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

Trane, Kristin; Aasbrenn, Kristian; Rønningen, Martin; Odden, Sigrun; Lexén, Annika; Landheim, Anne

doi:10.5334/ijic.6011

Cited by 12 publications

(14 citation statements)

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“…Delegation of tasks to primary care appeared to be a modification that maintained outreach intensity to some extent and improved crisis management. However, this means that the FACT teams must collaborate with other services and co-ordinate care they do not provide themselves, which might be challenging ( 30 ). Therefore, a high degree of delegation of tasks to other services can make the teams depart further from the FACT model, which specifies that other services should be used as little as possible to ensure a good overview and co-ordination ( 17 ).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, a high degree of delegation of tasks to other services can make the teams depart further from the FACT model, which specifies that other services should be used as little as possible to ensure a good overview and co-ordination ( 17 ). Neither urban nor rural Norwegian FACT teams provide all services themselves and co-ordination and collaboration are needed ( 30 ). This appears to be reinforced by the rural context, where even more services are provided by others.…”

Section: Discussionmentioning

confidence: 99%

“…Mental health services are affected by both geography and the service system ( 29 ). Norway has a complex and fragmented mental health service system ( 27 , 30 ), and adaptions of the FACT model to the system has been made ( 30 ). Prior to the establishment of FACT teams, several different services provided treatment and care to the target group ( 31 , 32 ), such as inpatient and outpatient specialist health services, Mental health and substance abuse services in primary care, The Norwegian Labor and Welfare Organization (NAV), and General practitioners (GP).…”

Section: Introductionmentioning

confidence: 99%

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

Trane

Aasbrenn

Rønningen

et al. 2022

Front. Public Health

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BackgroundFlexible 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?MethodsDigital 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 analyzed using thematic text analysis.ResultsThe 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.ConclusionsRural 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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Trane

Aasbrenn

Rønningen

et al. 2022

Front. Public Health

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“…The FACT model fidelity of this team was assessed as strong. 6 For more information on the context of the FACT teams and the leading project, please refer to Brekke et al (2021) and Trane et al (2021Trane et al ( , 2022aTrane et al ( , 2022b.…”

Section: Contextmentioning

confidence: 99%

The therapeutic relationship in music therapy in a Flexible Assertive Community Treatment team: A joint interview study of service users and their Music Therapist

Skånland,

Trondalen

2023

British Journal of Music Therapy

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Flexible Assertive Community Treatment provides integrated and community-based support to clients with mental illness and challenges in social functioning. Music therapy has been incorporated into several Norwegian Flexible Assertive Community Treatment teams, but there is limited published research on its outcomes. The Flexible Assertive Community Treatment model is recovery oriented, and the significance of robust relationships with staff members is emphasised. To understand the processes and critical factors in the relationships between service users and their Music Therapist in Flexible Assertive Community Treatment, we addressed the following research question: What characterises the relationship and interaction between the Music Therapist and the service user in the context of Flexible Assertive Community Treatment? Six joint interviews with service users and their Music Therapist were conducted using a dyadic approach. Using reflexive thematic analysis, the characteristics of the music therapy relationship were categorised in three themes; (1) the humanistic, therapeutic relationship, (2) the friendship-like relationship and (3) the musical relationship. The relationship between the service user and the Music Therapist is essential to therapeutic outcome, and links to common factors in therapy. Building relationships with the Music Therapist and the Flexible Assertive Community Treatment team may be a vital step towards social participation for the service user and may be understood as a critical factor towards recovery.

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“…Two studies by Trane et al [7,10] examined the implementation of the FACT model in Norway. One of the studies looked at barriers for integrated care in a fragmented service system such as the Norwegian system, which showed that different digital systems, including EHR systems, represented a major barrier to integrated care [10]. This was described as a factor that could lead to errors in medication.…”

Section: Introductionmentioning

confidence: 99%

Experiences and Expectations of Information and Communication Technologies in Flexible Assertive Community Treatment Teams: Qualitative Study

Bønes¹,

Granja²,

Solvoll³

2023

JMIR Form Res

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Background Flexible Assertive Community Treatment (FACT) is a model of integrated care for patients with long-term serious mental illness. FACT teams deliver services using assertive outreach to treat patients who can be hard to reach by the health care service, and focus on both the patient’s health and their social situation. However, in Norway, FACT team members have challenges with their information and communication (ICT) solutions. Objective The aim of this study was to explore Norwegian FACT teams’ experiences and expectations of their ICT solutions, including electronic health records, electronic whiteboards, and calendars. Methods We gathered data in two phases. In the first phase, we conducted semistructured interviews with team leaders and team coordinators, and made observations in FACT teams targeting adults. In the second phase, we conducted semistructured group interviews in FACT teams targeting youth. We performed a thematic analysis of the data in a theoretical manner to address the specific objectives of the study. Results A total of 8 teams were included, with 5 targeting adults and 3 targeting youth. Due to the COVID-19 pandemic, we were not able to perform observations in 2 of the teams targeting adults. Team leaders and coordinators in all 5 teams targeting adults were interviewed, with a total of 7 team members participating in the teams targeting youth. We found various challenges with communication, documentation, and organization for FACT teams. The COVID-19 pandemic was challenging for the teams and changed the way they used ICT solutions. There were issues with some technical solutions used in the teams, including electronic health records, electronic whiteboards, and calendars. Lack of integration and access to data were some of the main issues identified. Conclusions Despite the FACT model being successfully implemented in Norway, there are several issues regarding the ICT solutions they use, mainly related to access to data and integration. Further research is required to detail how improved ICT solutions should be designed. While FACT teams targeting adults and youth differ in some ways, their needs for ICT solutions are largely similar.

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

Cited by 12 publications

References 69 publications

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

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

The therapeutic relationship in music therapy in a Flexible Assertive Community Treatment team: A joint interview study of service users and their Music Therapist

Experiences and Expectations of Information and Communication Technologies in Flexible Assertive Community Treatment Teams: Qualitative Study

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