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

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

Open Access
|May 2022

References

  1. 1Kelly TM, Daley DC. Integrated treatment of substance use and psychiatric disorders. Social Work in Public Health. 2013; 28(3–4): 388406. DOI: 10.1080/19371918.2013.774673
  2. 2Priester MA, Browne T, Iachini A, Clone S, DeHart D, Seay KD. Treatment access barriers and disparities among individuals with co-occurring mental health and substance use disorders: an integrative literature review. Journal of Substance Abuse Treatment. 2016; 61: 4759. DOI: 10.1016/j.jsat.2015.09.006
  3. 3Fortuna KL, Ferron J, Pratt SI, Muralidharan A, Aschbrenner KA, Williams AM, et al. Unmet needs of people with serious mental illness: perspectives from certified peer specialists. Psychiatric Quarterly. 2019; 90(3): 57986. DOI: 10.1007/s11126-019-09647-y
  4. 4Karapareddy V. A review of integrated care for concurrent disorders: cost effectiveness and clinical outcomes. Journal of Dual Diagnosis. 2019; 15(1): 5666. DOI: 10.1080/15504263.2018.1518553
  5. 5Bjørkquist C, Hansen GV. Coordination of services for dual diagnosis clients in the interface between specialist and community care. Journal of Multidisciplinary Healthcare. 2018; 11: 23343. DOI: 10.2147/JMDH.S157769
  6. 6Ådnanes M, Steihaug S. “You never know what happens next”–young adult service users’ experience with mental health care and treatment through one year. International Journal of Integrated Care. 2016; 16(3): 5. DOI: 10.5334/ijic.2435
  7. 7Melamed OC, Fernando I, Soklaridis S, Hahn MK, LeMessurier KW, Taylor VH. Understanding engagement with a physical health service: a qualitative study of patients with severe mental illness. Canadian Journal of Psychiatry. 2019; 64(12): 87280. DOI: 10.1177/0706743719862980
  8. 8Ellis LA, Churruca K, Braithwaite J. Mental health services conceptualised as complex adaptive systems: what can be learned? International Journal of Mental Health Systems. 2017; 11: 43. DOI: 10.1186/s13033-017-0150-6
  9. 9Triliva S, Ntani S, Giovazolias T, Kafetsios K, Axelsson M, Bockting C, et al. Healthcare professionals’ perspectives on mental health service provision: a pilot focus group study in six European countries. International Journal of Mental Health Systems. 2020; 14: 16. DOI: 10.1186/s13033-020-00350-1
  10. 10Hannigan B, Coffey M. Where the wicked problems are: the case of mental health. Health Policy. 2011; 101(3): 2207. DOI: 10.1016/j.healthpol.2010.11.002
  11. 11Stergiopoulos V, Saab D, Francombe Pridham K, Aery A, Nakhost A. Building flexibility and managing complexity in community mental health: lessons learned in a large urban centre. BMC Psychiatry. 2018; 18(1): 20. DOI: 10.1186/s12888-018-1597-y
  12. 12Isaacs S, Jellinek P, Martinez Garcel J, Hunt KA, Bunch W. New York State Health Foundation: integrating mental health and substance abuse care. Health Affairs (Project Hope). 2013; 32(10): 184650. DOI: 10.1377/hlthaff.2013.0479
  13. 13Cetrano G, Salvador-Carulla L, Tedeschi F, Rabbi L, Gutiérrez-Colosía MR, Gonzalez-Caballero JL, et al. The balance of adult mental health care: provision of core health versus other types of care in eight European countries. Epidemiology and Psychiatric Sciences. 2020; 29: e6. DOI: 10.1017/S2045796018000574
