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A model of collaborative practice in community mental health care.
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Collaborative practice in health care is hailed by Zwarenstein, Goldman, and Reeves (2009), and Hopkin (2010), as an approach that can produce improved health outcomes by preventing fragmentation in Healthcare and strengthening healthcare systems. A great deal of efforts is being extended by international organizations such as WHO and national Heal...
Citations
... These approaches involve research and action through cooperation between key community stakeholders (Israel et al. 2017). In collaborative approaches, it is essential that different voices and perspectives are represented (Ness et al. 2014b). Through partnership and reciprocal learning, core issues can be identified and addressed by a given community, generating locally relevant and meaningful knowledge and action (Hummelvoll 2011). ...
Recovery in co-occurring substance use and mental health problems is a personal and social process that involves quality of life and community inclusion. Recovery-oriented practices consequently need to address both personal and social issues, and collaborative approaches can be useful in developing recovery-oriented practices to promote recovery and citizenship. The aim of the present study was to examine the potential benefits of using a collaborative approach to recovery-oriented practice development for self-reported recovery and citizenship among residents at a supported housing site. Residents, staff, and researchers collaborated to develop principles for a recovery-oriented practice, which were then to be integrated into practice. A prospective comparative design was applied with residents at a supported housing site with an ongoing collaborative recovery-oriented practice development initiative (n = 7), and a reference group of residents at supported housing sites following practice as usual (n = 21). There was a significant increase in the recovery domain of willingness to ask for help after the recovery-oriented practice development among residents at the project site. The reported levels of the citizenship domains civil and legal rights and staff support among residents at the project site demonstrated stability, whereas the levels of these domains decreased among residents at the reference sites. The results suggest that facilitating collaborative approaches to developing recovery-oriented practices can help promote recovery and protect citizenship for residents in supported housing. The study had several meth-odological limitations; thus, further research on the promotion of recovery and citizenship in supported housing is needed.
... Furthermore, collaboration is central in recovery-oriented practices and is deeply valued when successfully achieved (Biong & Soggiu, 2015). Recovery-oriented practices may be described as a collaborative, relational effort, where staff cooperate with residents and engage to address matters related to recovery and citizenship at the service and system levels (Ness et al., 2014b). ...
... Flexibility and presence characterize such practices (Biong & Soggiu, 2015;Biringer et al., 2017;Ness et al., 2014b). In addition, organizational factors are central in providing the conditions necessary to best promote recovery (Borg et al., 2013;Le Boutillier et al., 2011). ...
... The recovery-oriented practice was established through a process of collaboration with the involved residents, staff, and researchers. This approach was applied with the knowledge that recovery-oriented practices are inherently collaborative efforts to promote recovery and citizenship (Ness et al., 2014b). The prospective comparative study that forms the basis for Paper 4 was conducted to test the hypothesis of whether such an approach would promote recovery and quality of life and address the core issues in supported housing in the community context among residents at the project site as compared to the residents in a reference group (Nesse et al., 2021c). ...
Background. The promotion of recovery and quality of life among persons
with co-occurring substance use and mental health problems is an important
objective. In Norway, many persons with co-occurring problems are
residents in supported housing, yet little is known about self-reported
recovery and quality of life within this population and about how core issues
in supported housing and in the community context relate to and may
promote recovery and quality of life. Several barriers to recovery have been
identified in the literature, including unsatisfactory housing conditions,
inflexible support, restricted opportunities for participation in occupations,
and limited citizenship. At the same time, issues such as staff support,
housing satisfaction, and sense of home have been highlighted as important
factors in the supported housing context, while issues related to participation
in occupations, sense of engagement in occupations, and citizenship have
been emphasized as essential factors in the community context. The
importance of addressing these issues through recovery-oriented practices
has been accentuated, particularly through collaborative approaches.
