Ongoing project

Integrated Services for Patients with Dual Diagnosis (ROPIT)

This project addresses one of the most difficult questions in the modern welfare state: how to organize services for people with concurrent addiction and mental health problems in ways that make these services more coordinated as seen by the users. Improving services for this patient group is a highly prioritized aim in the service organizations and in education of health and welfare professions as well.

The participatory research project proposes to explore and evaluate the organization of services for patients with concurrent addiction and mental health problems (“patients with dual diagnosis”) at local levels, with a particular focus on factors that promote or prevent the implementation of integrated services. The collaboration will explore how co-ordination across professional and service boundaries can be accomplished in this local context, and go on to outline the implications for professional training. An evaluation and dissemination strategy is built into the project, to ensure relevant sharing of knowledge and implementation of findings.

Participants

Bjørkquist, Catharina & Ramsdal, Helge Normann (2021). Structural disavowal and personal inundation of responsibility – a local perspective on pressure on mental health front-line professionals. European Journal of Social Work. ISSN 1369-1457. doi: 10.1080/13691457.2021.1882399.
Fineide, Mona Jerndahl; Løken, Therese Dwyer & Haug, Erna (2021). Samordning av lokalbaserte tjenester: Når svake formelle samordningsstrukturer kompenseres av uformelle samordningsgrep . In Bjørkquist, Catharina & Ramsdal, Helge Normann (Ed.), Statlig politikk og lokale utfordringer: Organisering av tjenester innen rus og psykisk helse. Cappelen Damm Akademisk. ISSN 978-82-02-73453-4. p. 175–194. doi: 10.23865/noasp.140.ch9.
Ramsdal, Helge Normann (2021). Statlige reformer på rus- og psykisk helsefeltet - er virkemidlene tilstrekkelige? In Bjørkquist, Catharina & Ramsdal, Helge Normann (Ed.), Statlig politikk og lokale utfordringer: Organisering av tjenester innen rus og psykisk helse. Cappelen Damm Akademisk. ISSN 978-82-02-73453-4. p. 63–87. doi: https:/doi.org/10.23865/noasp.140.
Ramsdal, Helge Normann & Bjørkquist, Catharina (2021). Nasjonale veiledere - "soft governance" og "nudging"? In Bjørkquist, Catharina & Ramsdal, Helge Normann (Ed.), Statlig politikk og lokale utfordringer: Organisering av tjenester innen rus og psykisk helse. Cappelen Damm Akademisk. ISSN 978-82-02-73453-4. p. 89–109. doi: https:/doi.org/10.23865/noasp.40.ch5.
Røste, Rannveig & Bjørkquist, Catharina (2021). Samarbeid om rus- og psykisk helsetjenester - erfaringer fra en innovasjonsprosess i en storbykommune. In Bjørkquist, Catharina & Ramsdal, Helge Normann (Ed.), Statlig politikk og lokale utfordringer: Organisering av tjenester innen rus og psykisk helse. Cappelen Damm Akademisk. ISSN 978-82-02-73453-4. p. 195–216. doi: https:/doi.org/10.23865/noasp.140.ch10.
Hansen, Gunnar Vold (2021). Trenger ROP-brukere en individuell plan? In Bjørkquist, Catharina & Ramsdal, Helge Normann (Ed.), Statlig politikk og lokale utfordringer: Organisering av tjenester innen rus og psykisk helse. Cappelen Damm Akademisk. ISSN 978-82-02-73453-4. p. 111–129. doi: https:/doi.org/10.23865/noasp.140.
Hansen, Gunnar Vold (2021). Oppfølging av ROP-brukere for, under og etter at de har sonet en dom i fengsel. In Bjørkquist, Catharina & Ramsdal, Helge Normann (Ed.), Statlig politikk og lokale utfordringer: Organisering av tjenester innen rus og psykisk helse. Cappelen Damm Akademisk. ISSN 978-82-02-73453-4. p. 259–249. doi: https:/doi.org/10.23865/noasp.140.
Hansen, Gunnar Vold (2021). Helhetlige tjenestetilbud i en liten kommune. In Bjørkquist, Catharina & Ramsdal, Helge Normann (Ed.), Statlig politikk og lokale utfordringer: Organisering av tjenester innen rus og psykisk helse. Cappelen Damm Akademisk. ISSN 978-82-02-73453-4. p. 155–173. doi: https:/doi.org/10.23865/noasp.140.
