• Startsiden
• Om RBUP
• Ansatte
• Vis alt innhold

Implementation and use of Individual Plans in a group of youths with long term and complex mental health problems

Prosjektdeltakere:

Lene Holum, Stipendiat, stipendiat, cand.psychol., Ullevål universitetssykehus HF, BUP Holmlia
Ruth Toverud Hovedveileder, seksjonsleder, dr.psychol, RBUP
Odd Arne Tjersland, Biveileder, professor, UiO

Sammendrag:

Individuelle planer (IP) er innført i pasientrettighetsloven, psykisk helsevernloven, spesialisthelsetjenesteloven, kommunehelsetjenesteloven og sosialtjenesteloven, og er ment å være hjelp til mennesker med behov for koordinerte hjelpetiltak over tid, med fokus på økt livskvalitet og brukermedvirkning. Utgangspunktet er brukers egne mål og ressurser. IP skal være en overordnet plan.

Hovedproblemstilling
Under hvilke forutsetninger fungerer IP etter intensjonen, i gruppen av unge med langvarige og alvorlige psykiske problemer? Og hvilke faktorer er det som faglig og organisatorisk hemmer og fremmer disse forutsetningene, både på system- og individnivå?

Metode
Undersøkelsen baseres på følgende tilnærminger: spørreskjema og klinisk forskningsintervju. Informantene er 22 ledere innen psykisk helsevern, 4 representanter for brukerorganisasjoner og 24 pasienter og deres koordinator samt enkelte pårørende. Pasientene vil intervjues to ganger med to års mellomrom.

Vitenskapelig betydning
Resultatene vil være av interesse for det kliniske fagfeltet i forhold til bruk av IP, for brukerorganisasjonene ift økt brukerstyring, for helsemyndighetene ift innføring av ny praksis generelt og ift innføringen av IP spesielt. Resultatene kan relateres til internasjonal forskning på case management, assertive community treatment, og opp mot forskning på helsefremmende tiltak, empowerment og salutogenese.

Abstract:

Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (R-BUP) and Oslo University Hospital, Child and Adolescent Outpatient Clinic, Early Intervention Psychosis Team (TIPS) for adolescents in Oslo South
Supervisors: Ruth Toverud, R-BUP & Odd Arne Tjersland, University of Oslo
Background
Lene Chr Holum is clinical psychologist and leader of the TIPS-team in the south of Oslo. She has been working with implementation of “Individual Plans” since 2002, and made a research project on the theme, starting in 2004. The work forms a doctoral thesis to be submitted to the Department of Psychology, University of Oslo. Founding is received from the Norwegian Foundation for Health and Rehabilitation (Helse & Rehabilitering) and R-BUP. Oslo university hospital has granted necessary leave of absence.

“Individual Plan” (IP) is a kind of managed care plan and is meant as a tool to promote user-involvement and collaboration. The intentions behind IP are that patients in need of extensive services shall be included in planning their own treatment, have a written master plan built on their own goals, needs and resources and an appointed service-provider coordinating the services involved.

Objectives
Achieve systematic knowledge on implementation and use of IP; in a group of youths/young adults with long-term and complex mental health problems. Herunder which factors promote or hamper IP function, both on a system and individual level, and how IP is transformed into practical measures.

Sample
Clinical research interviews of
• 26 patients and relatives (a total of 24 patient cases), which are interviewed twice, in 2006 and 2008
• their 19 personal coordinators and 2 therapists
• 6 representatives from 3 user-organisations
• 22 leaders within mental health service

Method
The study is qualitative, consisting of 89 in-depth interviews. The project is a naturalistic study, anchored in the author’s prolonged practice in the field. The methodological approach is mainly understood as evaluation research, due to Patton. Within this perspective triangulation of sources is central to get the different perspectives on what IP is for whom. The analyses are done with inspiration from grounded theory, phenomenological perspectives and content analysis.

Main results
What hamper IP function:
• IP do not influence on unclear or lack of framework conditions, like economy, lack of suitable measures, lack of people, questions about which service-department has the responsibility for treatment and coordination or disagreement between service-providers
• Some of the leaders and coordinators do find IP difficult to use, wonder who is having the responsibility for the plan, who is supposed to be the coordinator and what’s in the role of being a coordinator
• The leaders do not believe in IP and has not taken the implementation seriously
• IP try to fulfil several needs at the same time; some of them conflicting. IP is in the area of tension between IP as a user-run tool versus a control tool, where the health authorities count plans and use it as a quality indicator for some groups of patients
• The patients have an unclear diagnostic condition and there is not a single institution or department ready to take on the responsibility for the treatment and coordination
• The patient do not cooperate and show massive ambivalence to receive help

What promote IP function:
• Leaders who believe in IP and have implemented the tool in a systematic way
• An active coordinator who is confident and believe in the patient’s resources
• The patients have a clear diagnostic condition, even complex, and then there is not a big question about who is responsible for what measures
• The patients needs are to be fulfilled within existing framework conditions
• The patients are cooperative, do want help and trust in their service-providers

General findings:
• Some patients have received better and more coordinated help, and it might even give some increased quality of life. Others say they can not tell any difference, while a couple even say IP have made the situation worse since they got some expectations which is not fulfilled.
• In 10 out of 24 cases IP is used as intended by the law and in accordance with the patients wishes and needs in either the first or second interview. In only 6 of these cases at both times. In 14 cases IP are not in use according to the law and the patients needs.

Research participants
The study is done by Holum alone, in collaboration with supervisors.
Holum cooperate to some extend with two other Ph.D-students (University of Stavanger and NTNU Trondheim) working on qualitative projects on Individual Plans.





Sist oppdatert: 02/06/2013