Kwalitatieve evaluatie van 10 jaar zorgcoördinatie en case management in de Oost-Vlaamse drughulpverlening: een rondvraag bij hulpverleners en cliënten

Sinds 10 jaar wordt door de Provincie Oost-Vlaanderen – in samenwerking met het provinciaal overlegplatform geestelijke gezondheidszorg (PopovGGZ) en alle betrokken voorzieningen – geïnvesteerd in zorgvernieuwing, coördinatie en afstemming van de zorg in de drughulpverlening. Dit heeft naast heel wat ‘onzichtbare’ realisaties (bv. grotere bekendheid van het zorgaanbod, de intakeprocedure en werkwijze van andere voorzieningen, betere samenwerking tussen voorzieningen als gevolg van meer (informele) contactmomenten), ook tot een aantal duidelijk tastbare resultaten geleid. Het betreft onder meer de oprichting van een netwerkcomité middelenmisbruik, de aanstelling van een zorgcoördinator, de uitbouw van een case managementteam en de organisatie van een driewekelijks cliëntenoverleg. Met name deze laatste twee realisaties komen in voorliggend onderzoeksrapport uitgebreid aan bod. We doen dit in de eerste plaats door de direct betrokkenen (cliënten, hulpverleners en verantwoordelijken) zelf aan het woord te laten. De bevindingen van onze kwalitatieve evaluatie worden afzonderlijk besproken met betrekking tot het cliëntenoverleg en case management. Vooreerst worden beide werkvormen beschreven en worden enkele cijfergegevens meegegeven over de interventie in kwestie. Daarna volgt een beknopte bespreking van de gevolgde methodologie. Bij de rapportage van de onderzoeksresultaten wordt een onderscheid gemaakt tussen de bevindingen van hulpverleners over het cliëntenoverleg, de visie van cliënten over case management en het perspectief van case managers en projectverantwoordelijken over deze laatste interventie. We sluiten af met een aantal globale conclusies en aanbevelingen voor de toekomstige praktijk, die we terugbrachten tot tien concrete suggesties ter optimalisatie van het cliëntenoverleg en het case management. In tegenstelling tot eerdere publicaties beroepen we ons in dit onderzoeksrapport slechts in beperkte mate op de literatuur. In voorliggend rapport wilden we vooral het ‘insider’-perspectief laten primeren en voor meer theoretische beschouwingen verwijzen we dan ook naar eerdere publicaties (cf. Vanderplasschen, 2004)

Substance use among individuals with intellectual disabilities living independently in Flanders

Background: Over the past decades, there has been increased scientific and clinical interest in substance use among individuals with intellectual disabilities (ID). Despite raised interest and awareness in the topic, lack of supportive data on prevalence and risk factors highlights the need for ongoing research. The aims of this cross-sectional multicenter study were to examine the nature and extent of substance use in individuals with ID living independently, to investigate group differences in substance use and related problems, and to explore the role of substance-related knowledge and attitudes in substance use behaviors. Method: Participants were 123 individuals with mild to moderate ID receiving support from independent living services. Data were gathered by means of a structured interview strategy (i.e. the Substance Use and Misuse in Intellectual Disability - Questionnaire; SumID-Q). Results: Findings revealed that rates of lifetime use of licit and illicit substances were higher than those found in earlier studies among individuals with ID and the general population. While cannabis use was the only illicit substance reported, current tobacco and alcohol use were shown to be highly prevalent (48%-45.5%). Rates for the latter were similar to earlier studies among community samples of individuals with ID. In contrast to our hypotheses, few group differences in substance use behaviors were observed. Male gender was associated with age of onset of alcohol and tobacco use and tobacco use-related problems, while younger age was found to be associated with lifetime use of cannabis. No evidence was found regarding the role of knowledge; however, smokers and alcohol users rated tobacco and alcohol use more positively. Conclusion: This study demonstrated that individuals with ID living independently use a wide range of licit and illicit substances and present divergent levels and patterns of substance use. Notwithstanding the role of personal choice in substance use, more research is needed to better understand the nature and extent of substance use and related problems, as well as the role of substance-related knowledge and attitudes in individuals with ID

Villa Voortman : carte blanche or not?

