The Work of Getting Better: An Institutional Ethnography of an Early Psychosis Intervention Clinic

The imperative to provide recovery-oriented services in mental healthcare settings has become foundational to mental health policies world-wide. However, in the context of psychiatric services, historically characterized as paternalistic and coercive, the translation of recovery policy into practice is complex, challenging and unevenly taken up. Early intervention services for young people experiencing a first episode of psychosis adhere to a recovery-oriented approach that aims to be client-centred, flexible and collaborative, empowering young people with the right and responsibility to be engaged in shared decision-making about their treatment options, which involve low-dose medication and psychosocial services. However, how these recovery practices unfold in young peoples’ interactions in early psychosis intervention (EPI) programs is not clear. In this study, I employ an institutional ethnographic approach to explore how the social organization of an EPI clinic coordinates young people’s everyday work of recovery. Methods included over 110 hours of ethnographic observation, in-depth interviews with 27 participants (18 clinic staff, four young people and five family members) and textual analysis of clinic documents (e.g., case files, administrative forms, policy reports). I provide an ethnographic description of “what actually happens” in young people’s interactions with service providers of an EPI clinic situated in Ontario, Canada. Findings detail how institutional processes shaped by the medication adherence discourse produced a disjuncture between service providers intent to provide recovery-principled care and young people’s experiences of medication uptake via institutional relations of informal coercion. In a related disjuncture of conflicting directives and objectives that govern the clinic, this analysis also outlines how the clinic manager’s and staff’s resistance to hospital rulings that impeded EPI policy principles were part of the extended sequence of activities that produced trust. These findings have important implications for shifts at the system level in terms of medication management and an emphasis from risk management and quality governance to an organizing framework based on trust.Ph.D

Institutional Ethnography as a Method of Inquiry: A Scoping Review

The purpose of this scoping review is to examine the extent, range, and nature of the use of institutional ethnography (IE) as a method of inquiry in peer-reviewed journal publications. Fifteen databases were searched between the years of 2003 and 2013. Relevant data were extracted from 179 included articles. Findings relate to nine key areas including year of publication, authorship and geography, types of journals, format of resources, authors’ descriptions of how they used IE, approaches used in conjunction with IE, data collection methods, standpoint, and institutional relations. Institutional ethnography was diversely conceptualized as: a (sociological) method of inquiry, methodology, research approach, feminist sociology, theory and methodology, framework, lens, field, perspective, and form of analysis. Inevitably, authors applied IE differently across their research and writing, ranging from direct usage or close adherence to IE in a comprehensive manner; to indirect usage or loose adherence to IE by drawing on it as inspiration, guidance, or influence; or borrowing from a certain facet of IE such as a particular theory, concept, method, tool, or analytic strategy. Additionally, some authors adapted IE to suit a specific purpose, which entailed using modified versions of IE to fit a given context or objective, while others strived to extend existing understandings of IE through critique, explanation, review, elaboration, or reflection. The results from this study are useful to both beginning and experienced institutional ethnographers, as the insights gained provide clarity about the use of IE, identify trends in its application, and raise additional questions

Ineffable knowledge : tensions (and solutions) in art-based research representation and dissemination

This article draws upon an art-based health research (ABHR) study that examines the work of health/social science researchers and artists who use a wide variety of art genres to create and disseminate scientific health-based research. The intent of their work is to reduce the knowledge to action gap as well as to enable engagement with the research findings on the part of the target audience. With respect to the use of art genres to disseminate research findings, the representation of the source material often poses a dilemma for both artists and researchers alike, particularly vis-à-vis the extent to which the research is made explicit. We consider here the methodological and epistemological expectations of the ABHR community (both artists and researchers) regarding dissemination of research findings. We detail the tensions experienced in creative teams engaged in ABHR projects when deciding exactly how much information about the research should be provided to the audience and then move on to highlight the strategies identified by our study participants to address these tensions

Ineffable knowledge: Tensions (and solutions) in art-based research representation and dissemination

This article draws upon an art-based health research (ABHR) study that examines the work of health/social science researchers and artists who use a wide variety of art genres to create and disseminate scientific health-based research. The intent of their work is to reduce the knowledge to action gap as well as to enable engagement with the research findings on the part of the target audience. With respect to the use of art genres to disseminate research findings, the representation of the source material often poses a dilemma for both artists and researchers alike, particularly vis-à-vis the extent to which the research is made explicit. We consider here the methodological and epistemological expectations of the ABHR community (both artists and researchers) regarding dissemination of research findings. We detail the tensions experienced in creative teams engaged in ABHR projects when deciding exactly how much information about the research should be provided to the audience and then move on to highlight the strategies identified by our study participants to address these tensions

The production and dissemination of knowledge: a scoping review of arts-based health research

