Publications by authors named "Torleif Ruud"

110 Publications

Family involvement practices for persons with psychotic disorders in community mental health centres - a cross-sectional fidelity-based study.

BMC Psychiatry 2021 Jun 2;21(1):285. Epub 2021 Jun 2.

Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Fredrik Holsts hus, 0450, Oslo, Norway.

Background: Family involvement for persons with psychotic disorders is supported by scientific evidence, as well as legal and ethical considerations, and recommended in clinical practice guidelines. This article reports a cross-sectional measurement of the level of implementation of such guidelines in fifteen community mental health centre units in Norway, and presents a novel fidelity scale to measure basic family involvement and support. The aim was to investigate current family involvement practices comprehensively, as a basis for targeted quality improvement.

Methods: We employed three fidelity scales, with 12-14 items, to measure family involvement practices. Items were scored from 1 to 5, where 1 equals no implementation and 5 equals full implementation. Data was analysed using descriptive statistics, a non-parametric test, and calculation of interrater reliability for the scales.

Results: The mean score was 2.33 on the fidelity scale measuring basic family involvement and support. Among patients with psychotic disorders, only 4% had received family psychoeducation. On the family psychoeducation fidelity assessment scale, measuring practice and content, the mean score was 2.78. Among the eight units who offered family psychoeducation, it was 4.34. On the general organizational index scale, measuring the organisation and implementation of family psychoeducation, the mean score was 1.78. Among the units who offered family psychoeducation, it was 2.46. As a measure of interrater reliability, the intra-class correlation coefficient was 0.99 for the basic family involvement and support scale, 0.93 for the family psychoeducation fidelity assessment scale and 0.96 for the general organizational index scale.

Conclusions: The implementation level of the national guidelines on family involvement for persons with psychotic disorders was generally poor. The quality of family psychoeducation was high, but few patients had received this evidence-based treatment. Our novel fidelity scale shows promising psychometric properties and may prove a useful tool to improve the quality of health services. There is a need to increase the implementation of family involvement practices in Norway, to reach a larger percentage of patients and relatives.

Trial Registration: ClinicalTrials.gov Identifier NCT03869177 . Registered 11.03.19.
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http://dx.doi.org/10.1186/s12888-021-03300-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8170939PMC
June 2021

Relationship between satisfaction with mental health services, personal recovery and quality of life among service users with psychosis: a cross-sectional study.

BMC Health Serv Res 2021 May 8;21(1):439. Epub 2021 May 8.

R&D Department, Division of Mental Health Services, Akershus University Hospital, P.O. box 1000, 1478, Lørenskog, Norway.

Background: Mental health policy internationally emphasizes patient centredness and personal recovery. This study investigated the relationship between satisfaction with mental health services among service users with psychosis in Norway, and personal recovery, perceived support for personal recovery, and quality of life.

Methods: Cross-sectional data were collected from 292 service users diagnosed with psychosis from 39 clinical sites across Norway. Satisfaction with services was assessed using the Client Satisfaction Questionnaire-8. A linear mixed model was estimated to explore the relationship between satisfaction with services and preselected covariates, and to control for confounding factors.

Results: A large majority of participants (89%) reported moderate-to-high levels of satisfaction. Satisfaction with services was positively associated with perceived support for personal recovery, but not with personal recovery or quality of life. In addition, service users under a Community Treatment Order (CTO) were significantly less satisfied than those who were not.

Conclusions: Satisfaction levels among service users were higher compared with similar, international studies. Those who feel supported in their personal recovery were more satisfied with the care they receive, which support the need for implementation of recovery-oriented practices for service users with psychosis. However, satisfaction with services was not related to service user-rated quality of life or level of personal recovery; thus, more follow-up studies are needed. The lower satisfaction of service users placed under CTOs shows the importance of targeted interventions to improve satisfaction with services among this group.

Trial Registration: NCT03271242 , date of registration: 5 sept. 2017.
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http://dx.doi.org/10.1186/s12913-021-06409-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8105980PMC
May 2021

The Importance of Personal Recovery and Perceived Recovery Support Among Service Users With Psychosis.

Psychiatr Serv 2021 Jun 22;72(6):661-668. Epub 2021 Apr 22.

Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway (Skar-Fröding, Clausen, Ruud, Sverdvik Heiervang); Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders and Mental Health Division, Innlandet Hospital Trust, Brumunddal (Clausen); Institute of Clinical Medicine, Campus Ahus, University of Oslo, Oslo (Šaltytė Benth, Ruud); Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway (Šaltytė Benth); Institute of Mental Health, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom (Slade); Centre for Medical Ethics, Faculty of Medicine, University of Oslo, Oslo (Sverdvik Heiervang).

Objective: More knowledge is needed about whether personal recovery, as defined by the CHIME framework (connectedness, hope, identity, meaning and purpose, and empowerment), is considered important by service users with psychosis. This study examined the importance of personal recovery for a large, heterogeneous group of service users with psychosis and their perceived support from clinicians for personal recovery.

Methods: This cross-sectional study used baseline data from 321 service users with psychosis from 39 clinical units across Norway. The INSPIRE Measure of Staff Support for Personal Recovery (based on CHIME) was used to examine personal recovery and perceived support provided for recovery. Twenty support-for-recovery items were each rated on importance (yes or no) and on the extent of support received (5-point scale). Bivariate and multiple linear regression models assessed variables associated with rated importance and support. Most service users rated personal recovery items as important, regardless of their symptomatology and functioning. Previous experience with Illness Management and Recovery, knowledge about coping with stress and illness, and having a plan for early detection and prevention of relapse were significantly associated with higher perceived support. Higher self-reported depressive symptoms, lower score on the Global Assessment of Functioning symptom subscale, and male sex were significantly associated with less perceived support.

Conclusions: Most service users with psychosis found personal recovery important, regardless of symptomatology and functioning, which has implications for clinical practice and provides empirical evidence that recovery-oriented treatments are relevant for most service users with psychosis in various mental health services.
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http://dx.doi.org/10.1176/appi.ps.202000223DOI Listing
June 2021

The Effect of Intensive Implementation Support on Fidelity for Four Evidence-Based Psychosis Treatments: A Cluster Randomized Trial.

Adm Policy Ment Health 2021 Apr 19. Epub 2021 Apr 19.