Aims. As a part of a large research project focused on recovery-oriented
practice development in supported housing, the purpose of this doctoral
research was to explore the relevance of core issues in supported housing
and the community context for recovery among residents with co-occurring
problems and to examine if addressing these issues through a recovery-oriented
practice based on a collaborative approach could promote recovery
and citizenship. The thesis consists of four papers. The aim of Paper 1 was
to investigate the psychometric properties of a translation of the Citizenship
Measure. The aim of Paper 2 was to explore and examine the associations
between the core issues in supported housing, namely staff support, housing
satisfaction and sense of home, and recovery. The aim of Paper 3 was to
explore and examine the associations between core issues in the community
context, namely participation in occupations, sense of engagement in
occupations, and citizenship, and recovery. Finally, the aim of Paper 4 was
to examine the potential benefits of employing a collaborative approach to
recovery-oriented practice development for recovery and citizenship.
Methods. Two research designs were adopted: a cross-sectional research
design (Paper 1, Paper 2, and Paper 3) and a prospective comparative design
(Paper 4). In addition, as a part of the preparatory work for the thesis, the
Citizenship Measure was translated and adapted to Norwegian (Paper 1).
The cross-sectional study was conducted with 104 residents at 21 supported
housing sites across six Norwegian cities. The prospective comparative
study was based on a subset of the cross-sectional sample at pre-test
(Autumn 2018), followed up at post-test (Autumn 2019). The study
compared residents at the project site, where there was an ongoing recoveryoriented
practice development, with residents at reference sites following
practice as usual. In both approaches, self-report measures of demographic
characteristics, recovery (the Recovery Assessment Scale Revised,
Corrigan et al., 1999; Giffort et al., 1995), quality of life (the Manchester
Short Assessment of Quality of Life, Priebe et al., 1999; positive and
negative affect, Nes et al., 2018), staff support (the BRIEF Inspire, Williams
et al., 2015), sense of engagement in occupations (the Engagement in
Meaningful Activity Survey, Goldberg et al., 2002), and citizenship (the
Citizenship Measure, Rowe et al., 2012) were used. In addition to
descriptive statistics, linear regression analyses, mediation analyses, onesample
t-tests, and independent samples t-tests were used to examine the
relationships between the variables.
Results. The results that are reported in Paper 2 showed that core issues in
supported housing, namely staff support, housing satisfaction, and sense of
home, were positively associated with recovery in terms of confidence,
seeking support, goals for the future, and reliance on other people. In
addition, these core issues in supported housing were associated with life
satisfaction and satisfaction with different life domains. The results
described in Paper 1 imply that citizenship may be understood as having a
relational and inclusive dimension and a more formal dimension connected
to rights and resources. Furthermore, the results imply that citizenship and
recovery are related yet distinct concepts. The results that are reported in
Paper 3 demonstrated that core issues in the community context, which refer
to sense of engagement in occupations and citizenship, were consistently
associated with recovery across domains as well as with life satisfaction and
satisfaction with life domains and negatively associated with negative affect.
In addition, participation in occupations was associated with recovery
through the relational domains of citizenship, namely caring for others and
community participation. The results that are reported in Paper 4 showed
consistency as well as some, albeit limited, group differences in change in
favor of the residents at the project site. The results showed that the
collaborative approach to recovery-oriented practice development had some
modest benefits in promoting recovery and citizenship. This included an
increased willingness to ask for help for the residents at the project site as
well as stability in civil rights, legal rights, and staff support. For the
residents at the reference sites, there was a decrease in these domains.
Conclusion. Based on the findings, core issues in supported housing and the
community context can be argued to hold great relevance for the promotion
of recovery and quality of life among residents with co-occurring problems.
Keywords: Tenants, dual diagnosis, co-occurring substance use and mental
health problems, recovery, quality of life, citizenship, social inclusion,
supported housing
... Peer recovery services have been implemented in mental health and substance abuse services for many years in Europe, Canada and US (Åkerblom, Agdal, & Haakseth, 2020) and can be defined as the process of giving and receiving non-professional, non-clinical assistance from individuals with similar conditions or circumstances to achieve long-term recovery from psychiatric, alcohol, and/ or other drug-related distress (Tracy & Wallace, 2016). Internationally, countries have sought to reform services aiming to maximize the potential of users to assert control over their health care decisions and throughout their trajectory of care (Ness, Kvello, Borg, Semb, & Davidson, 2017, Ness et al., 2014. A recovery orientation among systems that care for those with substance abuse distress, and often mental health distress, involves collaborating with people on personal goals, conveying hopefulness, promoting choice, and focusing on people's strengths (Chinman et al., 2017). ...