Hansen, Gunnar Vold (2021). Bolig til brukere med omfattende rus- og psykiske lidelser. In Bjørkquist, Catharina & Ramsdal, Helge Normann (Ed.), Statlig politikk og lokale utfordringer: Organisering av tjenester innen rus og psykisk helse. Cappelen Damm Akademisk. ISSN 978-82-02-73453-4. p. 217–234. doi: https:/doi.org/10.23865/noasp.140.
Løken, Therese Dwyer (2021). Rekruttering og deltakelse i kvalitativ forskning: Tjenestemottakere og pårørende som deltakere. In Bjørkquist, Catharina & Ramsdal, Helge Normann (Ed.), Statlig politikk og lokale utfordringer: Organisering av tjenester innen rus og psykisk helse. Cappelen Damm Akademisk. ISSN 978-82-02-73453-4. p. 43–62. doi: https:/doi.org/10.23865/noasp.140.
Helgesen, Marit Kristine (2021). Kommunal organisering, ledelse og endring: En casestuide av implementering av psykiske helsetjenester i en norsk kommune. In Bjørkquist, Catharina & Ramsdal, Helge Normann (Ed.), Statlig politikk og lokale utfordringer: Organisering av tjenester innen rus og psykisk helse. Cappelen Damm Akademisk. ISSN 978-82-02-73453-4. p. 131–154. doi: https:/doi.org/10.23865/noasp.140.
Fugletveit, Ragnhild (2021). «… det vanskeligste er jo å finne noe fornuftig å gjøre». - Om betydningen av arbeid og aktivitet for mennesker med ROP-utfordringer. In Bjørkquist, Catharina & Ramsdal, Helge Normann (Ed.), Statlig politikk og lokale utfordringer: Organisering av tjenester innen rus og psykisk helse. Cappelen Damm Akademisk. ISSN 978-82-02-73453-4. p. 235–257. doi: https:/doi.org/10.23865/noasp.140.
Fineide, Mona Jerndahl; Haug, Erna & Bjørkquist, Catharina (2021). Organisational and Professional Integration Between Specialist and Primary Healthcare Services: A Municipal Perspective. . International Journal of Integrated Care (IJIC). ISSN 1568-4156. 21(2). doi: 10.5334/ijic.5606. Show summary
Introduction: Care transitions between specialist and primary healthcare services for people with concurrent substance abuse and mental health problems are characterised by vulnerability and arbitrariness. Objectives: By studying factors that influence integration in a Norwegian context, this study aims to investigate, from a municipal perspective, why care transitions are still tricky after the introduction of the key Coordination Reform. Methods: This study has an explorative approach based on interviews with managers and front-line professionals in primary care. We applied the conceptual framework of functional and normative integration of the Rainbow Model. Results: The municipal actors emphasise that integration is hampered by limited cooperation with general practitioners in referrals to hospital, challenges of communication and loss of meeting points. They experienced close cooperation with sociomedical polyclinics for substance abuse, while challenges in cooperation with district psychiatric centres indicated an interdependence of functional and normative integration. Questioning hospital discharge of patients to primary care was a recurring theme for the municipal actors. Thus, the governing framework of the Coordination Reform has coexisted with fragmentation in organisational structures and divided professional cultures. Conclusions: The coexistence of the new and the old regimes seems to hamper functional and normative integration in care transitions.
Hansen, Gunnar Vold (2020). For noen beboere er bofellesskap en god løsning. Tidsskrift for psykisk helsearbeid. ISSN 1503-6707. p. 95–104. doi: 10.18261/issn.1504-3010-2020-02-03-03.
Bjørkquist, Catharina & Hansen, Gunnar Vold (2018). Coordination of services for dual diagnosis clients in the interface between specialist and community care. Journal of Multidisciplinary Healthcare. ISSN 1178-2390. 11 . doi: 10.2147/JMDH.S157769. Full text in Research Archive

