The project “Tricky Transitions” worked to find smoother ways through a complex health and social care service system for people with drug addiction and mental health problems in a Norwegian locality. Tricky Transitions was a collaboration between researchers from University College Østfold, representatives of a user organisation and staff from managerial and operative levels in a Norwegian municipality and associated hospital trust.
Background
The project followed on from a phase one investigation of service coordination in the field of addictions and mental health problems. Phase one identified the complexity of the system together with a number of issues this complexity caused, and also suggested that many issues were addressed in everyday service delivery. The work in phase 2 therefore focussed on ways existing practice could be modified and knitted together in new ways to address co- ordination issues, without instigating new separate projects that would further fragment an already complex collaborative landscape.
Aims
To identify, implement and evaluate solutions to co-ordination issues that extend existing practice and build on user perspectives. To draw out wider practical implications.
Methods
We used contribution analysis, a tool of service development that helps uncover the potential for change in existing arrangements. The focus is not an intervention or new service to be implemented, but small changes in existing arrangements that can produce desired results. The tool helps multi service and professional groups negotiate and clarify the outcomes they wish a particular service arrangement to produce, and then work “backwards” to identify changes in existing collaboration arrangements that can help produce these outcomes. Changes are adjusted according to continuous evaluation.
Results
Adjustments to existing practice were developed in three areas:
- User diary: a form of Cognitive Behaviour Therapy that puts user in charge of developing awareness of patterns of drug use, identify their consequences and find solutions to problems drug use creates.
- A multiprofessional version of KOR, a tool to evaluate the impact of a consultation on user’s ability to understand and cope with his or her circumstances.
- “A multiprofessional panel” where users with irregular service contact met representatives of key services in order to jointly agree appropriate service arrangements. “The panel” became the focus of the project and where we collected most material about the potential for user centred adjustment of service arrangements.
User representatives contribution were the most innovative aspect of the project. These representatives helped set the agenda for the project around recovery, i.e. recognising users’ resources and ability to take responsibility for his or her life choices. User perspectives were instrumental in suggestions for service arrangements that adjust to complex recovery trajectories, including set backs and periods of poor ability to engage with services. This led to new ways of thinking about service delivery both at an individual level and also at system levels. We now work to develop theory and practice on how a recovery perspective can contribute to organisational development in a situation of increased need and shrinking resources.