Westat, Lebanon, NH, USA.

Purpose: Service providers need effective strategies to implement evidence-based practices (EBPs) with high fidelity. This study aimed to evaluate an intensive implementation support strategy to increase fidelity to EBP standards in treatment of patients with psychosis.

Methods: The study used a cluster randomized design with pairwise assignment of practices within each of 39 Norwegian mental health clinics. Each site chose two of four practices for implementation: physical health care, antipsychotic medication management, family psychoeducation, illness management and recovery. One practice was assigned to the experimental condition (toolkits, clinical training, implementation facilitation, data-based feedback) and the other to the control condition (manual only). The outcome measure was fidelity to the EBP, measured at baseline and after 6, 12, and 18 months, analyzed using linear mixed models and effect sizes.

Results: The increase in fidelity scores (within a range 1-5) from baseline to 18 months was significantly greater for experimental sites than for control sites for the combined four practices, with mean difference in change of 0.86 with 95% CI (0.21; 1.50), p = 0.009). Effect sizes for increase in group difference of mean fidelity scores were 2.24 for illness management and recovery, 0.68 for physical health care, 0.71 for antipsychotic medication management, and 0.27 for family psychoeducation. Most improvements occurred during the first 12 months.

Conclusions: Intensive implementation strategies (toolkits, clinical training, implementation facilitation, data-based feedback) over 12 months can facilitate the implementation of EBPs for psychosis treatment. The approach may be more effective for some practices than for others.
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http://dx.doi.org/10.1007/s10488-021-01136-4DOI Listing
April 2021

'No service is an island': experiences of collaboration with crisis resolution teams in Norway.

J Interprof Care 2021 Apr 14:1-7. Epub 2021 Apr 14.

Mental Health Services, Akershus University Hospital, Lillestrøm, Lørenskog, Norway.

Crisis resolution teams (CRTs) are a community-based service targeting adults experiencing acute mental health crises. The rationale for the development of CRTs is both value and efficacy based, suggesting that CRTs should contribute to the humanizing of mental health services and replace some acute hospital-based services with services in the community. Despite the collaborative nature of CRT work, how professionals from health and social services experience collaboration with CRTs is scantly explored. In the current study, semi-structured focus group interviews with eight different groups of 44 clinicians collaborating with CRTs in Norway were conducted. Data were analyzed using thematic analysis and categorized into four themes: (1) 'The accessible experts', (2) 'A broad and deep expertise', (3) 'Doing it together' and (4) 'Toward a new culture?'. The themes elaborate on issues related to the content and organization of CRT services, emphasizing the need for CRTs to be able to contribute their professional expertise in accessible, flexible and collaborative ways. A diversity in the knowledge base and in how services are organized may pose a challenge in interprofessional mental health crisis collaboration and mutual expectations. The study suggests that a shift toward a value-based and coherent mental health and social system could be a purposeful direction.
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http://dx.doi.org/10.1080/13561820.2021.1888900DOI Listing
April 2021

Improved Rehabilitation Outcomes for Persons With and Without Problematic Substance Use After 2 Years With Assertive Community Treatment-A Prospective Study of Patients With Severe Mental Illness in 12 Norwegian ACT Teams.

Front Psychiatry 2020 23;11:607071. Epub 2020 Dec 23.

Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway.

Persons with severe mental illness often face difficulties in accessing and receiving adequate services enabling them to live independently. Many have co-occurring substance use problems that increase the risk of adverse outcomes. Community-based service models have been implemented around the world, including assertive community treatment (ACT), but the knowledge of rehabilitation outcomes in different subgroups is limited. We aimed to explore rehabilitation outcomes among patients suffering severe mental illness with and without substance use problems who had received ACT services for at least 2 years. Additionally, we compared differences in changes between the two groups. A total of 142 patients who received services for 2 years from the first 12 Norwegian ACT teams were included. Eighty-four (59%) had problematic substance use, while 58 (41%) did not. Data regarding housing, activity, symptoms, functioning, and subjective quality of life were collected upon enrollment into ACT and at 2 years of follow-up. Clinician-rated scales and self-report questionnaires were used. Changes within the two groups and differences in change between the groups were assessed using generalized linear mixed models. Both groups were more likely to have good housing, higher level of functioning, and less anxiety and depressive symptoms after 2 years. The odds of good housing among participants with problematic substance use increased only after adjusting for age and gender. Participants with problematic substance use had less severe symptoms, particularly negative and manic symptoms, while participants without problematic substance use reported improved satisfaction with life in general. Neither group experienced a change in having a meaningful daily activity, positive symptoms, practical and social functioning, or subjective quality of life. The reduction of manic symptoms in the substance use group was the only difference between the groups. After 2 years, patients with and without problematic substance use experienced improvements in several important domains. Furthermore, the improvements were similar in both groups for most outcomes. This may suggest that ACT has a place in the continued effort toward integrated and comprehensive community services empowering patients with severe mental illness to achieve and sustain an independent life, including marginalized groups with severe substance use.
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http://dx.doi.org/10.3389/fpsyt.2020.607071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7785822PMC
December 2020

Patient-controlled admission contracts: a longitudinal study of patient evaluations.

BMC Health Serv Res 2021 Jan 7;21(1):36. Epub 2021 Jan 7.

Division of Mental Health Services, Akershus University Hospital, PB 1000, 1478, Lørenskog, Norway.

Background: Mental health professionals usually decide patients' access to inpatient care to ensure care based on need and potential benefit. The purpose of the current study is to investigate how patients evaluate admissions under a contract of Patient-Controlled Admissions (PCA), where the patient could initiate 5 day stays at a community mental health center at their own discretion.

Methods: Patients with a PCA contract in 2011 and 2012 were invited to participate in the study. Staff first recorded clinical baseline values for patients. Towards the end of each PCA stay, staff conducted a structured discharge interview of the admission with the patient. A structured follow-up interview evaluating the PCA arrangement 2 years after inclusion was also performed. We report frequencies from data on PCA requests, PCA admissions and the 2 year evaluation interview, and we used multiple regression models to explore predictors of perceived helpfulness and improvement from the PCA admissions.