... Peer services provide an alternative to inpatient care and can help decrease costs associated with hospitalization or rehabilitation services. Internationally, countries have sought to reform services to maximize the potential of users and patients to have control over health care decisions and throughout their trajectory of care (Ness et al., 2014;Ness, Kvello, Borg, Semb, & Davidson, 2017). A recovery systems orientation involves collaborating with people's personal goals, conveying hopefulness, promoting choice, and focusing on people's strengths (Chinman et al., 2017). ...
Peer recovery services (PRS) in Norwegian municipalities fill a gap in available care in mental health care and/ or substance abuse treatment. In this qualitative study, we interviewed six peer recovery workers (PRWs). Our aim was to explore how the PRWs understood their competences as vital for carrying out the work in PRS. Through a thematic analysis, we found themes the PRWs recognize as important in their recovery competence. The findings can be of practical relevance to those aiming to develop more recovery oriented mental health distress and substance abuse services.
... This is a concrete way of inviting all voices to be expressed and heard (Andersen, 1991(Andersen, , 1995. The process was conducted in a collaborative manner that focused on the relationships between the participants in the dialogical context (Ness et al., 2014;Ulland, Andersen, Larsen, & Seikkula, 2014). The underlying assumption of this process was the incomplete nature of knowledge and the recognition that different participants use different sorts of knowledge. ...
This article contributes methodological reflections on how dialogical and reflective approaches can enhance many voices in research. An epistemological assumption in research with a participatory design is that knowledge can be developed by collaborative processes between researchers and individuals with lived experiences. The study was conducted by arranging a reflective process meeting with different participants: researchers and mental health service providers and users. Using reflective thematic analysis and an analytical perspective, it describes the reflective process as the tailoring of different voices, which is a way of facilitating research that enables different participants to contribute their experiences in a dialogical process. The findings show that reflective processes can encourage people to both listen and talk and, in that sense, have both inner and outer dialogues that endorse the use of different types of knowledge, including research and lived experiences, to create new understandings together. This can have an impact on both collaborative research and practice in mental health services.
... Ness et al. [20] proposed a framework for collaborative practice for community mental health care that identifies and describes the key orientations, components, principles, and processes for collaborative practice. This paper in a series of our work in advancing collaborative practice in community mental health care elaborates, expands, and refines this framework with a specific focus on formalizing a person/professional collaborative practice by articulating specific collaborative strategies. ...
... This proposed model anchored in the framework proposed by Ness et al. [20] extends it and elaborates specific collaborative, dialogical strategies applicable in the collaborative processes for and with MHSA service users drawing upon the results of a meta-synthesis of our empirical work presented in Part One of the papers in the series. The objective of this paper is a specification and elaboration of "the collaborative, dialogue-based clinical practice model" (CDCP Model) as the next step of specifying the collaborative practice framework presented by Ness et al. [20], which can be applied as the representative model of MHSA practice incorporating the tenets of person-centered care, recovery-orientation, and pluralistic-orientation. ...
... This proposed model anchored in the framework proposed by Ness et al. [20] extends it and elaborates specific collaborative, dialogical strategies applicable in the collaborative processes for and with MHSA service users drawing upon the results of a meta-synthesis of our empirical work presented in Part One of the papers in the series. The objective of this paper is a specification and elaboration of "the collaborative, dialogue-based clinical practice model" (CDCP Model) as the next step of specifying the collaborative practice framework presented by Ness et al. [20], which can be applied as the representative model of MHSA practice incorporating the tenets of person-centered care, recovery-orientation, and pluralistic-orientation. ...
Background:
Various models for collaborative practice in mental health care incorporating the perspectives of service-user participation and collaboration in the care have been developed. However, the emphasis in these practice models has not been on identifying specific features of "how" collaboration and service-user participation can occur and be nurtured. This suggests a need for a collaborative practice model that specifies essential strategies operationalizing the tenets of service-user participation and collaboration applicable in mental health and substance abuse (MHSA) care.