  14. 14Mueller-Stierlin AS, Meixner F, Kohlmann A, Schumacher M, Hänsel A, Pouwels M, et al. Effectiveness and cost-effectiveness of a community-based mental health care programme (GBV) for people with severe mental illness in Germany: study protocol for a randomised controlled trial. Trials. 2020; 21(1): 598. DOI: 10.1186/s13063-020-04492-y
  15. 15Davidsen AS, Davidsen J, Jønsson ABR, Nielsen MH, Kjellberg PK, Reventlow S. Experiences of barriers to trans-sectoral treatment of patients with severe mental illness. A qualitative study. International Journal of Mental Health Systems. 2020; 14: 87. DOI: 10.1186/s13033-020-00419-x
  16. 16Ruud T, Friis S. Community-based mental health services in Norway. Consortium Psychiatricum. 2021; 2(1): 4754. DOI: 10.17816/CP43
  17. 17Weaver N, Coffey M, Hewitt J. Concepts, models and measurement of continuity of care in mental health services: a systematic appraisal of the literature. Journal of Psychiatric and Mental Health Nursing. 2017; 24(6): 43150. DOI: 10.1111/jpm.12387
  18. 18Lee SJ, Crowther E, Keating C, Kulkarni J. What is needed to deliver collaborative care to address comorbidity more effectively for adults with a severe mental illness? The Australian and New Zealand Journal of Psychiatry. 2013; 47(4): 33346. DOI: 10.1177/0004867412463975
  19. 19Maruthappu M, Hasan A, Zeltner T. Enablers and barriers in implementing integrated care. Health Systems & Reform. 2015; 1(4): 2506. DOI: 10.1080/23288604.2015.1077301
  20. 20World Health Organization. Mental health action plan 2013–2020. World Health Organization; 2013. Available from; Mental health action plan 2013 – 2020 (who.int)
  21. 21Tansella M, Thornicroft G, Lempp H. Lessons from community mental health to drive implementation in health care systems for people with long-term conditions. International Journal of Environmental Research and Public Health. 2014; 11(5): 471428. DOI: 10.3390/ijerph110504714
  22. 22Ala-Nikkola T, Pirkola S, Kaila M, Joffe G, Kontio R, Oranta O, et al. Identifying local and centralized mental health services-the development of a new categorizing variable. International Journal of Environmental Research and Public Health. 2018; 15(6): 1131. DOI: 10.3390/ijerph15061131
  23. 23Axelsson R, Axelsson S. Integration and collaboration in public health – a conceptual framework. International Journal of Health Planning and Management. 2006; 21: 7588. DOI: 10.1002/hpm.826
  24. 24Heyeres M, McCalman J, Tsey K, Kinchin I. The complexity of health service integration: a review of reviews. Frontiers in Public Health. 2016; 4: 223. DOI: 10.3389/fpubh.2016.00223
  25. 25Gurung G, Atmore C, Gauld R, Stokes T. Integrated ambulatory care in the New Zealand health system: a scoping review. Journal of Integrated Care. 2020; 28(3): 25380. DOI: 10.1108/JICA-01-2020-0003
  26. 26Amelung V, Stein V, Goodwin N, Balicer R, Nolte E, Suter E. Handbook integrated care. Springer; 2017. DOI: 10.1007/978-3-319-56103-5
  27. 27World Health Organization. Integrated care models: an overview. World Health Organization; 2016.
  28. 28Goodwin N, Stein V, Amelung V. What is integrated care? In: Goodwin N, Stein V, Amelung V (eds.), Handbook integrated care. Springer. 2017; 323. DOI: 10.1007/978-3-319-56103-5_1
  29. 29World Health Organization. People-centred and integrated health services: an overview of the evidence: interim report. World Health Organization; 2015.
