Diana Roeg

European Approach to Assertive Outreach for Substance Users: Assessment of Program Components

Model programs for assertive outreach for substance users (an active and persistent type of community-based health care) are still in their infancy. Most programs were formulated in the United States, and one problem is the lack of feasible and effective models for application in Europe. Therefore, in 2003 all assertive outreach programs for substance users in The Netherlands (n = 277) received a questionnaire about their main program components. The programs were found to differ in case-finding methods, label, focus, corporate strategy, care package, and team structure. The only association found was between the program strategy (referral or long-term care) and the program focus (nuisance reduction or care). Contextual and practical reasons for the differences between the programs are discussed as well as the implications for practice and future studies.

When a push is not a shove: assertive care, Dutch‐style

The Dutch are not afraid of getting their hands dirty in order to get things done. Faced with increasing numbers of chaotic drug users with little hope or inclination of contacting services, Dutch treatment services have developed a controversial way of getting normally out‐of‐reach clients into care. Based on a treatment model for care in the community patients, drug and alcohol services are resorting to ‘friendly’ persuasion to get people the help they need. This is a historical perspective on ‘interferential’ care and how it can be applied to treatment in the substance misuse field.

Towards structural quality indicators for intensive community-based care programmes for substance abusers.

Although the importance of structure for the quality of intensive community-based care was already acknowledged in the 1980s, the subject has not received much attention since. The object of this study was to identify the perceived structural quality indicators for intensive community-based care for substance abusers and expand a classification system in order to enable meaningful effect studies and to substantiate structure—outcome links. Using concept mapping based on a purposive sample of experts, seven clusters of structural quality indicators were identified. Finally, the validity of the classification system is discussed

Effects of interferential care: A community-based care program for persons with severe problems on several life areas

Background and aims: Interferential care differs from the current community-based care programs in that it targets a larger, heterogeneous group and combines brokerage and full service elements in a multi-organizational care team. The team provides all the services itself, but with the aim to prepare clients within a few months for referral to regular (ambulant) healthcare services. The aim of this study was to assess the effectiveness of interferential care. Methods: In a multisite, pretest–posttest design, 523 patients of three interferential care teams were followed. Quality of life, problem severity, problems with referral and engagement were assessed at baseline, at referral and again after 6 months. Analyses were performed using linear mixed modeling. Results: Interferential care showed moderate to strong effects on quality of life and problem severity. These effects persisted (quality of life) or further improved (problem severity) until follow-up 6 months after referral to regular services. There were also small effects on both engagement and problems with referral. Conclusion: Interferential care offers significant improvements in quality of life and problem severity in persons who have severe problems on several life areas and who are currently not reached by healthcare services. It is a promising community-based care program for healthcare systems in which regular care already contains many elements of home-based practice.

Identifying profiles of service users in housing services and exploring their quality of life and care needs

BackgroundHousing services aim to support people with mental illness in their daily life and recovery. As the level of recovery differs between service users, the quality of life and care needs also might vary. However, the type and amount of care and support that service users receive do not always match their recovery. In order to improve the quality of care, this study aims to explore whether subgroups of service users exist based on three dimensions of recovery and to examine and compare the quality of life and care needs of the persons in these subgroups.MethodsLatent class analysis was performed with data from 263 service users of housing services in the Netherlands. Classes were based on three variables: personal recovery (Mental Health Recovery Measure), social recovery (Social Functioning Scale), and clinical recovery (Brief Symptom Inventory). Subsequently, the quality of life (MANSA) and care needs (CANSAS) of the different classes were analysed by the use of descriptive and inferential statistics.ResultsThree classes could be distinguished. Class 1 (45%) comprised of people who score the highest of the three classes in terms of personal and social recovery and who experience the least number of symptoms. People in class 2 (44%) and class 3 (11%) score significantly lower on personal and social recovery, and they experience significantly more symptoms compared to class 1. The distinction between class 2 and 3 can be made on the significantly higher number of symptoms in class 3. All three classes differ significantly on quality of life and unmet needs.ConclusionsThe quality of life of service users of housing services needs improvement, as even persons in the best-recovered subgroup have a lower quality of life than the average population. Workers of housing services need to be aware of the recovery of a client and what his or her individual needs and goals are. Furthermore, better care (allocation) concerning mental and physical health and rehabilitation is needed. Care should be provided on all dimensions of recovery at the same time, therefore mental health care organisations should work together and integrate their services.Trial registrationISRCTN registry ISRCTN77355880 retrospectively registered 05/07/2013.