View all works in Cristin

Bjørkquist, Catharina & Ramsdal, Helge Normann (2021). Statlig politikk og lokale utfordringer: Organisering av tjenester innen rus og psykisk helse. Cappelen Damm Akademisk. ISBN 978-82-02-73453-4. 302 p.

View all works in Cristin

Bjørkquist, Catharina; Fineide, Mona Jerndahl & Løken, Therese Dwyer (2023). Mange – og varierende veier til kommunale helse- og velferdstjenester.
Bjørkquist, Catharina (2022). Muligheter og utfordringer i organisering av lokalbaserte tjenester. Statlig politikk vs. lokale utfordringer på ROP-området.
Bjørkquist, Catharina (2022). Ser behov for sterkere styring og mer øremerkede midler. [Internet]. NAPHA.
Bjørkquist, Catharina & Ramsdal, Helge Normann (2021). Introduksjon. In Bjørkquist, Catharina & Ramsdal, Helge Normann (Ed.), Statlig politikk og lokale utfordringer: Organisering av tjenester innen rus og psykisk helse. Cappelen Damm Akademisk. ISSN 978-82-02-73453-4. p. 9–25. doi: https:/doi.org/10.23865/noasp.40.ch1.
Bjørkquist, Catharina & Ramsdal, Helge Normann (2021). Om ROPIT-prosjektet, teoretisk forankring og metode. In Bjørkquist, Catharina & Ramsdal, Helge Normann (Ed.), Statlig politikk og lokale utfordringer: Organisering av tjenester innen rus og psykisk helse. Cappelen Damm Akademisk. ISSN 978-82-02-73453-4. p. 27–41. doi: https:/doi.%20org/10.23865/noasp.40.ch2.
Bjørkquist, Catharina & Ramsdal, Helge Normann (2021). "Det nye paradigmet" i rus- og psykiske helsetjenester - utfordringer og muligheter. In Bjørkquist, Catharina & Ramsdal, Helge Normann (Ed.), Statlig politikk og lokale utfordringer: Organisering av tjenester innen rus og psykisk helse. Cappelen Damm Akademisk. ISSN 978-82-02-73453-4. p. 281–299. doi: https:/doi.org/10.23865/noasp.40.ch14.
Bjørkquist, Catharina & Ramsdal, Helge Normann (2021). «Hva er viktig for deg?» i et styringsperspektiv».
Bjørkquist, Catharina (2021). Structural Disavowal and Individual Inundation – Dilemmas of Mental Health Work. International Journal of Integrated Care (IJIC). ISSN 1568-4156. 21. doi: 10.5334/ijic.ICIC20130.
Bjørkquist, Catharina (2021). Presentasjon av ROPIT antologien.
Ramsdal, Helge Normann (2021). Utviklingstrekk – nye utfordringer innen rus og psykisk helse.
Bjørkquist, Catharina (2021). Stort mangfold i hvordan tjenester på ROP-feltet organiseres. [Internet]. NKROP.
Løken, Therese Dwyer (2021). «Offentlige styringsverdier og vilkår for integrerte og personorienterte tjenester». .
Røste, Rannveig & Bjørkquist, Catharina (2020). Utvikling av helhetlige tjenester innen rus- og psykisk helse: erfaringer fra en innovasjonsprosess i en storbykommune.
Hoel, Tone Larsen & Hansen, Gunnar Vold (2020). Er bofelleskap egnet for mennesker med ROP-lidelser? Erfaringskompetanse.no.
Fineide, Mona Jerndahl & Haug, Erna (2020). Achieving horizontal and vertical integration in local services - creating sustainable mechanisms?
Ramsdal, Helge Normann (2020). Tjenesteperspektiver på psykisk helsearbeid. In Gonzalez, Marianne Thorsen (Eds.), Psykiske lidelser - Faglig forståelse og terapeutisk tilnærming. Sykepleiefaglige og flerfaglige perspektiver. Gyldendal Akademisk. ISSN 9788205516700. p. 476–484.
Løken, Therese Dwyer; Johannessen, Aud & Bjørkquist, Catharina (2020). Organizing financial resources in the municipality: a case study on integrated services to persons with concurrent substance abuse and mental health challenges. Show summary
Introduction: There is a risk of fragmentation of services for persons with concurrent drug addiction and mental health challenges (dual diagnosis). The services are primarily given in separate systems with separate funding streams and budgets. This can lead to structural barriers, and we presume that this division of work and the structure and flow of funds can affect various aspects of integrated services. In this study, we view integration as a coherent set of methods and models on the funding, administrative and organisational levels designed to create connectivity, alignment and collaboration within and between the government agencies and departments in Norwegian municipalities. The aim is to investigate how the organising of financial resources in Norwegian municipalities affect integrated service provision to persons with dual diagnosis. Method: This is a case study, using three municipalities as units of analysis. The case is how the organising of municipalities` financial resources affect integrated municipal services to persons with dual diagnosis. We conducted in-depth interviews with employees and managers. In addition, we made observations of meetings where services to persons with dual diagnosis were discussed, assessed and allocated. The data was analysed with a Stepwise- Deductive Inductive approach. Results: Preliminary findings point at the tendency to shift responsibility for the financing of individuals` services between the different government agencies and departments in the organisation. This applies for both municipal services, as well as admissions in private institution units. The government agencies and departments have separate budgets, and none of them has admissions in private institution units as a budget item in their main