Methods:
A double helix approach of coalescing theoretical ideas and empirical findings to develop a practice model that is applicable in MHSA practice. A theoretical analysis is carried out to identify the critical, foundational elements for collaborative practice in MHSA practice, and has identified the philosophical-theoretical orientations of Habermas' theory of communicative action, Bakhtin's dialogicality, and the philosophy of personhood as the foundational features of collaboration. This base is juxtaposed with the results of a qualitative meta-analysis of 18 empirical articles on collaboration in MHSA to advance a collaborative practice model specifically in the domain of service user/professional collaboration.
Results:
"The collaborative, dialogue-based clinical practice model" (CDCP Model) for community mental health care is proposed, within the structure of four main components. The first specifies the framework for practice that includes person-centered care, recovery-orientation, and a pluralistic orientation and the second identifies the domains of collaboration as service user/professional collaboration, inter-professional collaboration, and service sector collaboration. The third identifies self-understanding, mutual understanding, and shared decision-making as the essential principles of collaboration. The fourth specifies interactive-dialogic processes, negotiated-participatory engagement processes, and negotiated-supportive processes as the essential strategies of collaboration applicable in service user/professional collaboration which were extracted in the empirical work. An illustration of the CDCP Model in a clinical case is given.
Conclusions:
The CDCP Model presented fills the gap that exists in the field of community MHSA practice regarding how to operationalize systematically the tenets of person-centeredness, recovery-oriented, and pluralism-oriented practice in terms of user/professional collaboration.
... Collaboration in this context refers to (a) arriving at mutually agreed values, goals, and positions, and (b) working in partnership with each other arriving at goals. The processes of collaboration in client-professional relationships have been identified in general terms as dialogic and sharing [5,6], shared problem-solving and decision making [7,8], recovery-orientation [8][9][10] and partnership and participatory engagement [11][12][13]. However, there is a paucity of research delineating strategies for professionals to apply in collaborative practice with users in general as well as in MHSA care. ...
... The meta-themes of the interactive-dialogic processes are oriented primarily to mutual understanding and sharing, which are the foundational base for collaboration [13]. The six meta-themes of this type (maintaining human relationship, walking alongside, information sharing, seizing the present moment, taking the perspective of the other, and alignment and scaffolding) point to strategies for professionals to achieve mutual understanding and sharing. ...
Background:
Collaboration has become a cornerstone for healthcare practice in recent decades resulting in the efforts at international and national levels to integrate the concept into healthcare practice and services. However, there is a paucity of research delineating strategies for professionals to apply in collaborative practice with clients in general as well as in mental health and substance abuse (MHSA) care.
Methods:
The method applied in this paper is a form of qualitative meta-synthesis referring to the integration of findings from multiple qualitative studies within a program of research by the same investigators. Eighteen empirical papers with the focus on community MHSA practice and recovery-orientation with relevance to the service user-professional relationship in MHSA practice were included in this meta-synthesis.
Results:
Three types of processes of collaboration specified by meta-themes were identified. The meta-themes of the interactive-dialogical process type include (a) maintaining human relationship, (b) walking alongside, (c) information sharing, (d) seizing the present moment, (e) taking the perspective of the other, and (f) aligning/scaffolding. The meta-themes of the negotiated-participatory engagement type include (a) feedback-informing process, (b) putting differences to work, (c) negotiated partnering, (d) accommodating user participation, and (e) addressing the tension between help and control. The meta-themes of the negotiated supportive process type are (a) helping in context, (b) coordinating, (c) pulling together, (d) advocating, and (e) availing. These meta-themes are strategies for collaboration applicable in MHSA practice.
Conclusions:
This meta-synthesis of collaborative processes found in community mental health practice points to the possibility of developing a set of repertoires of practice for service user/professional collaboration, especially in community MHSA practice.
... Ness et al. [20] proposed a framework for collaborative practice for community mental health care that identifies and describes the key orientations, components, principles, and processes for collaborative practice. This paper in a series of our work in advancing collaborative practice in community mental health care elaborates, expands, and refines this framework with a specific focus on formalizing a person/professional collaborative practice by articulating specific collaborative strategies. ...
