories creating trust were found in the Integrated Network and Family Model and two in the Traditional context. Acceptance of the patient's expertise concerning his/her life situation, openness and joint discussions concerning knowledge are important. Trust is closely connected to autonomy and power: patients feel that trust increases as their experience of autonomy increases and in such situations power is not owned by any one person.
Trust between psychiatric patients and personnel can be created in both the Integrated Network and Family Model and traditional context, but in different ways.
Clinical workers and nursing personnel can use our findings in their practical work with psychiatric patients. Our findings support theoretical considerations concerning trust and can be used as guidelines for nursing personnel in their work.
There is an increasing divergence of focus group practice between social researchers and commercial market researchers. This book addresses the key issues and practical requirements of the social researcher, namely: the kinds of social research issues for which focus groups are most and least suitable; optimum group size and composition; and the designing of focusing exercises, facilitation and appropriate analysis. The authors use examples, drawn from their own focus groups research experience, and provide exercises for further study. They address the three main components of composition, conduct and analysis in focus group research and also acknowledge the increasing impact the Internet has had on social research by covering the role and conduct of `virtual focus groups'.
Inter-agency collaboration is seen as an effective way to support children and families with multiple and complex needs. Children in out-of-home care, especially those exhibiting challenging and disruptive behaviour, often require the services of multiple agencies. Ninety-two South Australian stakeholders experienced in supporting children in out-of-home care were interviewed about their experience of collaborative practice, using the specific example of supporting children with extremely challenging behaviour. Participants were teachers, foster parents, child welfare workers, child mental health professionals and residential care workers. Thematic analysis revealed several tensions inherent in such collaboration. Results are discussed in terms of their unique implications for managing challenging behaviour, and suggestions are made for improving collaborative approaches to behaviour and multi-agency practice.
Dialogue in the polyphony of inner and outer voices in the present moment of family therapy is analysed. In Western Lapland a focus on social networks and dialogues in the meeting with families has proved to be effective in psychotic crises.
This paper explores the relationship between time allocation on formal and informal forms of contact within interprofessional teams and an interdependent collaboration. Data were collected by a questionnaire including items on work organization, team climate and time allocation that was responded to by 226 professionals from 44 interprofessional teams. An additional sample of 139 professionals from 18 teams responded to the same questionnaire except for the item on time allocation. The teams worked within occupational health care, psychiatry, rehabilitation and school health care. On average, team members spent about 22% of their available work time on internal meetings/consultations and they perceived their collaboration as fairly interdependent. No correlation was found between, on the one hand, time invested in meetings and informal consultations within the team and, on the other hand, degree of team interdependence. Instead, interdependence was predicted by team climate, followed by manager coordination and self-regulation. However, there may be a lower limit: all 44 teams allocated at least about 10% of their work time to internal meetings and consultations. The results suggest three ways to strengthen interprofessional team collaboration - development of team climate and communication and more opportunity for both manager coordination and self-regulation.
Our topic concerns four relational modes of speaking and listening, and their relationship to truth and falsity. In a separate article, Part I introduced the topic and discussed the modes of diplomacy and integrity. The focus of Part II is on sincerity and authenticity, and on the interrelationship among all four modes and their differing functions in the totality of the clinical situation. Together the papers disentangle and address some of the technical issues that concern the relational group psychotherapist regarding topics of intersubjectivity, presentation of self, and self-disclosure. The four overlapping categories while nonexclusive are exhaustive; they supply conceptual references for the therapeutic stance one has adopted, allowing the therapist to be more aware of what he or she is doing and why.
The ability to work with professionals from other disciplines to deliver collaborative, patient-centred care is considered a critical element of professional practice requiring a specific set of competencies. However, a generally accepted framework for collaborative competencies is missing, which makes consistent preparation of students and staff challenging. Some authors have argued that there is a lack of conceptual clarity of the "active ingredients" of collaboration relating to quality of care and patient outcomes, which may be at the root of the competencies issue. As part of a large Health Canada funded study focused on interprofessional education and collaborative practice, our goal was to understand the competencies for collaborative practice that are considered most relevant by health professionals working at the front line. Interview participants comprised 60 health care providers from various disciplines. Understanding and appreciating professional roles and responsibilities and communicating effectively emerged as the two perceived core competencies for patient-centred collaborative practice. For both competencies there is evidence of a link to positive patient and provider outcomes. We suggest that these two competencies should be the primary focus of student and staff education aimed at increasing collaborative practice skills.