Results: The included patients (n = 74) made 628 requests for PCAs during the 2 years after inclusion, and 507 PCAs took place. The five-day limit could not be upheld in 7.5% of PCAs. Patients rated PCAs as helping considerably (33.1%), a good deal (30.4%) or somewhat (21.1%), and reported feeling considerably (15.2%), a good deal (26.2%) or somewhat (36.3%) better during the admission. Significant predictors of helpfulness and feeling better were socializing more during the stay and reporting higher motivation to get away from a difficult situation or getting to the ward safety and calmness. A diagnosis of schizophrenia spectrum or bipolar disorder and more services from mental health specialist care also predicted feeling better during the PCA. In the two-year follow-up interview, 90% rated themselves as very or quite satisfied, and more than 90% would recommend PCAs to others.

Conclusions: The PCA arrangement was feasible and was frequently utilized by patients. Patients were satisfied with PCAs and the PCA arrangement. These short stays seemed particularly helpful for patients with a more severe diagnosis. Strong patient satisfaction gives reasons for testing and implementing increased patient influence on the mental health admission procedures in the form of PCAs.
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http://dx.doi.org/10.1186/s12913-020-06033-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7791868PMC
January 2021

'I have cried a lot': a qualitative study on children experiencing severe parental illness.

Scand J Caring Sci 2020 Dec 3. Epub 2020 Dec 3.

Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.

Background: A considerable body of research has explored implications of severe parental illness on children. However, less is known about what children and adolescents with a severely ill parent experience as the most challenging.

Aims: To describe what children with a severely ill parent experience as their most difficult challenge.

Methods: A qualitative descriptive design with a manifest content analysis was used on data from a cross-sectional, multicenter study on children of patients in five Norwegian Health trusts. Data consisted of written textual responds from 238 children (age 8-18) to one open-ended question in a self-report questionnaire.

Results: The overall theme concerning the children's most difficult challenge was named 'the drama of life unfoldment', reflecting the parental illness' impact on themselves, their relationships with others, and their life circumstances. The subthemes consisted of: Children's experiences of difficult thoughts and feelings; negatively impaired relationship with parents, friends and others; and challenging life events and obstacles in welfare.

Conclusions: The most difficult challenge experienced by the children with a severely ill parent implies life unfoldment challenges and include negative personal and relational impact, challenging life events and obstacles in welfare.
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http://dx.doi.org/10.1111/scs.12938DOI Listing
December 2020

Mental health professionals' experiences with shared decision-making for patients with psychotic disorders: a qualitative study.

BMC Health Serv Res 2020 Nov 27;20(1):1093. Epub 2020 Nov 27.

Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, P. B 104, 2381, Brumunddal, Norway.

Background: Shared decision-making (SDM) is a process whereby clinicians and patients work together to select treatments based on both the patient's preferences and clinical evidence. Although patients with psychotic disorders want to participate more in decisions regarding their care, they have limited opportunities to do so because of various barriers. Knowing about health professionals' experiences with SDM is important toward achieving successful implementation. The study aim was to describe and explore health professionals' SDM experiences with patients with psychotic disorders.

Methods: Three focus group interviews were conducted, with a total of 18 health professionals who work at one of three Norwegian community mental health centres where patients with psychotic disorders are treated. We applied a descriptive and exploratory approach using qualitative content analysis.

Results: Health professionals primarily understand the SDM concept to mean giving patients information and presenting them with a choice between different antipsychotic medications. Among the barriers to SDM, they emphasized that patients with psychosis have a limited understanding of their health situation and that time is needed to build trust and alliances. Health professionals mainly understand patients with psychotic disorders as a group with limited abilities to make their own decisions. They also described the concept of SDM with little consideration of presenting different treatment options. Psychological or social interventions were often presented as complementary to antipsychotic medications, rather than as an alternative to them.

Conclusion: Health professionals' understanding of SDM is inconsistent with the definition commonly used in the literature. They consider patients with psychotic disorders to have limited abilities to participate in decisions regarding their own treatment. These findings suggest that health professionals need more theoretical and practical training in SDM.
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http://dx.doi.org/10.1186/s12913-020-05949-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7694931PMC
November 2020

Implementation of guidelines on family involvement for persons with psychotic disorders in community mental health centres (IFIP): protocol for a cluster randomised controlled trial.

BMC Health Serv Res 2020 Oct 9;20(1):934. Epub 2020 Oct 9.

Centre for Medical Ethics, University of Oslo, Kirkeveien 166 Fredrik Holsts hus, 0450, Oslo, Norway.

Background: Family involvement for persons with psychotic disorders is under-implemented in mental health care, despite its firm scientific, economic, legal and moral basis. This appears to be the case in Norway, despite the presence of national guidelines providing both general recommendations on family involvement and support in the health- and care services, and specific guidance on family interventions for patients with psychotic disorders. The aim of this project is to improve mental health services and the psychosocial health of persons with psychotic disorders and their relatives, by implementing selected recommendations from the national guidelines in community mental health centres, and to evaluate this process.

Methods: The trial is cluster randomised, where 14 outpatient clusters from community mental health centres undergo stratified randomisation with an allocation ratio of 1:1. The seven intervention clusters will receive implementation support for 18 months, whereas the control clusters will receive the same support after this implementation period. The intervention consists of: 1. A basic level of family involvement and support. 2. Family psychoeducation in single-family groups. 3. Training and guidance of health care personnel. 4. A family coordinator and 5. Other implementation measures. Fidelity to the intervention will be measured four times in the intervention arm and two times in the control arm, and the differences in fidelity changes between the arms constitute the primary outcomes. In each arm, we aim to include 161 patients with psychotic disorders and their closest relative to fill in questionnaires at inclusion, 6 months and 12 months, measuring psychosocial health and satisfaction with services. Clinicians will contribute clinical data about patients at inclusion and 12 months. Use of health and welfare services and work participation, for both patients and relatives, will be retrieved from national registries. We will also perform qualitative interviews with patients, relatives, health care personnel and leaders. Finally, we will conduct a cost-effectiveness analysis and a political economy analysis.

Discussion: This project, with its multilevel and mixed methods approach, may contribute valuable knowledge to the fields of family involvement, mental health service research and implementation science.