Die Verwendung kunstbasierter Forschung hat unser Verständnis dessen, was evident ist, verändert, und die Komplexität und Multidimensionalität deutlicher werden lassen, die mit der Produktion neuen Wissens verbunden sind. In diesem Scoping-Review kunstbasierter Gesundheitsforschung inspizieren wir die Breite und Vielfalt begutachteter Veröffentlichungen in diesem Feld, skizzieren wichtige Ergebnisse und benennen künftige Forschungsrichtungen. Ausgehend von einer Literaturrecherche haben wir 71 Studien identifiziert, die unseren Kriterien entsprachen. Sie variieren mit Blick auf  Genres, Forschungsdesigns und behandelte Thematiken. Insgesamt folgen aus der Nutzung von künstlerischen Verfahren die Möglichkeit eines größeren Engagements sowohl der Forschungsteilnehmer/innen als auch des Publikums, die Chance, Kommunikation anzureichern und Forschung auch jenseits der Universitäten zugänglich zu machen und ein Zugang jenseits der zumeist üblichen Interviewverfahren.Drei zentrale Forschungslücken wurden identifiziert: die Notwendigkeit eines kritischen Dialogs zur Frage des Impacts von kunstbasierter Forschung, zu deren angemessener Evaluation und zu ethischen Herausforderungen, die mit diesem Ansatz verbunden sind. Wir gehen davon aus, dass die Öffnung qualitativer Methodologien für kunstbasierte Studien nicht einfach eine zusätzliche Möglichkeit der Datenerhebung und der Dissemination der Ergebnisse bedeutet, sondern neue Wege des Wissens bzw. des Umgangs mit Wissen beinhaltet. Dies bedeutet möglicherweise eine grundsätzlichere Neuorientierung im Sinne eines paradigmatischen Wandels in der Art und Weise, wie wir uns als Forschende der sozialen Welt nähern mit einem innovativen Set an Techniken, die wir nutzen können, um traditionelle qualitative Forschungsmethoden anzureichern.The use of arts-based research is shifting our understanding of what counts as evidence and highlights the complexity and multidimensionality involved in creating new knowledge. A scoping review of arts-based health research was undertaken to identify the breadth of peer-reviewed literature, summarize findings and identify gaps. A literature database search identified 71 original studies meeting our criteria for review. Studies were characterized by diverse art genres, designs, and substantive health topics. The arts in qualitative research were considered an opportunity for enhanced engagement of participants and audiences alike, a way to enrich communication and make research accessible beyond academia, and a method for generating data beyond the scope of most interview-based methods. Three central gaps were identified: the need for critical dialogue regarding the impact of arts-based health research, the need to focus on how the quality of such projects is judged, and the need to address the ethical challenges of engaging in this work. We suggest that the broadening of qualitative methodologies to include arts-based approaches offers more than simply adjuncts to typical data collection and dissemination approaches, and instead, presents different ways of knowing. We believe that this may be a significant moment in the field in which to question whether or not we are witness to a paradigmatic shift in the ways we approach inquiry into the social world and/or the emergence of an innovative set of techniques that researchers can draw upon to enhance traditional methods of conducting qualitative inquiry.El uso de la investigación basada en el arte está cambiando nuestro conocimiento de lo que cuenta como evidencia y resalta la complejidad y la multi-dimensionalidad involucrada al crear nuevo conocimiento. Se realizó una revisión de ámbitos de la investigación en salud basada en el arte para identificar el alcance de la literatura dictaminada por pares, resumir los resultados e identificar los huecos. Una búsqueda en la base de datos de la literatura identificó 71 estudios originales que cumplieron nuestros criterios de revisión. Los estudios fueron caracterizados por diversos géneros del arte, diseños y tópicos de salud sustantivos. Se considera a las artes en investigación cualitativa como una oportunidad para generar mayor participación de las audiencias y participantes, una forma de enriquecer la comunicación y hacer la investigación accesible más allá de la academia y un método de generar datos más allá de los ámbitos de la mayoría de métodos basados en entrevistas. Se identificaron tres huecos centrales: la necesidad del dialogo crítico en cuanto el impacto de la investigación basada en el arte, la necesidad de enfocarnos en como se juzga la calidad de estos proyectos y la necesidad de hacer frente a los desafíos éticos de participación en este trabajo. Sugerimos que la ampliación de las metodologías cualitativas para incluir enfoques basados en el arte ofrece más que simplemente adjuntarse a colecciones típicas de datos y enfoques de diseminación, pues presenta diferentes formas de conocer. Creemos que esto puede ser un momento significante en el campo en el que preguntar si o no somos testigos de un cambio paradigmático en las formas en que aproximamos a la investigación en el mundo social y/o la emergencia de una serie de técnicas innovadoras que los investigadores pueden aprovechar para mejorar métodos tradicionales de conducir investigación cualitativa

La producción y diseminación del conocimiento: Una revisión de ámbitos de la investigación en salud basada en el arte

