Individual Placement and Support is the keyhole : Employer experiences of supporting persons with mental illness

BACKGROUND: Rehabilitation professionals are increasingly interested in the vocational rehabilitation approach called Individual Placement and Support (IPS) for persons with serious mental illness. OBJECTIVE: Since employers play a crucial supporting role for the IPS service user in the workplace, the aim of this study was to explore the experiences and views of employers in Sweden who have participated in the IPS network and taken IPS service users into their workforce. METHODS: Grounded theory with situational analysis was used to analyze data from nine employers. RESULTS: The core category being socially committedwas identified. Six stages/categories illustrated the employer process, from taking on IPS service users to supporting them at work: 1) IPS is the keyhole, 2) being ready to open the door, 3) making a job offer, 4) removing barriers, 5) achieving the goal, and 6) pride mixed with negative feelings. CONCLUSION: The study results suggest that collaborative relationships with employers must be based on trust and professionalism, and that employers must be provided with adequate support

Flexible assertive community treatment teams can change complex and fragmented service systems: experiences of service providers

Background Implementing innovative health service models in existing service systems is complicated and context dependent. Flexible assertive community treatment (FACT) is a multidisciplinary service model aimed at providing integrated care for people with severe mental illness. The model was developed in the Netherlands and is now used in several countries, such as Norway. The Norwegian service system is complex and fragmented, with challenges in collaboration. Limited research has been performed on FACT teams and other new integrative health service models as part of such systems. However, such knowledge is important for future adjustments of innovation processes and service systems. Our aim was to explore how FACT teams are integrated into the existing formal public service system, how they function and affect the system, and describe some influencing factors to this. We sought to address how service providers in the existing service system experience the functioning of FACT teams in the system. Methods Five focus group interviews were undertaken 3 years after the FACT teams were implemented. Forty service providers representing different services from both levels of administration (primary and specialist healthcare) from different Norwegian regions participated in this study. Team leaders of the FACT teams also participated. Service providers were recruited through purposeful sampling. Interviews were analysed using thematic text analysis. Results The analysis revealed five main themes regarding FACT teams: (1) They form a bridge between different services; (2) They collaborate with other services; (3) They undertake responsibility and reassure other services; (4) They do not close all gaps in service systems; and (5) They are part of a service system that hampers their functioning. Conclusions The FACT teams in this study contributed to positive changes in the existing service system. They largely contributed to less complex and fragmented systems by forming a bridge and undertaking responsibility in the system and by collaborating with and reassuring other services; this has reduced some gaps in the system. The way FACT teams function and needs of the existing system appear to have contributed positively to these findings. However, complexity and fragmentation of the system partly hamper functioning of the FACT teams.publishedVersio

Flexible Assertive Community Treatment in Rural and Remote Areas: A Qualitative Study of the Challenges and Adaptations of the Model

Flexible assertive community treatment (FACT) is an innovative model for providing long-term treatment to people with severe mental illness. The model was developed in the Netherlands but is now used in other countries, including Norway, which has a geography different from the Netherlands, with many rural and remote areas. Implementation of innovations is context dependent. The FACT model’s potential in rural and remote areas has not been studied. Therefore, we aimed to gain knowledge regarding the challenges and modifications of the model in rural and remote contexts and discuss how they can affect the model’s potential in such areas. This knowledge can improve the understanding of how FACT or similar services can be adapted to function most optimally in such conditions. We sought to address the following questions: Which elements of the FACT model do team leaders of the rural FACT teams find particularly challenging due to the context, and what modifications have the teams made to the model. Digital interviews were conducted with five team leaders from five rural FACT teams in different parts of Norway. They were selected using purposive sampling to include team leaders from some of the most rural teams in Norway. The interviews were analysed using thematic text analysis. The following three themes described elements of the FACT model that were experienced particularly challenging in the rural and remote context: multidisciplinary shared caseload approach, intensive outreach, and crisis management. The following eight themes described the modifications that the teams had made to the model: intermunicipal collaboration, context-adaptive planning, delegation of tasks to municipal services, part-time employment, different geographical locations of staff, use of digital tools, fewer FACT board meetings, and reduced caseload. Rural and remote contexts challenge the FACT model’s potential. However, modifications can be made, some of which can be considered innovative modifications that can increase the model’s potential in such areas, while others might move the teams further away from the model.publishedVersio