Trial Registration: ClinicalTrials.gov Identifier NCT03869177 . Registered 11.03.19.
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http://dx.doi.org/10.1186/s12913-020-05792-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547488PMC
October 2020

Substance use among patients in specialized mental health services in Norway: prevalence and patient characteristics based on a national census.

Nord J Psychiatry 2021 Apr 18;75(3):160-169. Epub 2020 Sep 18.

Department of Health, SINTEF Technology and Society, Trondheim, Norway.

Purpose: The aim of this study was to investigate the clinical and demographic variation in the prevalence of substance use among the general psychiatric population in Norway.

Methods: A national census in psychiatric institutions and outpatient clinics was conducted. Data were returned for 2358 inpatients (response rate, 65%) and 23,167 outpatients (response rate, 60%). Substance use was measured based on substance use disorder diagnosis or reported substance use in the last 4 weeks (alcohol 2-4 days a week or more frequently/illicit drug use). Regression analyses controlling for demographic and sociodemographic characteristics were carried out.

Results: Substance use was identified in 32.4% of inpatients and 13.9% of outpatients. The most frequently reported substances used were alcohol, sedatives and cannabis. Among inpatients, the prevalence of substance use was highest in patients with schizophrenia, personality disorders and anxiety disorders. Among outpatients, the prevalence was highest in patients with schizophrenia and other psychoses. Inpatients with anxiety disorders and outpatients with schizophrenia and other psychoses had a significantly higher risk of substance use than other patients. In both samples, the prevalence of substance use was higher among males, 24 to 29-year-olds and the most socially deprived.

Conclusions: This study provides further knowledge about patients at risk for co-morbid substance abuse and poor treatment outcomes. Clinicians may consider targeting patients with schizophrenia and other psychoses, young males and those who are socially deprived in efforts to prevent emerging substance abuse and improve outcomes.
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http://dx.doi.org/10.1080/08039488.2020.1817553DOI Listing
April 2021

Collaborative care for mental health: a qualitative study of the experiences of patients and health professionals.

BMC Health Serv Res 2020 Sep 9;20(1):844. Epub 2020 Sep 9.

R&D Department of Mental Health, Akershus University Hospital, Lørenskog, Norway.

Background: Health policy in many countries directs treatment to the lowest effective care level and encourages collaboration between primary and specialist mental health care. A number of models for collaborative care have been developed, and patient benefits are being reported. Less is known about what enables and prevents implementation and sustainability of such models regarding the actions and attitudes of stakeholders on the ground. This article reports from a qualitative sub-study of a cluster-RCT testing a model for collaborative care in Oslo, Norway. The model involved the placement of psychologists and psychiatrists from a community mental health centre in each intervention GP practice. GPs could seek their input or advice when needed and refer patients to them for assessment (including assessment of the need for external services) or treatment.

Methods: We conducted in-depth qualitative interviews with GPs (n = 7), CMHC specialists (n = 6) and patients (n = 11) in the intervention arm. Sample specific topic guides were used to investigate the experience of enablers and barriers to the collaborative care model. Data were subject to stepwise deductive-inductive thematic analysis.

Results: Participants reported positive experiences of how the model improved accessibility. First, co-location made GPs and CMHC specialists accessible to each other and facilitated detailed, patient-centred case collaboration and learning through complementary skills. The threshold for patients' access to specialist care was lowered, treatment could commence early, and throughput increased. Treatment episodes were brief (usually 5-10 sessions) and this was too brief according to some patients. Second, having experienced mental health specialists in the team and on the front line enabled early assessment of symptoms and of the type of treatment and service that patients required and were entitled to, and who could be treated at the GP practice. This improved both care pathways and referral practices. Barriers revolved around the organisation of care. Logistical issues could be tricky but were worked out. The biggest obstacle was the funding of health care at a structural level, which led to economic losses for both the GP practices and the CMHC, making the model unsustainable.

Conclusions: Participants identified a range of benefits of collaborative care for both patients and services. However, the funding system in effect penalises collaborative work. It is difficult to see how policy aiming for successful, sustainable collaboration can be achieved without governments changing funding structures.

Trial Registration: ClinicalTrials.gov identifier: NCT03624829.
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http://dx.doi.org/10.1186/s12913-020-05691-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487713PMC
September 2020

Prevalence and distribution of psychological diagnoses and related frequency of consultations in Norwegian urban general practice.

Scand J Prim Health Care 2020 Jun 27;38(2):124-131. Epub 2020 Jun 27.

Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.

To investigate the prevalence and distribution of psychological diagnoses made by general practitioners (GPs) in urban general practice and the related frequency of consultations during 12 consecutive months in Norwegian general practice. A cross-sectional study with data extracted from 16,845 electronic patient records in 35 urban GP practices Six GP group practices in Groruddalen, Norway. All patients aged 16-65 with a registered contact with a GP during 12 months in 2015. Frequency and distribution of psychological diagnoses made by GPs, and the number of patients' consultations. GPs made a psychological diagnosis in 18.8% of the patients. The main diagnostic categories were depression symptoms or disorder, acute stress reaction, anxiety symptoms or disorder and sleep disorder, accounting for 67.1% of all psychological diagnoses given. The mean number of consultations for all patients was 4.09 (95% CI: 4.03, 4.14). The mean number of consultations for patients with a psychological diagnosis was 6.40 (95% CI: 6.22, 6.58) compared to 3.55 (95% CI 3.50, 3.51) (<0.01) for patients without such a diagnosis. Seven percent of the diagnostic variation was due to differences among GPs. Psychological diagnoses are frequent in urban general practice, but they are covered using rather few diagnostic categories. Patients with psychological diagnoses had a significantly higher mean number of GP consultations regardless of age and sex. The knowledge of the burden of psychological health problems in general practice must be strengthened to define evidence-based approaches for detecting, diagnosing and treating mental disorders in the general practice population.Key PointsEighteen percent of patients aged 16-65 in our study of patients in urban general practice received one or more psychological diagnoses in 12 months.Depression was the most common diagnosis; followed by acute stress reaction, anxiety and sleep disturbance.Patients with psychological diagnoses had a significantly higher mean number of consultations compared to patients without such diagnoses regardless of age and sex.
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http://dx.doi.org/10.1080/02813432.2020.1783477DOI Listing
June 2020

Factors associated with quality of life for children affected by parental illness or substance abuse.