Purpose - Influenced by evolutions in mental health, a meeting house, "Villa Voortman", was recently developed. It is based on an integration of therapeutic community (TC) and psychoanalytical Lacanian thinking. The purpose of this paper is to investigate the position of Villa Voortman in the treatment continuum for dually diagnosed clients. Two research questions are addressed: how does Villa Voortman operate ? and how do clients perceive the Villa? Design/methodology/approach - The first question was tackled by a personal account of the founders of Villa Voortman. The second question was addressed by a qualitative study using video-material of 19 visitors' personal accounts. Findings - The visitors mentioned three themes: social inclusion, personal development and equality. These aspects are further refined into sub-themes including the provision of "asylum"; the instalment of a warm and welcoming atmosphere; the focus on real human encounter; a permissive, supportive and "waiting" environment; a minimal but "good enough" structure; the necessity of a place where persons can develop themselves; the striving for social inclusion and future perspectives; and the support in becoming inclusive citizens again. Originality/value - The value of the paper lies in disclosing the visitors' lived experience. This is an essential part of shedding light on the "active ingredients" of support, In reference to the title, visitors nor treatment staff have "carte blanche" with regard to how support develops, as this is driven by the dialectal course of everything that occurs during the support process

A systems approach to social entrepreneurship

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Treatment satisfaction and quality of support in outpatient substitution treatment: opiate users' experiences and perspectives

Aims: Patient-reported outcomes have become an important source of information to guide service provision. Although opiate substitution treatment (OST) is an evidence-based and widely available intervention for opiate dependent individuals, evaluation studies have primarily focused on objective outcome indicators rather than on clients’ perspectives and personal experiences. This study aims to assess opiate users’ satisfaction with various aspects of substitution treatment and their subjective experiences and expectations regarding the provision of psychosocial support. Methods: The study sample consisted of 77 opiate- dependent individuals who had been involved in OST for at least three months in some cities in Belgium. Qualitative interviews were used to explore clients’ subjective experiences, in addition to some quantitative measures. Findings: About half of the respondents recently received some form of psychosocial support and they were generally satisfied about these services. However, the number of persons who wanted psychosocial support clearly outnumbered those actually receiving these services. Respondents stressed the importance of building trusting relationships with OST staff. Also, the need for more flexible and individualised support was emphasised. Conclusions: Compared with other stakeholders’ perspectives or traditional outcome indicators, service users’ subjective experiences shed an alternative light on the impact of opiate dependence and OST on individuals’ daily lives. This information should be incorporated in individual treatment planning and when designing and evaluating OST services

A meta-analysis of the efficacy of case management for substance use disorders : a recovery perspective

Background: Case management is a client-centered approach to improve the coordination and continuity of service delivery, especially for persons with substance use disorders (SUD) and multiple and complex support needs. This intervention supports individuals by helping them identify needed services, facilitate linkage with services, and promote participation and retention in services. However, it is questionable whether case management is equally effective in promoting recovery and aspects of personal functioning. The objective was to conduct an updated meta-analysis and to assess whether case management was more effective than treatment as usual (TAU) among persons with SUD for improving treatment-related (e.g., successful linkage with and retention in treatment) as well as personal functioning outcomes (e.g., substance use). Methods: This meta-analysis focuses on randomized controlled trials (RCTs) that included persons with alcohol or drug use disorders and compared case management with TAU. To be eligible, interventions had to meet core case management functions as defined in the literature. We conducted searches of the following databases to May 2017: the Cochrane Drugs and Alcohol Specialized Register, CENTRAL, PubMed, Embase, CINAHL, and Web of Science. Also, reference lists of retrieved publications were scanned for relevant (un) published studies. Results: The overall effect size for case management compared to TAU across all outcome categories and moments was small and positive (SMD = 0.18, 95% CI 0.07-0.28), but statistically significant. Effects were considerably larger for treatment tasks (SMD = 0.33, 95% CI 0.18-0.48) than for personal functioning outcomes (SMD = 0.06, 95% CI -0.02 to 0.15). The largest effect sizes were found for retention in substance abuse treatment and linkage with substance abuse services. Moderator effects of case management models and conditions were assessed, but no significant differences were observed. Conclusions: The primary results from earlier meta-analyses were supported: case management is more effective than TAU conditions for improving outcomes, but this effect is significantly larger for treatment-related tasks than for personal functioning outcomes. Case management can be an important supplement to available services for improving linkage and retention, although further research is needed to assess its potential for supporting recovery from a longitudinal perspective