Open Dialogue, need‐adapted mental health care, and implementation fidelity: A discussion paper

Abstract

Open Dialogue is a need‐adapted approach to mental health care that was originally developed in Finland. Like other need‐adapted approaches, Open Dialogue aims to meet consumer’s needs and promote collaborative person‐centred dialogue to support recovery. Need‐adapted mental health care is distinguished by flexibility and responsiveness. Fidelity, defined from an implementation science perspective as the delivery of distinctive interventions in a high quality and effective fashion is a key consideration in health care. However, flexibility presents challenges for evaluating fidelity, which is much easier to evaluate when manualization and reproducible processes are possible. Hence, it remains unclear whether Open Dialogue and other need‐adapted mental health interventions can be meaningfully evaluated for fidelity. The aim of this paper was to critically appraise and advance the evaluation of fidelity in need‐adapted mental health care, using Open Dialogue as a case study. The paper opens a discussion about how fidelity should be evaluated in flexible, complex interventions, and identifies key questions that need to be asked by practitioners working in need‐adapted mental health care to ensure they deliver these interventions as intended and in an evidence‐based fashion.

“Always opening and never closing”: How dialogical therapists understand and create reflective conversations in network meetings

“…As a needs adapted approach, the content of network meetings may vary significantly across families, and even between meetings. This has added complexity to the measurement of fidelity to the Open Dialogue approach ( Waters et al, 2021 ). Insights from the current study provide a greater understanding of the approaches some practitioners use in reflecting teams and dialogical therapy more broadly.…”

Implementing Open Dialogue approaches: A scoping review

“…These practices can have destabilizing and anxiety‐provoking effects that have previously been under‐estimated in planning and executing Open Dialogue implementations. The high levels of indeterminate practices complicate organizational implementation processes that traditionally rely on high levels of technicality, such as fidelity measures and manualized protocols for practice (Waters et al, 2021).…”

“…In the study by Clement and McKenny (2019), parents of children undergoing social assessment unequivocally described feeling supported during network meetings, and that the Open Dialogue approach made it easier to access help compared to previous experiences with services. In Dawson et al's (2021) description of a network meeting, a young person at the center of concern had some trepidation before and during the meeting, but she and her family found it meaningful to share their concerns about each other. In the study by Sidis et al (2020), young clients expressed being nervous before and after meetings but being able to say what they wanted to say.…”

“…However, it remains unclear exactly how these principles were established, and how they should inform implementation and service delivery in other contexts, particularly considering that they emerged in the context of extensive deinstitutionalization and mainstreaming of services. Open Dialogue implementation is further challenged by an absence of widely accepted manuals or fidelity criteria for Open Dialogue practices (Waters et al, 2021). Open Dialogue approaches can be described as complex interventions as they involve several interacting, non‐standardized practices at several organizational levels.…”

Open Dialogue trainees’ expectations of ‘shared concern’: An international focus group study

“…Open Dialogue is often positioned as a challenging, ‘counterhegemonic’ (Hopper et al, 2020), alternative to conventional mental health approaches with complex therapeutic practices that are difficult to learn and implement in sustainable ways (Waters et al, 2021). To our knowledge, there is no published research on trainees’ expectations of Open Dialogue training, and we were interested in studying the early professional socialisation processes in the approach.…”