budget. When the severity and complexity in the service recipients` situation requires such an admission, the participants describe this responsibility shift as a way to avoid these kinds of high-price solutions. In practice, this leads to discussions regarding which of the service recipients challenges that are most dominant, in order to place responsibility at the most suitable municipal service. There existed no unwillingness to collaborate once the responsibility was clarified. These processes throws persons with dual diagnosis back and forth in the system, and can lead to complex needs not being met. Discussion: The results point at the framework conditions in the organisation, the silo-budgets and keeping the costs as low as possible. The responsibility shift becomes a structural barrier where the patients` issues are explained as more or less dominant in order to force other departments to “pay the bill”, instead of joining up to address the persons complex needs together in an integrated manner. Conclusions: There is a need to evaluate the organizing of Norwegian municipalities’ financial resources in order to find solutions that integrates mental health-, social- and somatic services. This is a case study, which can lead to challenges when it comes to generalising the findings. There is a need for further research on how funding solutions can promote integrated care to persons with dual diagnosis.
Bjørkquist, Catharina & Ramsdal, Helge Normann (2020). Structural Disavowal and Individual Inundation – Dilemmas of Mental Health Work .
Fineide, Mona Jerndahl & Haug, Erna (2019). Sirkulære prosesser - utfordringer når ulike institusjonelle logikker møtes i behandling av mennesker med dobbeltdiagnoser. . Show summary
Foreløpige resultater fra en studie som er knyttet til prosjektet «ROPIT – Integrated Services for Patients with Dual Diagnosis» ble presentert.
Ramsdal, Helge Normann & Bjørkquist, Catharina (2019). Dilemmaer i profesjonelt arbeid med ROP-pasienter – mellom ansvarsfraskrivelse og ansvarsoversvømmelse.
Ramsdal, Helge Normann & Bjørkquist, Catharina (2019). Structural disavowal and personal inundation of responsibility – a local perspective on pressure on mental health work.
Løken, Therese Dwyer; Johannessen, Aud; Helgesen, Marit Kristine & Bjørkquist, Catharina (2019). “Money talks”: a qualitative study on how organising of financial resources affect integrated services to persons with dual diagnosis.
Fugletveit, Ragnhild (2019). Fra rus til arbeidsliv.
Hansen, Gunnar Vold (2019). Helhetlige tjenester til Rop-pasienter som skal sone en dom i fengsel.
Hansen, Gunnar Vold (2019). Er en bolig alltid et hjem? .
Bjørkquist, Catharina & Ramsdal, Helge Normann (2019). Integrerte tjenester – er det mulig? ROPIT - prosjektet.
Bjørkquist, Catharina (2019). Integrerte tjenester til mennesker med ROP-lidelser – er det mulig?
Fineide, Mona Jerndahl & Haug, Erna (2019). Competing Institutional Logics; Professionals and management experiences during care transitions between hospital and local services. Show summary
The focus of this article is to explore the contexts in which persons with dual diagnosis is in need for integrated treatment from specialist health services. Our main research question is how professionals and management in three municipalities interpret patient’s care transitions through specialist health services. By analysing data from focus-group interviews and documents, we identified four main themes related to integrated treatment. Firstly, the arrangements of transitions are formally regulated by law and an agreement between hospital and local services, but to what extent the agreement is known and practised seem to differ. Secondly, the two silos in specialist health services represented by Sociomedical Polyclinics (SMP) and District psychiatric centres (DPS) seem not to be internal coordinated. The patients have to have either substance abuse or mental health issues. Thirdly, the patient’s family doctor has limited space and time for the patients. Fourthly, the professionals and managements face these gaps; consequently, they demonstrate goodwill and creative practise in order to compensate for loss of integrated treatment. However, this is repeatedly not sufficient to meet the patient's needs for integrated treatment and there is a risk for patient’s continuous transitions between local services, GP, DPS and SMP. Across these themes, the competing institutional logics of hospital services DPS and SMP and local services represented by the family doctor and municipal units is especially challenging for receiving the policy goal of integrated treatment for people with dual diagnosis.
Hansen, Gunnar Vold & Bjørkquist, Catharina (2018). Pårørende - ressurs eller problem? Fredrikstad Blad.
Ramsdal, Helge Normann (2018). Psykisk helse og levekår: Hvordan kan Knutepunkt for Recovery jobbe med dette? .
Ramsdal, Helge Normann (2018). Hvilke endringer ser du når det gjelder forekomst av psykiske lidelser og konsekvensene dette vil få for kompetansebehov i kommunenes psykiske helse- og rustjenester? .

View all works in Cristin

Published Jan. 28, 2019 11:21 AM - Last modified Mar. 14, 2022 10:39 AM