Integration of Care in Complex and Fragmented Service Systems: Experiences of Staff in Flexible Assertive Community Treatment Teams

Introduction: To provide more integrated care, several countries have implemented the Flexible Assertive Community Treatment (FACT) model. However, this model does not guarantee full integration, especially in complex and fragmented service systems like in Norway. Hence, we investigated which barriers that might reduce the potential for integrated care in the Norwegian system, as described by staff in FACT teams, and how they adjust their way of working to increase the opportunities for integration. Methods: Online focus group interviews involving 35 staff members of five Norwegian FACT teams were conducted using a semi-structured interview guide. The material was analysed using thematic text analysis. Results: Six themes described the barriers to integrated care in the service system: fragmentation, different legislation and digital systems, challenges in collaboration, bureaucracy and limited opening hours. Three themes described adjustments in the teams’ way of working to enhance integration: working as the responsible co-ordinator, being a collaborator, and the only entry channel into the service system. Conclusion: The FACT team staff described several barriers to integration within the system. However, they made some adjustments in their way of working that might provide opportunities for integrated care within complex and fragmented service systems.publishedVersio

Service User Experiences of How Flexible Assertive Community Treatment May Support or Inhibit Citizenship: A Qualitative Study

The aim of this study was to explore and describe service user experiences of how receiving services from a Flexible Assertive Community Treatment (FACT) team may support or inhibit citizenship. Within a participatory design, individual interviews with 32 service users from five Norwegian FACT teams were analyzed using thematic, cross-sectional analysis. The findings showed that FACT may support citizenship by relating to service users as whole people, facilitating empowerment and involvement, and providing practical and accessible help. Experiences of coercion, limited involvement and authoritarian aspects of the system surrounding FACT had inhibited citizenship for participants in this study.publishedVersio

Swedish occupational therapists’ considerations for leaving their profession : outcomes from a national survey

Background: Occupational therapists are an essential healthcare profession and play a vital role in rehabilitating patients in the activities of daily life. Nevertheless, many occupational therapists in Sweden are leaving the profession and this jeopardises occupational therapy services. Objective: To explore factors that cause occupational therapists to seriously consider leaving their profession. Material and methods: As part of a larger national study of Swedish occupational therapists’ health and work environment, qualitative content analysis with a summative approach was applied to explore the reasons for considering leaving their profession among 1279 Swedish occupational therapists. Results: Three themes emerged: (1) facing work environment deficiencies, (2) pursuing own development and (3) Personal factors and external constraints. The largest category, belonging to theme 1, was stress and high work pressure given 344 times as a reason to consider leaving the profession. Conclusions and significance: This article provides new and important insights on the reasons why occupational therapists may seriously consider leaving their profession. The results are significant for managers and employing organizations to consider in order to prevent a shortage of occupational therapy services

Mental health professional experiences of the flexible assertive community treatment model : a grounded theory study

Background: Despite the lack of evidence for effectiveness of the Flexible Assertive Community Treatment (Flexible ACT), the model is considered feasible and is well received by mental health professionals. No current studies have adequately examined mental health professional experiences of working with Flexible ACT. Aims: The aim of this study was to explore mental health professional experiences of working with the Flexible ACT model compared with standard care. Method: The study was guided by grounded theory and based on the interviews with 19 theoretically chosen mental health professionals in Swedish urban areas primarily working with consumers with psychosis, who had worked with the Flexible ACT model for at least 6 months. Results: The analysis resulted in the core category: “Flexible ACT and the shared caseload create a common action space” and three main categories: (1) “Flexible ACT fills the need for a systematic approach to crisis intervention”; (2) “Flexible ACT has advantages in the psychosocial working environment”; and (3) “Flexible ACT increases the quality of care”. Conclusions: Mental health professionals may benefit from working with the Flexible ACT model through decreased job-strain and stress, increased feeling of being in control over their work situation, and experiences of providing higher quality of care