  30. 30Murtagh S, McCombe G, Broughan J, Carroll Á, Casey M, Harrold Á, et al. Integrating primary and secondary care to enhance chronic disease management: a scoping review. International Journal of Integrated Care. 2021; 21(1): 4. DOI: 10.5334/ijic.5508
  31. 31Svensson B, Hansson L, Lexén A. Outcomes of clients in need of intensive team care in Flexible Assertive Community Treatment in Sweden. Nordic Journal of Psychiatry. 2018; 72(3): 22631. DOI: 10.1080/08039488.2018.1430168
  32. 32Svensson B, Hansson L, Markström U, Lexén A. What matters when implementing Flexible Assertive Community Treatment in a Swedish healthcare context: a two-year implementation study. International Journal of Mental Health. 2017; 46(4): 28498. DOI: 10.1080/00207411.2017.1345041
  33. 33Nielsen CM, Hjorthøj C, Killaspy H, Nordentoft M. The effect of flexible assertive community treatment in Denmark: a quasi-experimental controlled study. The Lancet Psychiatry. 2021; 8(1): 2735. DOI: 10.1016/S2215-0366(20)30424-7
  34. 34Ruimveld J, Bosma M, Hermanides R, van Os J, Becker H, Mauricio M, et al. Mental health in Bonaire – an inspiration for the Dutch New Mental Health Movement. Tijdschrift voor Psychiatrie. 2018; 60(7): 46270.
  35. 35Delespaul P. Belgische FACT-teams: op zoek naar borging van goede zorg. [Belgian FACT teams: looking for assurance of good care]. Tijdschrift voor Psychiatrie. 2018; 60: 3865.
  36. 36Neijmeijer LJ, Didden R, Nijman HLI, Kroon H. Assertive community treatment for people with mild intellectual disability or borderline intellectual functioning and mental health problems or challenging behavior: state of the art and implementation in the Netherlands. Journal of Policy and Practice in Intellectual Disabilities. 2018; 15(4): 32942. DOI: 10.1111/jppi.12254
  37. 37Nakhost A, Law SF, Francombe Pridham KM, Stergiopoulos V. Addressing complexity and improving access in community mental health services: an inner-city adaptation of flexible ACT. Psychiatric Services. 2017; 68(9): 8679. DOI: 10.1176/appi.ps.201700195
  38. 38van Veldhuizen J, Bahler M. Manual: Flexible assertive community treatment: vision, model, practice and organization. CCAF; 2013.
  39. 39Rodgers M, Dalton J, Harden M, Street A, Parker G, Eastwood A. Integrated care to address the physical health needs of people with severe mental illness: a mapping review of the recent evidence on barriers, facilitators and evaluations. International Journal of Integrated Care. 2018; 18(1): 9. DOI: 10.5334/ijic.2605
  40. 40van Duijn S, Zonneveld N, Lara Montero A, Minkman M, Nies H. Service integration across sectors in Europe: literature and practice. International Journal of Integrated Care. 2018; 18(2): 6. DOI: 10.5334/ijic.3107
  41. 41Tsasis P, Evans JM, Owen S. Reframing the challenges to integrated care: a complex-adaptive systems perspective. International Journal of Integrated Care. 2012; 12: e 190. DOI: 10.5334/ijic.843
  42. 42Ling T, Brereton L, Conklin A, Newbould J, Roland M. Barriers and facilitators to integrating care: experiences from the English Integrated Care Pilots. International Journal of Integrated Care. 2012; 12: e129. DOI: 10.5334/ijic.982
  43. 43Armitage GD, Suter E, Oelke ND, Adair CE. Health systems integration: state of the evidence. International Journal of Integrated Care. 2009; 9: e82. DOI: 10.5334/ijic.316
  44. 44Goodwin N. Understanding integrated care. International Journal of Integrated Care. 2016; 16(4): 6. DOI: 10.5334/ijic.2530
  45. 45Zonneveld N, Driessen N, Stüssgen RA, Minkman MM. Values of integrated care: a systematic review. International Journal of Integrated Care. 2018; 18(4): 9. DOI: 10.5334/ijic.4172
  46. 46von Esenwein SA, Druss BG. Using electronic health records to improve the physical healthcare of people with serious mental illnesses: view from the front lines. International Review of Psychiatry. 2014; 26(6): 62937. DOI: 10.3109/09540261.2014.987221
  47. 47Urbanski D, Reichert A, Amelung V. Discharge and transition management in integrated care. In: Goodwin N, Stein V, AmelungV (eds.), Handbook integrated care. Springer. 2017; 97111. DOI: 10.1007/978-3-319-56103-5_6
