The community mental health team fidelity scale: A measure of program fidelity of social networks interventions for severe mental illness

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 services around the world: a scoping survey exploring organizational characteristics in the implementation of the Open Dialogue approach in mental health services

ObjectiveThis cross-sectional study investigates the characteristics and practices of mental health care services implementing Open Dialogue (OD) globally.MethodsA structured questionnaire including a self-assessment scale to measure teams’ adherence to Open Dialogue principles was developed. Data were collected from OD teams in various countries. Confirmatory Composite Analysis was employed to assess the validity and reliability of the OD self-assessment measurement. Partial Least Square multiple regression analysis was used to explore characteristics and practices which represent facilitating and hindering factors in OD implementation.ResultsThe survey revealed steady growth in the number of OD services worldwide, with 142 teams across 24 countries by 2022, primarily located in Europe. Referrals predominantly came from general practitioners, hospitals, and self-referrals. A wide range of diagnostic profiles was treated with OD, with psychotic disorders being the most common. OD teams comprised professionals from diverse backgrounds with varying levels of OD training. Factors positively associated with OD self-assessment included a high percentage of staff with OD training, periodic supervisions, research capacity, multi-professional teams, self-referrals, outpatient services, younger client groups, and the involvement of experts by experience in periodic supervision.ConclusionThe findings provide valuable insights into the characteristics and practices of OD teams globally, highlighting the need for increased training opportunities, supervision, and research engagement. Future research should follow the development of OD implementation over time, complement self-assessment with rigorous observations and external evaluations, focus on involving different stakeholders in the OD-self-assessment and investigate the long-term outcomes of OD in different contexts

Fidelity measurement for the implementation of social networks interventions in complex mental health

This thesis examines the concept of programme fidelity as related to multi-component mental health interventions for severe mental health difficulties. Part 1, the literature review, explores existing measures in the field to identify the ‘best standards’ for programme fidelity assessment and an initial articulation of their typology. 31 papers are examined using a narrative synthesis approach. The content and psychometric properties of the 12 identified measures are described, identifying common practices, and highlighting neglected assessment areas. Findings highlight a scarcity of measures despite their increasing relevance to the field of implementation science. Further, although arguably consistent in design, assessment procedures, and scoring, there is great variability in the domains covered. Part 2, the empirical paper, describes the development, piloting and implementation of the Community Mental Health Fidelity Scale (CoMFideS), as part of the Open Dialogue: Development and Evaluation of a Social Network Intervention for Severe Mental Illness (ODDESSI) trial. The ODDESSI trial aims to assess whether Open Dialogue (OD) –when integrated within standard NHS mental health services for adults in crisis– improves the clinical and cost-effectiveness of traditional crisis and continuing community mental health care (CAU). CoMFideS was developed based on findings from the systematic review and drawing from expertise and existing measures in the field. CoMFideS was piloted in 6 OD and 6 CAU services. Findings suggests that CoMFideS may be a reliable and feasible programme fidelity measure of high-quality CAU and specific OD features. Part 3, the critical appraisal, provides some final thoughts about the research project, including a discussion on some methodological and theoretical considerations, as well as some reflections on the research process as a whole

Open Dialogue services around the world: a scoping survey exploring organizational characteristics in the implementation of the Open Dialogue approach in mental health services

Objective: This cross-sectional study investigates the characteristics and practices of mental health care services implementing Open Dialogue (OD) globally.// Methods: A structured questionnaire including a self-assessment scale to measure teams’ adherence to Open Dialogue principles was developed. Data were collected from OD teams in various countries. Confirmatory Composite Analysis was employed to assess the validity and reliability of the OD self-assessment measurement. Partial Least Square multiple regression analysis was used to explore characteristics and practices which represent facilitating and hindering factors in OD implementation.// Results: The survey revealed steady growth in the number of OD services worldwide, with 142 teams across 24 countries by 2022, primarily located in Europe. Referrals predominantly came from general practitioners, hospitals, and self-referrals. A wide range of diagnostic profiles was treated with OD, with psychotic disorders being the most common. OD teams comprised professionals from diverse backgrounds with varying levels of OD training. Factors positively associated with OD self-assessment included a high percentage of staff with OD training, periodic supervisions, research capacity, multi-professional teams, self-referrals, outpatient services, younger client groups, and the involvement of experts by experience in periodic supervision.// Conclusion: The findings provide valuable insights into the characteristics and practices of OD teams globally, highlighting the need for increased training opportunities, supervision, and research engagement. Future research should follow the development of OD implementation over time, complement self-assessment with rigorous observations and external evaluations, focus on involving different stakeholders in the OD-self-assessment and investigate the long-term outcomes of OD in different contexts

Dialogue as a Response to the Psychiatrization of Society? Potentials of the Open Dialogue Approach

In recent decades, the use of psychosocial and psychiatric care systems has increased worldwide. A recent article proposed the concept of psychiatrization as an explanatory framework, describing multiple processes responsible for the spread of psychiatric concepts and forms of treatment. This article aims to explore the potentials of the Open Dialogue (OD) approach for engaging in less psychiatrizing forms of psychosocial support. While OD may not be an all-encompassing solution to de-psychiatrization, this paper refers to previous research showing that OD has the potential to 1) limit the use of neuroleptics, 2), reduce the incidences of mental health problems and 3) decrease the use of psychiatric services. It substantiates these potentials to de-psychiatrize psychosocial support by exploring the OD’s internal logic, its use of language, its processes of meaning-making, its notion of professionalism, its promotion of dialogue and how OD is set up structurally. The conclusion touches upon the dangers of co-optation, formalization and universalization of the OD approach and stresses the need for more societal, layperson competencies in dealing with psychosocial crises.peerReviewe