Scand J Caring Sci 2021 Jun 7;35(2):405-419. Epub 2020 May 7.

Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway.

Background: There have been inconsistent findings from studies examining factors associated with quality of life (QoL) for children affected by parental illness.

Aim: The aim of this study was to explore factors associated with self-reported QoL in children affected by parental illness or parental substance abuse.

Design: A cross-sectional multicentre study.

Methods: The sample included 246 families with children 8-18 years recruited via ill parents who received treatment for severe physical illness, mental illness or substance abuse in specialised health services. We performed multiple linear regression analyses to examine factors associated with the children's self-reported QoL.

Main Outcome Measure: KIDSCREEN-27.

Results: The children's self-reported QoL was positively associated with the ill parent's self-reported physical health, the children's self-reported social skills, the degree to which other adults took over the ill parent's responsibilities, provision of sibling care, provision of health care for the ill parent and positive outcome of caregiving. The children's QoL was negatively associated with the children's self-reported responsibilities due to parental illness, provision of emotional care for the ill parent, negative outcomes of caregiving and external locus of control. The model explained 63% of the variance (adjusted R ) in children's total QoL.

Study Limitations: Sampling bias may have occurred during recruitment.

Conclusions: The findings suggest factors of importance for the children's QoL. Clinicians should assess whether an ill parent's physical health may influence negatively on their ability to perform daily responsibilities at home and care for their children, and clinicians can use children's self-reported QoL to identify children who are most negatively affected.
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http://dx.doi.org/10.1111/scs.12868DOI Listing
June 2021

When patients decide the admission - a four year pre-post study of changes in admissions and inpatient days following patient controlled admission contracts.

BMC Health Serv Res 2020 Mar 18;20(1):229. Epub 2020 Mar 18.

R&D Department, Division of Mental Health Services, Akershus University Hospital, PB 1000, 1478, Lørenskog, Norway.

Background: Mental health professionals usually decide patients' access to inpatient care to ensure the rational and fair distribution of care based on need and prognosis. The purpose of the current study is to investigate the effects of increasing patients' influence on admission by enabling patients to initiate brief inpatient stays of up to five days at a community mental health center. Patients can initiate admission according to their own discretion, outside the existing referral and gatekeeping system.

Methods: Patient-controlled admission (PCA) contracts were offered to eligible patients for inpatient stays in four community mental health centers in one health trust in Norway. Data on included patients' inpatient stays at any of the hospitals' mental health or addiction wards were collected by hospital electronic journal data extraction specialists for the two years before PCA contracts were introduced and the first two years after PCA contracts were introduced for the included patients.

Results: The included patients (n = 57) had 406 PCAs in the two years following signing PCA contracts. When comparing the periods before and after the introduction of the contracts, the total number of admissions increased from 203 to 498 (p < .001), while the number of inpatient days decreased from 7172 to 3178 (p < .001). No significant change in involuntary care was observed. A comparison of box plots of inpatient day use in the eight half-year periods of the study indicates a gradual increase in median inpatient days up to the signing of a PCA contract for the sample, and an abrupt reduction to a stable median level of inpatient days after signing a contract.

Conclusions: The included patients' use of inpatient days changed profoundly after signing PCA contracts, similar to what previous studies of PCAs have indicated. In spite of the marked reductions in inpatient days, the pre-post design makes it impossible to rule out that the reductions were caused by regression toward the mean. No study of PCAs has reported negative effects, indicating that giving patients control over very short admissions is a feasible and potentially positive scheme in mental health care wards.
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http://dx.doi.org/10.1186/s12913-020-05101-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7079511PMC
March 2020

Psychometric Properties of the General Organizational Index (GOI): A Measure of Individualization and Quality Improvement to Complement Program Fidelity.

Adm Policy Ment Health 2020 11;47(6):920-926

Westat, Lebanon, NH, USA.

To assess the implementation of effective practices, mental health programs need standardized measures. The General Organizational Index (GOI), although widely used for this purpose, has received minimal psychometric research. For this study, we assessed psychometric properties of the GOI scale administered four times over 18 months during the implementation of a new program in 11 sites. The GOI scale demonstrated high levels of interrater reliability (.97), agreement between assessors on item ratings (86% overall), internal consistency (.77-.80 at three time points), sensitivity to change, and feasibility. We conclude that the GOI scale has acceptable psychometric properties, and its use may enhance implementation and research on evidence-based mental health practices.Trial registration: REK2015/2169. ClinicalTrials.gov Identifier: NCT03271242.
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http://dx.doi.org/10.1007/s10488-020-01025-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547970PMC
November 2020

The Physical Health Care Fidelity Scale: Psychometric Properties.

Adm Policy Ment Health 2020 11;47(6):901-910

Westat, Lebanon, NH, USA.

Mental health programs need an instrument to monitor adherence to evidence-based physical health care for people with serious mental illness. The paper describes the Physical Health Care Fidelity Scale and study interrater reliability, frequency distribution, sensitivity to change and feasibility. Four fidelity assessments were conducted over 18 months at 13 sites randomized to implementation support for evidence-based physical health care. We found good to excellent interrater reliability, adequate sensitivity for change, good feasibility and wide variability in fidelity across sites after 18 months of implementation. Programs were more successful in establishing Policies stating physical health care standards than in implementing these Policies. The Physical Health Care Fidelity Scale measures and guides implementation of evidence-based physical health care reliably.Trial registration: ClinicalTrials.gov Identifier: NCT03271242.
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http://dx.doi.org/10.1007/s10488-020-01019-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547955PMC
November 2020

The Antipsychotic Medication Management Fidelity Scale: Psychometric properties.

Adm Policy Ment Health 2020 11;47(6):911-919

Westat, Lebanon, NH, USA.

The paper describes the Antipsychotic Medication Management Fidelity Scale and its psychometric properties, including interrater reliability, frequency distribution, sensitivity to change and feasibility. Fidelity assessors conducted fidelity reviews four times over 18 months at eight sites receiving implementation support for evidence-based antipsychotic medication management. Data analyses shows good to fair interrater reliability, adequate sensitivity to change over time and good feasibility. At 18 months, item ratings varied from poor to full fidelity on most items. Use of the scale can assess fidelity to evidence-based guidelines for antipsychotic medication management and guide efforts to improve practice. Further research should improve and better calibrate some items, and improve the procedures for access to information.Trial registration: ClinicalTrials.gov Identifier: NCT03271242.
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http://dx.doi.org/10.1007/s10488-020-01018-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547997PMC
November 2020

Enabling patients to cope with psychotropic medication in mental health care: Evaluation and reports of the new inventory MedSupport.