  48. 48Mackie S, Darvill A. Factors enabling implementation of integrated health and social care: a systematic review. British Journal of Community Nursing. 2016; 21(2): 827. DOI: 10.12968/bjcn.2016.21.2.82
  49. 49Beere D, Page IS, Diminic S, Harris M. A mixed methods evaluation of an integrated adult mental health service model. BMC Health Services Research. 2019; 19(1): 691. DOI: 10.1186/s12913-019-4501-7
  50. 50Williams PM. Integration of health and social care: a case of learning and knowledge management. Health & Social Care in the Community. 2012; 20(5): 55060. DOI: 10.1111/j.1365-2524.2012.01076.x
  51. 51Ion A, Sunderji N, Jansz G, Ghavam-Rassoul A. Understanding integrated mental health care in “real-world” primary care settings: what matters to health care providers and clients for evaluation and improvement? Families, Systems, & Health. 2017; 35(3): 271. DOI: 10.1037/fsh0000294
  52. 52Auschra C. Barriers to the integration of care in inter-organisational settings: a literature review. International Journal of Integrated Care. 2018; 18(1): 5. DOI:
  53. 53Kaehne A. The tacit assumptions of care integration. Journal of Integrated Care. 2018; 26(4): 2546. DOI: 10.1108/JICA-10-2018-057
  54. 54Head B, Alford J. Wicked problems: implications for public policy and management. Administration & Society. 2013; 47(6): 71139. DOI: 10.1177/0095399713481601
  55. 55Ness O, Borg M, Semb R, Karlsson B. “Walking alongside:” collaborative practices in mental health and substance use care. International Journal of Mental Health Systems. 2014; 8(1): 55. DOI: 10.1186/1752-4458-8-55
  56. 56Belling R, Whittock M, McLaren S, Burns T, Catty J, Jones IR, et al. Achieving continuity of care: facilitators and barriers in community mental health teams. Implementation Science. 2011; 6: 23. DOI: 10.1186/1748-5908-6-23
  57. 57Markström U. Staying the course? Challenges in implementing evidence-based programs in community mental health services. International Journal of Environmental Research and Public Health. 2014; 11(10): 1075269. DOI: 10.3390/ijerph111010752
  58. 58Mitterlechner M. Leadership in integrated care networks: a literature review and opportunities for future research. International Journal of Integrated Care. 2020; 20(3): 6. DOI: 10.5334/ijic.5420
  59. 59Van Veldhuizen JR. FACT: a Dutch version of ACT. Community Mental Health Journal. 2007; 43(4): 42133. DOI: 10.1007/s10597-007-9089-4
  60. 60Nielsen CM, Hjorthøj C, Nordentoft M, Christensen U. A qualitative study on the implementation of flexible assertive community treatment–an integrated community-based treatment model for patients with severe mental illness. International Journal of Integrated Care. 2021; 21(2): 13. DOI: 10.5334/ijic.5540
  61. 61Trane K, Aasbrenn K, Rønningen M, Odden S, Lexén A, Landheim A. Flexible assertive community treatment teams can change complex and fragmented service systems: experiences of service providers. International Journal of Mental Health Systems. 2021; 15(1): 38. DOI: 10.1186/s13033-021-00463-1
  62. 62Steihaug S, Johannessen A-K, Ådnanes M, Paulsen B, Mannion R. Challenges in achieving collaboration in clinical practice: the case of Norwegian health care. International Journal of Integrated Care. 2016; 16(3): 3. DOI: 10.5334/ijic.2217
  63. 63Vik E. Coordination between health care professions – a scoping review. Tidsskrift for velferdsforskning. 2018; 21: 11947. DOI: 10.18261/issn.2464-3076-2018-02-03
  64. 64Pedersen L-ML. Interprofessional collaboration in the Norwegian welfare context: a scoping review. Journal of Interprofessional Care. 2020; 34(6): 73746. DOI: 10.1080/13561820.2019.1693353
  65. 65Fineide MJ, Haug E, Bjørkquist C. Organisational and professional integration between specialist and primary healthcare services: a municipal perspective. International Journal of Integrated Care. 2021; 21(2): 21. DOI: 10.5334/ijic.5606
  66. 66Organisation of Economic Co-operation and Development. OECD Reviews of health care quality: Norway 2014: raising standards. OECD; 2014.
