Development and refinement of the open dialog adherence protocol in complex mental health care

Introduction: Open dialog (OD) is a both a therapeutic practice and a service delivery model that offers an integrated response to mental health care through mobilizing resources within the service user’s family and community networks through joint network meetings. Therapist adherence is a crucial to the effective delivery of interventions. A key way to measure this is through structured observation tools. Aims: The aim of this research project is to develop and refine the Dialogic Practice Adherence Scale, for use in OD research trials in the United Kingdom. Methods: This study was a mixed methods approach to the development of an OD practitioner adherence measure. Initial steps involved meetings and discussions with experts and a review of the literature. Content validation studies were completed using a modified Delphi technique. To assess reliability of the measure, OD network meetings were audio-recorded, and tapes were rated by two independent researchers. Inter-rater reliability and internal consistency were assessed through quantitative approaches assessing variance. Results: Results provide a description of how the OD Adherence Manual was developed in collaboration. Validation surveys showed high levels on consensus among experts in the field on the key elements of OD network meetings. Inter-rater reliability for the total score was excellent and internal consistency analyses suggest the scale is highly reliable. Discussion: The scale presented here is an initial attempt at rating practitioner adherence in OD network meetings. It provides encouraging evidence that this can be done with strong validity and reliability and can be completed by a range of raters with varying levels of clinical experience

Practitioner adherence measures in multimodal interventions for complex mental illness: Development of the Open Dialogue adherence scale

This three-part thesis examines the role and development of practitioner adherence measures for multimodal interventions for individuals with complex mental health difficulties. Part 1: Literature Review. A systematic review of the literature on practitioner adherence measures for multimodal interventions for complex mental health conditions. Results are presented and narratively synthesized examining measure content, development and use. The review revealed the lack of consensus around measure development and highlighted the need for guidelines for researchers. Part 2: Empirical Paper. A multimodal approach to the development and psychometric formalisation of an Open Dialogue (OD) practitioner adherence measure. This research describes the process of measure development using a Modified Delphi technique as well as inter-rater reliability and internal consistency analyses. Preliminary outcomes suggest that the OD Adherence Measure is a reliable and valid way of measuring practitioner adherence to OD principles within network meetings. Future directions for measure development and use are described. Part 3: Critical Appraisal. A reflection and appraisal of the research process. This includes reasons for undertaking research in this area, challenges of working in a multisite research project and a more detailed discussion of the limitations of this work