Riskilaste konverents 2012: Willy Tore Morch: Integrated services in primary health care family house

Riskilaste konverents 2012: Willy Tore Morch: Integrated services in primary health care family house

• 1.
  Integrated services inprimary health care The family house Implementation strategy Professor Willy-Tore Mørch University of Tromsø, Faculty of Health Sciences
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  Integrated services pyramide • Treatment • (Diagnosed) Clinics • Indicated • Targeted Municipalities Prevention Municipalities (health stations Child protection, social services) • Universal Screening prevention
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  The Family’s House– a Family Centre Model Third floor/level – Indicated intervention Children, adolescents and families with particular needs Second floor/level – Selective intervention Children, adolescents and families with individual needs First floor/level – Universal intervention All children and adolescents with families Foundation Professional infra-structure 3
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  The Family’s Houseis an interdisciplinary municipal service that is meant to support the mental and physical health of expectant mothers, children and adolescents. • The municipality’s primary healthcare and social measures geared toward children, adolescents and their families are coordinated, congregated and embedded locally. • The central services that often constitute the Family’s House are a healthcare clinic for children, including pregnancy care, child welfare services, pedagogical- psychological services, and an open kindergarten. 4 23.10.2012
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  The purpose ofthis collaboration is to promote good health and welfare among children, adolescents and their families, while strengthening the conditions in which children and adolescents grow up (RKCCY, 2008). The objective may be reached through: • making support and services readily available • supporting and strengthening parents in their role as caregiver and mentor • assisting children, adolescents and their families in strengthening social networks • developing communication and work methods that encourage children and parents to participate • developing good, coordinated and interdisciplinary services for consumers • being available as a neighborhood gathering place • distributing relevant information 5 23.10.2012
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  Activities - Family’sHouse project in Norway • Research  User satisfaction studies of parents in the Open Kindergarten  Collaboration among professionals  Survey of all Norwegian municipalities in order to determine the number of Family’s Houses, content and organizational structures. • Information and support to municipalities  Book (in English)  Network and conferences for practitioners 6 23.10.2012
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  Activity plan forsound mental health Levels , Research and Development of sound mental health for children and adolescents evidensbased practice E.g. IY, ART, Family group conference, «What about us» (Families with children with reduced level of functioning) Implementation Stimulate to use reserach and evidensbased interventions Evaluation Evaluate implementation of new interventions Adjustment (implementation strategy) Describe and justify Local health profile Prioritize Selection Organizing models in interventions in use and Interventions of screening and use and future potential interventions (Incidence and and practice assessment tools organizing models prevalence of mental (e.g. IY, ART, Family (e.g. ECBI, SDQ etc) (e.g. from separated health problems) group conference agencies to Family House Assessment Epidemiology and Science and evidens Validated screening Recommended Standards of living based practice. and organization models Practice in use Assessment (present (e.g. Estonian norms) (E.g. Family house) interventions)
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  Levels of services •Treatment Diagnosed disorder, above clinical cut-off • Indicated prevention Symptomes of disorders • Targeted prevention Presence of risk factors • Universal prevention No known risk factors or symptomes 8 23.10.2012
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  Implementation strategy Dissemination • The system model: Formal organizational structures in both the purveyor’s and the receiving organization’s are connected for safe anchoring of the intervention. Contact moves from a personel level to a system level in order to prepare for formal political and administrative decisions. The aim is to place the intervention as a part of the municipality’s health policy 9 23.10.2012
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  Implementation strategy Adaptation: • Assessmentof the characteristics of the municipality and the needs for the intervention Prevalence of individuals with the targeted problems, incidence rate of the problems, existing interventions etc. 10 23.10.2012
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  Implementation strategy Adaptation • Agency readyness assessment Acceptability for the intervention in the agencies (agreement) Motivation for implementation, ideological compatibility between the agency and the intervention (e.g. theory, manual based intertvention) Identification of eary adopters, late adopters and refusers (Roberts, 1995) Identification of agency characteristics (number of employees) Allocation of resources for the intervention, both human, time and monetary 11 23.10.2012
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  Implementation strategy Implementation: Selection of target population (e.g. adolescents with conduct disorder) Selection of service level (treatment, indicated/targeted and/or universal prevention) Training of personell by sertified mentors (program content, progression and methods, ethics, refinement/education, respect people’s needs and problems, integrity) Supervision and coaching, longlasting supervision 12 23.10.2012
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  Sustainability Organizational detoriation Prevention of organizational «amnesia» (shift of leadership, new ideas) Development of systems preventing close-down of the intervention due to resignments, pregnancies, illness etc Fidelity detoriation Drift in program content, dose, target population, implementation evaluatuion Competence detoriation Sertification, resertification, supervision, «super- days», annual conferences 13 23.10.2012
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  Thanks!