... The aim is to present a clinical collaborative practice model for application in practice by professional providers in mental health and substance abuse (MHSA) practice. This proposed model anchored in the framework proposed by Ness et al. [20] extends it and elaborates specific collaborative, dialogical strategies applicable in the collaborative processes for and with MHSA service users drawing upon the results of a meta-synthesis of our empirical work presented in Part One of the papers in the series. The objective of this paper is a specification and elaboration of "the collaborative, dialogue-based clinical practice model" (CDCP Model) as the next step of specifying the collaborative practice framework presented by Ness et al. [20], which can be applied as the representative model of MHSA practice incorporating the tenets of person-centered care, recovery-orientation, and pluralistic-orientation. ...
... This proposed model anchored in the framework proposed by Ness et al. [20] extends it and elaborates specific collaborative, dialogical strategies applicable in the collaborative processes for and with MHSA service users drawing upon the results of a meta-synthesis of our empirical work presented in Part One of the papers in the series. The objective of this paper is a specification and elaboration of "the collaborative, dialogue-based clinical practice model" (CDCP Model) as the next step of specifying the collaborative practice framework presented by Ness et al. [20], which can be applied as the representative model of MHSA practice incorporating the tenets of person-centered care, recovery-orientation, and pluralistic-orientation. ...
Background Various models for collaborative practice in mental health care incorporating the perspectives of service-user participation and collaboration in the care have been developed. However, the emphasis in these practice models has not been on identifying specific features of “how” collaboration and service-user participation can occur and be nurtured. This suggests a need for a collaborative practice model that specifies essential strategies operationalizing the tenets of service-user participation and collaboration applicable in mental health and substance abuse (MHSA) care.
Methods A double helix approach of coalescing theoretical ideas and empirical findings to develop a practice model that is applicable in MHSA practice. A theoretical analysis is carried out to identify the critical, foundational elements for collaborative practice in MHSA practice, and has identified the philosophical-theoretical orientations of Habermas’ theory of communicative action, Bakhtin’s dialogicality, and the philosophy of personhood as the foundational features of collaboration. This base is juxtaposed with the results of a qualitative meta-analysis of 18 empirical articles on collaboration in MHSA to advance a collaborative practice model specifically in the domain of service user/professional collaboration.
Results “The collaborative, dialogue-based clinical practice model” (CDCP Model) for community mental health care is proposed, within the structure of four main components. The first specifies the framework for practice that includes person-centered care, recovery-orientation, and a pluralistic orientation and the second identifies the domains of collaboration as service user/professional collaboration, inter-professional collaboration, and service sector collaboration. The third identifies self-understanding, mutual understanding, and shared decision-making as the essential principles of collaboration. The fourth specifies interactive-dialogic processes, negotiated-participatory engagement processes, and negotiated-supportive processes as the essential strategies of collaboration applicable in service user/professional collaboration which were extracted in the empirical work. An illustration of the CDCP Model in a clinical case is given.
Conclusions The CDCP Model presented fills the gap that exists in the field of community MHSA practice regarding how to operationalize systematically the tenets of person-centeredness, recovery-oriented, and pluralism-oriented practice in terms of user/professional collaboration.
... Ness et al. [20] proposed a framework for collaborative practice for community mental health care that identifies and describes the key orientations, components, principles, and processes for collaborative practice. This paper in a series of our work in advancing collaborative practice in community mental health care elaborates, expands, and refines this framework with a specific focus on formalizing a person/professional collaborative practice by articulating specific collaborative strategies. ...
... The aim is to present a clinical collaborative practice model for application in practice by professional providers in mental health and substance abuse (MHSA) practice. This proposed model anchored in the framework proposed by Ness et al. [20] extends it and elaborates specific collaborative, dialogical strategies applicable in the collaborative processes for and with MHSA service users drawing upon the results of a meta-synthesis of our empirical work presented in Part One of the papers in the series. The objective of this paper is a specification and elaboration of "the collaborative, dialogue-based clinical practice model" (CDCP Model) as the next step of specifying the collaborative practice framework presented by Ness et al. [20], which can be applied as the representative model of MHSA practice incorporating the tenets of person-centered care, recoveryorientation, and pluralistic-orientation. ...
... This proposed model anchored in the framework proposed by Ness et al. [20] extends it and elaborates specific collaborative, dialogical strategies applicable in the collaborative processes for and with MHSA service users drawing upon the results of a meta-synthesis of our empirical work presented in Part One of the papers in the series. The objective of this paper is a specification and elaboration of "the collaborative, dialogue-based clinical practice model" (CDCP Model) as the next step of specifying the collaborative practice framework presented by Ness et al. [20], which can be applied as the representative model of MHSA practice incorporating the tenets of person-centered care, recoveryorientation, and pluralistic-orientation. ...