Medicine (Baltimore) 2020 Jan;99(1):e18635

Department of R&D in Mental health service, Akershus university hospital.

This cross sectional study examined patients' perceptions of professional support regarding use of psychotropic medication in a specialist mental health care setting. The aims were to evaluate reliability and validity of the MedSupport inventory, and investigate possible associations between MedSupport scores and patient characteristics.A cross-sectional study was performed. The patients completed the MedSupport, a newly developed self-reported 6 item questionnaire on a Likert scale ranged 1 to 5 (1 = strongly disagree to 5 = strongly agree), and the Beliefs about Medicines Questionnaire. Diagnosis and treatment information were obtained at the clinical visits and from patient records.Among the 992 patients recruited, 567 patients (57%) used psychotropic medications, and 514 (91%) of these completed the MedSupport and were included in the study. The MedSupport showed an adequate internal consistency (Cronbach alpha.87; 95% CI.86-89) and a convergent validity toward the available variables. The MedSupport mean score was 3.8 (standard deviation.9, median 3.8). Increasing age and the experience of stronger needs for psychotropic medication were associated with perception of more support to cope with medication, whereas higher concern toward use of psychotropic medication was associated with perception of less support. Patients diagnosed with behavioral and emotional disorders, onset in childhood and adolescence perceived more support than patients with Mood disorders.The MedSupport inventory was suitable for assessing the patients' perceived support from health care service regarding their medication. Awareness of differences in patients' perceptions might enable the service to provide special measures for patients who perceive insufficient medication support.
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http://dx.doi.org/10.1097/MD.0000000000018635DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6946431PMC
January 2020

Ethical challenges of seclusion in psychiatric inpatient wards: a qualitative study of the experiences of Norwegian mental health professionals.

BMC Health Serv Res 2019 Nov 21;19(1):879. Epub 2019 Nov 21.

Innlandet Hospital Trust, Department of Acute Psychiatry and Psychosis Treatment Reinsvoll, 2840, Reinsvoll, Norway.

Background: Seclusion is an invasive clinical intervention used in inpatient psychiatric wards as a continuation of milieu therapy with vast behavioural implications that raise many ethical challenges. Seclusion is in Norway defined as an intervention used to contain the patient, accompanied by staff, in a single room, a separate unit, or an area inside the ward. Isolation is defined as the short-term confinement of a patient behind a locked or closed door with no staff present. Few studies examine how staff experiences the ethical challenges they encounter during seclusion. By making these challenges explicit and reflecting upon them, we may be able to provide better care to patients. The aim of this study is to examine how clinical staff in psychiatric inpatient wards describes and assess the ethical challenges of seclusion.

Methods: This study was based on 149 detailed written descriptions of episodes of seclusion from 57 psychiatric wards. A descriptive and exploratory approach was used. Data were analysed using qualitative content analysis.

Results: The main finding is that the relationship between treatment and control during seclusion presents several ethical challenges. This is reflected in the balance between the staff's sincere desire to provide good treatment and the patients' behaviour that makes control necessary. Particularly, the findings show how taking control of the patient can be ethically challenging and burdensome and that working under such conditions may result in psychosocial strain on the staff. The findings are discussed according to four core ethical principles: autonomy, beneficence, non-maleficence, and justice.

Conclusion: Ethical challenges seem to be at the core of the seclusion practice. Systematic ethical reflections are one way to process the ethical challenges that staff encounters. More knowledge is needed concerning the ethical dimensions of seclusion and alternatives to seclusion, including what ethical consequences the psychosocial stress of working with seclusion have for staff.
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http://dx.doi.org/10.1186/s12913-019-4727-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6873436PMC
November 2019

Psychometric Properties of a Fidelity Scale for Illness Management and Recovery.

Adm Policy Ment Health 2020 11;47(6):885-893

Westat, Philadelphia, USA.

This study examined the psychometric properties and feasibility of the Illness Management and Recovery (IMR) Fidelity scale. Despite widespread use of the scale, the psychometric properties have received limited attention. Trained fidelity assessors conducted assessments four times over 18 months at 11 sites implementing IMR. The IMR Fidelity scale showed excellent interrater reliability (.99), interrater item agreement (94%), internal consistency (.91-.95 at three time points), and sensitivity to change. Frequency distributions generally showed that item ratings included the entire range. The IMR Fidelity scale has excellent psychometric properties and should be used to evaluate and guide the implementation of IMR.Trial registration: ClinicalTrials.gov Identifier: NCT03271242.
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http://dx.doi.org/10.1007/s10488-019-00992-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547988PMC
November 2020

Predictors of family focused practice: organisation, profession, or the role as child responsible personnel?

BMC Health Serv Res 2019 Nov 5;19(1):793. Epub 2019 Nov 5.

Monash University Department of Rural Health, Box 973, Moe, Victoria, 3825, Australia.

Background: Health professionals in Norway are required by law to help safeguard information and follow-up with children of parents with mental or physical illness, or who have substance abuse problems, to reduce their higher risk of psychosocial problems. Knowledge is lacking regarding whether organisation and/or worker-related factors can explain the differences in health professionals' ability to support the families when patients are parents.

Methods: Employing a translated, generic version of the Family Focused Mental Health Practice Questionnaire (FFPQ), this cross-sectional study examines family focused practice (FFP) differences in relation to health professionals' background and role (N = 280) along with exploring predictors of parent, child, and family support.

Results: While most health professions had begun to have conversations with parents on children's needs, under one-third have had conversations with children. There were significant differences between nurses, social workers, psychologists, physicians, and others on seven of the FFP subscales, with physicians scoring lowest on five subscales and psychologists providing the least family support. Controlling for confounders, there were significant differences between child responsible personnel (CRP) and other clinicians (C), with CRP scoring significantly higher on knowledge and skills, confidence, and referrals. Predictors of FFP varied between less complex practices (talking with parents) and more complex practices (family support and referrals).