Investigation into coordinating dependencies between care pathways within mental healthcare : A qualitative case study and pilot testing of a new theoretical framework

Introduction Aiming to improve quality of care and reduce costs, mental healthcare organizations implemented care pathways. These pathways have mostly been evaluated as single entities. However, evidence suggests that improvements in individual pathways do not necessarily lead to better performance within the whole care process due to dependencies between pathways. Limited empirical research has been devoted to this theme. The aim of this study was to examine how departments coordinate dependencies between pathways, to discern types of coordination used and to construct a theoretical framework. Methods In a comparative case study of three departments within two mental healthcare organizations, 27 employees were interviewed on the subject of coordination of pathways. A document review was performed to gain general insights into the departments and their pathways. Interviews were transcribed and analyzed using content analysis, based on criteria derived from the theoretical framework. The cases were compared through pattern analysis. Results Findings indicate a lack of awareness among team members regarding the theoretical pathway structure within their department and that all departments deployed a function or system to monitor coordination practices. Within the departments, flow dependencies were found. Although departments coordinated pathways differently, these mostly were horizontal and programmed in nature. Discussion The findings suggest more explicit and structured communication about pathways can be helpful in organizations. Also, outcomes were better if coordination was monitored. Further research is warranted to verify and evaluate the preference for horizontal and programmed ways of coordinating pathway dependencies within mental healthcare.

Onderdelen van bemoeizorg voor mensen met (comorbide) verslaving en aanbevelingen voor richtlijnontwikkeling voor de Nederlandse praktijk

SamenvattingDe belangstelling voor kwaliteit in de zorg is de afgelopen decennia sterk toegenomen, evenals het aantal methoden en technieken om kwaliteit te bewaken en te bevorderen. Richtlijnen zijn hiervan een goed voorbeeld. Voor bemoeizorg, onderdeel van de openbare geestelijke gezondheidszorg, is richtlijnontwikkeling nog in een pril stadium. In dit artikel wordt ingegaan op welke onderdelen door professionals en managers van belang worden geacht bij bemoeizorg voor cliënten met (comorbide) verslaving en hoe vaak deze onderdelen in Nederland voorkomen. De gebruikte onderzoeksmethoden zijn concept mapping, semi-gestructureerde interviews en een vragenlijstonderzoek. Het onderzoek resulteerde in een gecategoriseerde lijst van onderdelen van bemoeizorg voor mensen met (comorbide) verslaving die van belang worden geacht met als hoofdthema’s: professionals, organisatie, zorgproces en doelstellingen. Het vragenlijstonderzoek liet zien dat de bemoeizorgprogramma’s in Nederland gemiddeld acht jaar oud zijn en in 97% van de gevallen bestaan uit een samenwerkingsverband van gemiddeld twaalf organisaties. Op een aantal aspecten bestaat er grote variatie tussen bemoeizorgprogramma’s in Nederland. Op grond van de bevindingen wordt aanbevolen om bemoeizorg voor mensen met (comorbide) verslaving te typeren aan de hand van vier onderdelen: professionals, organisatie, zorgproces en doelstellingen. Ten tweede dat een richtlijn niet kan bestaan uit een vastomlijnd pakket dat algemene geldigheid kent, maar beter uit een combinatie van vaste (verplichte) en variabele (attenderende) onderdelen. Verder bleek dat lang niet alle bemoeizorgprogramma’s een heldere omschrijving hebben van het ‘product’ dat ze leveren (onder andere: zorgvisie, zorgpakket, eindtermen), terwijl dit wel is aan te bevelen.