  67. 67Danbolt LJ, Hestad K, Kjønsberg K, Kvalvik A-M, Hynnekleiv T. From exclusivity to mutuality. Collaboration regarding patients with complex mental health care needs. Psykologtidsskriftet; 2016.
  68. 68Miles M, Huberman AM, Saldana J. Qualitative data analysis. A methods sourcebook. Sage Publications; 2020.
  69. 69Powell R, Single H. Focus groups. International Journal for Quality in Health Care. 1996; 8(5): 499504. DOI: 10.1093/intqhc/8.5.499
  70. 70Barbour R. Doing focus groups. Sage; 2018. DOI: 10.4135/9781526441836
  71. 71Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006; 3: 77101. DOI: 10.1191/1478088706qp063oa
  72. 72Browne T, Priester MA, Clone S, Iachini A, DeHart D, Hock R. Barriers and facilitators to substance use treatment in the rural south: a qualitative study. The Journal of Rural Health. 2016; 32(1): 92101. DOI: 10.1111/jrh.12129
  73. 73Eriksson E, Andersson T, Hellström A, Gadolin C, Lifvergren S. Collaborative public management: coordinated value propositions among public service organizations. Public Management Review. 2020; 22(6): 791812. DOI: 10.1080/14719037.2019.1604793
  74. 74Kousgaard MB, Scheele CE, Vrangbæk K. Inter-sectoral collaboration in municipal health centres: a multi-site qualitative study of supporting organizational elements and individual drivers. International Journal of Integrated Care. 2019; 19(2): 9. DOI: 10.5334/ijic.4196
  75. 75Winters S, Magalhaes L, Kinsella EA, Kothari A. Cross-sector service provision in health and social care: an umbrella review. International Journal of Integrated Care. 2016; 16(1): 10. DOI: 10.5334/ijic.2460
  76. 76Lexén A, Svensson B. Mental health professional experiences of the flexible assertive community treatment model: a grounded theory study. Journal of Mental Health. 2016; 25(4): 37984. DOI: 10.1080/09638237.2016.1207236
  77. 77Brekke E, Clausen HK, Brodahl MA, Lexén A, Keet R, Mulder CL, et al. Service user experiences of how Flexible Assertive Community Treatment may support or inhibit citizenship: a qualitative study. Frontiers in Psychology. 12: 727013. DOI: 10.3389/fpsyg.2021.727013
  78. 78Korstjens I, Moser A. Series: Practical guidance to qualitative research. Part 4: Trustworthiness and publishing. European Journal of General Practice. 2018; 24(1): 1204. DOI: 10.1080/13814788.2017.1375092
  79. 79Sim J, Waterfield J. Focus group methodology: some ethical challenges. Quality & Quantity. 2019; 53(6): 30033022. DOI: 10.1007/s11135-019-00914-5
  80. 80Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care. 2007; 19(6): 34957. DOI: 10.1093/intqhc/mzm042
DOI: https://doi.org/10.5334/ijic.6011 | Journal eISSN: 1568-4156
Language: English
Submitted on: Jun 30, 2021
Accepted on: May 16, 2022
Published on: May 25, 2022
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2022 Kristin Trane, Kristian Aasbrenn, Martin Rønningen, Sigrun Odden, Annika Lexén, Anne Landheim, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.