Conclusion: The type of profession was a key predictor of delivering family support, suggesting that social workers have more undergraduate training to support families, followed by nurses; alternately, the results could suggest that that social workers and nurses have been more willing or able than physicians and psychologists to follow the new legal requirements. The findings highlight the importance of multidisciplinary teams and of tailoring training strategies to health professionals' needs in order to strengthen their ability to better support children and families when a parent is ill.
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http://dx.doi.org/10.1186/s12913-019-4553-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6829823PMC
November 2019

Model fidelity and team members' experiences of assertive community treatment in Norway: a sequential mixed-methods study.

Int J Ment Health Syst 2019 16;13:65. Epub 2019 Oct 16.

4Mental Health Services, Akershus University Hospital, Lørenskog, Norway.

Background: Assertive community treatment (ACT) is an evidence-based treatment for people with severe mental illness, and this model is used widely throughout the world. Given the various adaptations in different contexts, we were interested in studying the implementation and adaptation of the ACT model in Norway. The first 12 Norwegian ACT teams were established between 2009 and 2011, and this study investigated the teams' model fidelity and the team members' experiences of working with ACT.

Methods: To investigate implementation of the ACT model, fidelity assessments were performed 12 and 30 months after the teams started their work using the Tool for Measurement of Assertive Community Treatment (TMACT). Means and standard deviations were used to describe the ACT teams' fidelity scores. Cohen's effect size d was used to assess the changes in TMACT scores from the first to second assessment. Qualitative focus group interviews were conducted in the 12 teams after 30 months to investigate the team members' experiences of working with the ACT model.

Results: The fidelity assessments of the Norwegian teams showed high implementation of the structural and organizational parts of the ACT model. The newer parts of the model, the recovery and evidence-based practices, were less implemented. Four of the six subscales in TMACT improved from the first to the second assessment. The team members experienced the ACT model to be a good service model for the target population: people with severe mental illness, significant functional impairment, and continuous high service needs. Team members perceived some parts of the model difficult to implement and that it was challenging to find effective ways to collaborate with existing health and social services.

Conclusion: The first 12 Norwegian ACT teams implemented the ACT model to a moderate degree. The ACT model could be implemented in Norway without extensive adaptations. Although the team members were satisfied with the ACT model, especially the results for their service users, inclusion of the ACT team to the existing service system was perceived as challenging.
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http://dx.doi.org/10.1186/s13033-019-0321-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6796407PMC
October 2019

Significance of Leaders for Sustained Use of Evidence-Based Practices: A Qualitative Focus-Group Study with Mental Health Practitioners.

Community Ment Health J 2019 11 12;55(8):1344-1353. Epub 2019 Jun 12.

Division of Mental Health Services, Akershus University Hospital, Sykehusveien 25, Lørenskog, 1478, Norway.

Evidence-based practices that are implemented in mental health services are often challenging to sustain. In this focus-group study, 26 mental health practitioners with high fidelity scores were interviewed regarding their experiences with implementing the illness management and recovery, an evidence-based practice for people with severe mental disorders, in their services and how this could influence further use. Findings indicate that high fidelity is not equivalent to successful implementation. Rather, to sustain the practice in services, the practitioners emphasized the importance of their leaders being positive and engaged in the intervention, and hold clear goals and visions for the intervention in the clinic. In addition, the practitioners' understanding of outcome monitoring as a resource for practice improvement must be improved to avoid random patient experiences becoming the decisive factor in determining further use.Trial registration: ClinicalTrials.gov NCT02077829. Registered 25 February 2014.
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http://dx.doi.org/10.1007/s10597-019-00430-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823318PMC
November 2019

Recovery for all in the community; position paper on principles and key elements of community-based mental health care.

BMC Psychiatry 2019 06 10;19(1):174. Epub 2019 Jun 10.

Department of Psychiatry, KU Leuven, UZ Herestraat 49, Leuven, Belgium.

Background: Service providers throughout Europe have identified the need to define how high-quality community-based mental health care looks to organize their own services and to inform governments, commissioners and funders. In 2016, representatives of mental health care service providers, networks, umbrella organizations and knowledge institutes in Europe came together to establish the European Community Mental Health Services Provider (EUCOMS) Network. This network developed a shared vision on the principles and key elements of community mental health care in different contexts. The result is a comprehensive consensus paper, of which this position paper is an outline. With this paper the network wants to contribute to the discussion on how to improve structures in mental healthcare, and to narrow the gap between evidence, policy and practice in Europe.

Main Text: The development of the consensus paper started with an expert workshop in April 2016. An assigned writing group representing the workshop participants built upon the outcomes of this meeting and developed the consensus paper with the input from 100 European counterparts through two additional work groups, and two structured feedback rounds via email. High quality community-based mental health care: 1) protects human rights; 2) has a public health focus; 3) supports service users in their recovery journey; 4) makes use of effective interventions based on evidence and client goals; 5) promotes a wide network of support in the community and; 6) makes use of peer expertise in service design and delivery. Each principle is illustrated with good practices from European service providers that are members of the EUCOMS Network.

Conclusions: Discussion among EUCOMS network members resulted in a blueprint for a regional model of integrated mental health care based upon six principles.
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http://dx.doi.org/10.1186/s12888-019-2162-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6558752PMC
June 2019

What are they returning to? Psychosocial work environment as a predictor of returning to work among employees in treatment for common mental disorders: A prospective observational pre-post study.

PLoS One 2019 24;14(4):e0215354. Epub 2019 Apr 24.

Lovisenberg Hospital, Nydalen, Oslo, Norway.

Introduction: Long-term sick leave and disabilities due to common mental disorders are challenging for society, employers, and individuals. Hence, we wanted to investigate whether psychosocial work environments experienced by employees undergoing treatment for such disorders was associated with return to work.

Methods: At the start of treatment, 164 patients responded to questionnaires concerning their psychosocial work environment (the Job Demand-Control-Support model and the Effort-Reward Imbalance model), symptoms (The Clinical Outcomes in Routine Evaluation Outcome Measure) and ability to work (Work Ability Index). In addition, the respondents reported whether they were working or on sick leave at the start and end of their courses of treatment. Their therapists provided information about diagnoses.