Background
Various models for collaborative practice in mental health care incorporating the perspectives of service-user participation and collaboration in the care have been developed. However, the emphasis in these practice models has not been on identifying specific features of “how” collaboration and service-user participation can occur and be nurtured. This suggests a need for a collaborative practice model that specifies essential strategies operationalizing the tenets of service-user participation and collaboration applicable in mental health and substance abuse (MHSA) care.
Methods
A double helix approach of coalescing theoretical ideas and empirical findings to develop a practice model that is applicable in MHSA practice. A theoretical analysis is carried out to identify the critical, foundational elements for collaborative practice in MHSA practice, and has identified the philosophical-theoretical orientations of Habermas’ theory of communicative action, Bakhtin’s dialogicality, and the philosophy of personhood as the foundational features of collaboration. This base is juxtaposed with the results of a qualitative meta-analysis of 18 empirical articles on collaboration in MHSA to advance a collaborative practice model specifically in the domain of service user/professional collaboration.
Results
“The collaborative, dialogue-based clinical practice model” (CDCP Model) for community mental health care is proposed, within the structure of four main components. The first specifies the framework for practice that includes person-centered care, recovery-orientation, and a pluralistic orientation and the second identifies the domains of collaboration as service user/professional collaboration, inter-professional collaboration, and service sector collaboration. The third identifies self-understanding, mutual understanding, and shared decision-making as the essential principles of collaboration. The fourth specifies interactive-dialogic processes, negotiated-participatory engagement processes, and negotiated-supportive processes as the essential strategies of collaboration applicable in service user/professional collaboration which were extracted in the empirical work. An illustration of the CDCP Model in a clinical case is given.
... Collaboration in this context refers to (a) arriving at mutually agreed values, goals, and positions, and (b) working in partnership with each other arriving at goals. The processes of collaboration in client-professional relationships have been identified in general terms as dialogic and sharing [5,6], shared problem-solving and decision making [7,8], recovery-orientation [8,9,10] and partnership and participatory engagement [11,12,13]. However, there is a paucity of research delineating strategies for professionals to apply in collaborative practice with users in general as well as in MHSA care. ...
... The meta-themes of the interactive-dialogic processes are oriented primarily to mutual understanding and sharing, which are the foundational base for collaboration [13]. The six meta-themes of this type (maintaining human relationship, walking alongside, information sharing, seizing the present moment, taking the perspective of the other, and alignment & scaffolding) point to strategies for professionals to achieve mutual understanding and sharing. ...
Background Collaboration has become a cornerstone for healthcare practice in recent decades resulting in the efforts at international and national levels to integrate the concept into healthcare practice and services. However, there is a paucity of research delineating strategies for professionals to apply in collaborative practice with clients in general as well as in mental health and substance abuse (MHSA) care.
Methods The method applied in this paper is a form of qualitative meta-synthesis referring to the integration of findings from multiple qualitative studies within a program of research by the same investigators. Eighteen empirical papers with the focus on community MHSA practice and recovery-orientation with relevance to the service user-professional relationship in MHSA practice were included in this meta-synthesis.
Results Three types of processes of collaboration specified by meta-themes were identified. The meta-themes of the interactive-dialogical process type include (a) maintaining human relationship, (b) walking alongside, (c) information sharing, (d) seizing the present moment, (e) taking the perspective of the other, and (f) aligning/scaffolding. The meta-themes of the negotiated-participatory engagement type include (a) feedback-informing process, (b) putting differences to work, (c) negotiated partnering, (d) accommodating user participation, and (e) addressing the tension between help and control. The meta-themes of the negotiated supportive process type are (a) helping in context, (b) coordinating, (c) pulling together, (d) advocating, and (e) availing. These meta-themes are strategies for collaboration applicable in MHSA practice.
Conclusions This meta-synthesis of collaborative processes found in community mental health practice points to the possibility of developing a set of repertoires of practice for service user/professional collaboration, especially in community MHSA practice.