The use of arts-based research is shifting our understanding of what counts as evidence and highlights the complexity and multidimensionality involved in creating new knowledge. A scoping review of arts-based health research was undertaken to identify the breadth of peer-reviewed literature, summarize findings and identify gaps. A literature database search identified 71 original studies meeting our criteria for review. Studies were characterized by diverse art genres, designs, and substantive health topics. The arts in qualitative research were considered an opportunity for enhanced engagement of participants and audiences alike, a way to enrich communication and make research accessible beyond academia, and a method for generating data beyond the scope of most interview-based methods. Three central gaps were identified: the need for critical dialogue regarding the impact of arts-based health research, the need to focus on how the quality of such projects is judged, and the need to address the ethical challenges of engaging in this work. We suggest that the broadening of qualitative methodologies to include arts-based approaches offers more than simply adjuncts to typical data collection and dissemination approaches, and instead, presents different ways of knowing. We believe that this may be a significant moment in the field in which to question whether or not we are witness to a paradigmatic shift in the ways we approach inquiry into the social world and/or the emergence of an innovative set of techniques that researchers can draw upon to enhance traditional methods of conducting qualitative inquiry.URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs1201327Die Verwendung kunstbasierter Forschung hat unser Verständnis dessen, was evident ist, verändert, und die Komplexität und Multidimensionalität deutlicher werden lassen, die mit der Produktion neuen Wissens verbunden sind. In diesem Scoping-Review kunstbasierter Gesundheitsforschung inspizieren wir die Breite und Vielfalt begutachteter Veröffentlichungen in diesem Feld, skizzieren wichtige Ergebnisse und benennen künftige Forschungsrichtungen. Ausgehend von einer Literaturrecherche haben wir 71 Studien identifiziert, die unseren Kriterien entsprachen. Sie variieren mit Blick auf  Genres, Forschungsdesigns und behandelte Thematiken. Insgesamt folgen aus der Nutzung von künstlerischen Verfahren die Möglichkeit eines größeren Engagements sowohl der Forschungsteilnehmer/innen als auch des Publikums, die Chance, Kommunikation anzureichern und Forschung auch jenseits der Universitäten zugänglich zu machen und ein Zugang jenseits der zumeist üblichen Interviewverfahren.Drei zentrale Forschungslücken wurden identifiziert: die Notwendigkeit eines kritischen Dialogs zur Frage des Impacts von kunstbasierter Forschung, zu deren angemessener Evaluation und zu ethischen Herausforderungen, die mit diesem Ansatz verbunden sind. Wir gehen davon aus, dass die Öffnung qualitativer Methodologien für kunstbasierte Studien nicht einfach eine zusätzliche Möglichkeit der Datenerhebung und der Dissemination der Ergebnisse bedeutet, sondern neue Wege des Wissens bzw. des Umgangs mit Wissen beinhaltet. Dies bedeutet möglicherweise eine grundsätzlichere Neuorientierung im Sinne eines paradigmatischen Wandels in der Art und Weise, wie wir uns als Forschende der sozialen Welt nähern mit einem innovativen Set an Techniken, die wir nutzen können, um traditionelle qualitative Forschungsmethoden anzureichern.URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs1201327El uso de la investigación basada en el arte está cambiando nuestro conocimiento de lo que cuenta como evidencia y resalta la complejidad y la multi-dimensionalidad involucrada al crear nuevo conocimiento. Se realizó una revisión de ámbitos de la investigación en salud basada en el arte para identificar el alcance de la literatura dictaminada por pares, resumir los resultados e identificar los huecos. Una búsqueda en la base de datos de la literatura identificó 71 estudios originales que cumplieron nuestros criterios de revisión. Los estudios fueron caracterizados por diversos géneros del arte, diseños y tópicos de salud sustantivos. Se considera a las artes en investigación cualitativa como una oportunidad para generar mayor participación de las audiencias y participantes, una forma de enriquecer la comunicación y hacer la investigación accesible más allá de la academia y un método de generar datos más allá de los ámbitos de la mayoría de métodos basados en entrevistas. Se identificaron tres huecos centrales: la necesidad del dialogo crítico en cuanto el impacto de la investigación basada en el arte, la necesidad de enfocarnos en como se juzga la calidad de estos proyectos y la necesidad de hacer frente a los desafíos éticos de participación en este trabajo. Sugerimos que la ampliación de las metodologías cualitativas para incluir enfoques basados en el arte ofrece más que simplemente adjuntarse a colecciones típicas de datos y enfoques de diseminación, pues presenta diferentes formas de conocer. Creemos que esto puede ser un momento significante en el campo en el que preguntar si o no somos testigos de un cambio paradigmático en las formas en que aproximamos a la investigación en el mundo social y/o la emergencia de una serie de técnicas innovadoras que los investigadores pueden aprovechar para mejorar métodos tradicionales de conducir investigación cualitativa.URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs120132

Co-Producing Narratives on Access to Care in Rural Communities: Using Digital Storytelling to Foster Social Inclusion of Young People Experiencing Psychosis (Dispatch)

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