Results: Return to work was associated with control of decisions, support from colleagues, esteem, and job promotion opportunities as measured at the start of treatment. In multivariate analyses, control over decisions and job promotion opportunities continued to predict return to work when adjusted for symptoms, current work ability, and expected future work ability.

Discussion: The working conditions that predicted return to work are considered to facilitate work performance and to be sources of motivation, job satisfaction, and job commitment. Consequently, it is important to examine whether this patient group has a favorable working environment and consider changes in the workplace if the environment is not favorable.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0215354PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6481810PMC
January 2020

Adult Mental Health Outpatients Who Have Minor Children: Prevalence of Parents, Referrals of Their Children, and Patient Characteristics.

Front Psychiatry 2019 2;10:163. Epub 2019 Apr 2.

Health Services Research, SINTEF, Trondheim, Norway.

A strong connection exists between parental mental illness and lifetime mental health risk for their children. Thus, it is important to determine, when parents attend for treatment for their illness, the prevalence and characteristics of parents with a mental illness and identify referral actions for their children. Previous studies indicate that 12-45% of adult mental health service patients are parents with minor children. There is a need for studies with larger sample sizes that investigate the prevalence and characteristics of parents, and factors associated with referral actions for their children. Data on 23,167 outpatients was drawn from a national census study across 107 Norwegian adult mental health outpatient clinics during 2 weeks in April 2013. Clinicians identified various socio-demographic characteristics of patients who were parents and referral actions for their children. Eight thousand thirty-five (36%) of outpatients had children under 18 years. Thirty-one percent were provided with referrals for their children and 58% were reported to have children with no need for referral. Three percent were reported to have children with unmet needs who were not referred. There were missing data on children's needs and referral actions for 8% of parents. Patients who care for minor children were more likely to be refugees, and less likely to be single, male, not own a house/apartment, and have a schizophrenia spectrum illness or substance use disorder. Children were more likely to be referred when their parent was single, with no income from paid work, low education, not owning house/apartment, poor family network, long outpatient treatment, and an individual care plan; and less likely for men with a moderate or less severe mental illness. Children were referred to child protection agencies, child and adolescent mental health services and school psychological/pedagogic services. The prevalence of outpatients with children is similar to other studies. Referrals were made for children of one third of outpatients with minor children. Needs and referrals of children was unknown for one in ten outpatients. Mental health outpatient clinics must improve procedures to identify parenting status and ascertain and act on children's needs.
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http://dx.doi.org/10.3389/fpsyt.2019.00163DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6456127PMC
April 2019

Less use of compulsory hospitalisation in mental health care?

Tidsskr Nor Laegeforen 2019 02 21;139(4). Epub 2019 Feb 21.

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http://dx.doi.org/10.4045/tidsskr.18.0657DOI Listing
February 2019

Differences in implementation of family focused practice in hospitals: a cross-sectional study.

Int J Ment Health Syst 2018 19;12:77. Epub 2018 Dec 19.

Norwegian Centre for Child Behavioural Development, Unirand, Majorstuen, Box 7053 0368 Oslo, Norway.

Background: Changes in Norwegian law and health policy require all health professionals to help safeguard the provision of information and follow-up for the children of parents with mental or physical illness, or substance abuse problems, to decrease their risk of psychosocial problems. There is a lack of knowledge on how the national changes have been received by hospital-based health professionals, and if they have led to an increase in family focused practice.

Methods: This cross-sectional study examined the adherence of health professionals' ( = 280) in five hospitals to new guidelines for family focused practice, using a translated and generic version of Family Focused Mental Health Practice Questionnaire.

Results: Overall, health professionals scored high on knowledge and skills, and were confident in working with families and children, but reported moderate levels of family support and referrals. Comparison of the five hospitals showed significant differences in terms of workplace support, knowledge and skills and family support. The smallest hospital had less workplace support and less knowledge and skills but scored medium on family support. The two largest hospitals scored highest on family support, but with significant differences on parents refusing to have conversations with children.

Conclusions: Differences in implementation of family focused practice highlight the need to tailor improvement strategies to specific barriers at the different hospitals. The use of implementation theories and improvement strategies could promote full implementation, where all families and children in need were identified and had access to family support. The study is approved by the Regional Committee on Medical and Health Research Ethics South-East Q5 37 (reg. no. 2012/1176) and by the Privacy Ombudsman.
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http://dx.doi.org/10.1186/s13033-018-0256-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6299542PMC
December 2018

Health-related quality of life (HRQoL) in children of ill or substance abusing parents: examining factor structure and sub-group differences.

Qual Life Res 2019 Apr 26;28(4):1063-1073. Epub 2018 Nov 26.

Department for Research and Development, Mental Health Services, Akershus University Hospital, Box 1000, 1478, Lørenskog, Norway.

Purpose: Health-related quality of life (HRQoL) may be helpful in identifying children at risk of developing adjustment problems. Few studies have focused on HRQoL among children of ill or substance abusing parents despite their considerable risk status. In the present study, we used the KIDSCREEN-27 to assess self-reported HRQoL in children and adolescents living in families with parental illness, or substance dependence. First, we tested whether the factor structure of the KIDSCREEN-27 was replicated in this population of children. Next, we examined differences in HRQoL according to age, gender, and type of parental illness. Finally, we compared levels of HRQoL in our sample to a normative reference population.

Method: Two hundred and forty-six children and adolescents aged 8-17 years and their ill parents participated. The construct validity of the KIDSCREEN-27 questionnaire was examined by confirmatory factor analysis (CFA). T-tests and ANOVA were used to test differences in HRQoL levels according to age, gender, and parental patient groups, and for comparisons with reference population.

Results: The KIDSCREEN-27 fit the theoretical five-factor model of HRQoL reasonably well. Boys and younger children reported significantly greater well-being on physical well-being, psychological well-being, and peers and social support, compared to girls and older children. Younger children also reported significantly greater well-being at school than did older children. There were no significant differences in HRQoL between groups of children living with different type of parental illness. The children in our sample reported their physical well-being significantly lower than the reference population.

Conclusion: The KIDSCREEN-27 questionnaire appears to work satisfactorily among children of ill or substance abusing parents.
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http://dx.doi.org/10.1007/s11136-018-2067-1DOI Listing
April 2019