Qualitative content analysis as described in published literature shows conflicting opinions and unsolved issues regarding meaning and use of concepts, procedures and interpretation. This paper provides an overview of important concepts (manifest and latent content, unit of analysis, meaning unit, condensation, abstraction, content area, code, category and theme) related to qualitative content analysis; illustrates the use of concepts related to the research procedure; and proposes measures to achieve trustworthiness (credibility, dependability and transferability) throughout the steps of the research procedure. Interpretation in qualitative content analysis is discussed in light of Watzlawick et al.'s [Pragmatics of Human Communication. A Study of Interactional Patterns, Pathologies and Paradoxes. W.W. Norton & Company, New York, London] theory of communication.
The primary aim of this paper is to present some findings from a pilot study and to outline a tentative model of interprofessional collaboration. A second aim is to reflect on how to design a main study. Seven professionals from school psychology services (3), a children's psychiatric clinic (2) and an elementary school (2), participated in the study. Two methods were used: Semi-structured interview in combination with a vignette and the Sentence Completion Technique. Categorization was used as the central analyzing tool together with condensation and interpretations. The data analysis is supported by the software program Nud*Ist N6. The results are presented in three main sections: (a) interprofessional group variations, (b) the situation of the central actors, and (c) collaboration as a working method.
Each health care profession has a different culture which includes values, beliefs, attitudes, customs and behaviours. Professional cultures evolved as the different professions developed, reflecting historic factors, as well as social class and gender issues. Educational experiences and the socialization process that occur during the training of each health professional reinforce the common values, problem-solving approaches and language/jargon of each profession. Increasing specialization has lead to even further immersion of the learners into the knowledge and culture of their own professional group. These professional cultures contribute to the challenges of effective interprofessional teamwork. Insight into the educational, systemic and personal factors which contribute to the culture of the professions can help guide the development of innovative educational methodologies to improve interprofessional collaborative practice.
Government and state policy, irrespective of jurisdiction, increasingly require and indeed specify the nature of collaboration with regard to the delivery of child welfare services for maltreated children. The rationale for collaboration appears obvious in as much as it is aimed at promoting multidisciplinary practice in order to meet the needs of the vulnerable child. However, collaboration, whilst a useful and motivating concept, is in reality far from straightforward and contains complexities and ambiguities.
The aim of this paper is to explore these complexities and ambiguities to provide an overview of key developmental frameworks relevant to the creation and maintenance of strategic high-level multiagency partnerships.
The authors begin by exploring the characteristic features of different levels of multiagency collaboration that is communication, co-operation, co-ordination, coalition, and integration. As the emphasis in a variety of jurisdictions in the Western world is on the highest levels of collaboration namely coalition and service integration this is the focus of the paper. The authors synthesize the main literature in the field to consider the critical elements for effective collaborative endeavors at this level including predisposing factors, mandate, leadership, machinery, process, and outcomes. The paper concludes by recognizing that the drive towards integrated services is occurring in a climate of continuing change. The need to identify the impact of such an environment when managing multiagency partnerships is explored using five steps to change.
Case study research. Design and methods. London: Sage
- R K Yin
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Tverrprofesjonelt samarbeid i praksis og utdanning i helse- og sosial sektoren
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Open dialogue across cultures: Establishing a therapeutic relationship with the refugee family
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The transdisciplinary team. A model for family-centered early intervention
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The Valdres project: A study of perceptions and experiences with network meetings, including mental health clients, social network members and professional staff members
- V Holloway
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Transdisciplinary collaboration and role release in Open Dialogue with adolescents' social network
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Åpne Samtaler - mer enn ord? Nettverksmøter som kommunikative hendelser, kunnskapsproduksjon og sosial strukturering
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Fokusgrupper. Denmark: Samfundslitteratur &
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- T E Arnkil
Innovating mental health care
- K D Søndergaard