Ledelse mellom sterke ideologier og lillebrorkomplekser – en eksplorerende studie i tverrfaglig spesialisert rusbehandling

Background: Substance use treatment has long traditions in Norway, but it was not until 2004 that it became part of the specialist health service, leading to new leadership requirements. The aim of this study was to understand how the field is perceived from a leadership perspective and how leaders perceive their leadership role. Method: The study is based on three focus group interviews with the mentors of 28 network groups. Data were analysed through systematic text condensation. Results: The analysis resulted in a clustering of four aspects the informants reported to characterise their perceptions of their leadership role: the inferiority complex, values ​​in substance use treatment, pragmatic leadership, and subjective leadership. Implications: The analysis shows that informal hierarchies of power, ideology, and expectations of interdisciplinarity in all decisions provide fertile ground for a flat structure and ambiguity in management. The findings reveal the need for measures to strengthen recognition of the field and develop the leadership role. Keywords: Substance use treatment, leadership, drugs, addiction, health, leadership development

Terapirommet er ikke et nøytralt rom. Om Friluftssykehuset og potensialet i de fysiske omgivelsene for barn og unge i behandling.

Background and aim: The purpose of this article is to demonstrate how we can use nature cabins and their natural surroundings therapeutically. Method: Published research of relevance for this therapeutic practice is discussed in relation to and informed by experiences from practice, collected through conversations with therapists using the Outdoor care retreat at Rikshospitalet in Norway. Results: The literature review demonstrates how therapy in nature cabins can influence cognitive and emotional processes. All physical environments carry symbolic meanings; therefore, no therapy setting is neutral, and the setting will affect the client and therapist. Place attachment may contribute to create a safe foundation for exploration and self-development. The experiences from practice demonstrate how nature and natural objects are rich in potential for the creative application of symbols in therapy and opens for different stories on growth and development. Conclusions and implications: The evidence-based approach of this article supplies a therapeutic rationale to use cabins in natural surroundings more strategically for positive therapeutic outcomes. Keywords: nature, architecture, therapy settings, hospital environments

Bli venn med maten: evaluering av et lavterskel kurstilbud for personer med overspisingsproblematikk

This study evaluates a mindful eating-based program for people with self-reported binge eating problems. The study was initiated by a non-governmental eating disorder interest organization. Participants met once a week over eight weeks. The Eating Disorder Questionnaire (EDE-Q) and three subscales of the Self-Compassion Scale (SCS) were used to measure eating pathology, self-compassion and mindfulness before, after, and six-months after the program. Results: Significant improvements in EDE-Q and SCS scores were found, and results remained stable at the six-month follow-up. The number of binge eating days decreased significantly during the study, both from before to after program participation, and from post-program participation to six-month follow-up. Conclusion: Future studies investigating the current program are clearly needed. These preliminary results are nonetheless encouraging and illustrate that mindful eating-based interventions as an interesting treatment avenue for individuals with binge eating pathology, a group which currently has few treatment options available to them.

Døgnvariasjoner for innleggelser ved akuttpsykiatriske enheter

Aim: The aim of this study was to investigate diurnal variations of admissions in acute psychiatry. Method: The registration of 2763 submissions were conducted from 01.04.15–31.12.17 at the University Hospital of North-Norway by completing a form for every admission. Results: The results revealed that a majority of the admissions took place at evening and nighttime. There were significantly (p = .001) more admissions at evening and night. Results revealed that 21,[A1] 5 % (539) of the admissions were between 00:00–08:00, whereas 27,5 % (758) of the admissions were between 08:00–16:00, and 51 % (1409) of the admissions were between 16:00–00:00. Conclusion: The causes behind this distribution of the admissions should be investigated in future studies. Future studies should ask the patients about the causes of the late admissions. Keywords: diurnal variations, admissions, acute psychiatry

Tidlig avklaring – et møte mellom mennesker. Ny tilnærming for vurdering og planlegging av behandling i poliklinisk psykisk helsevern.

Background: Mental health care services are facing challenges due to the increasing number of referrals of patients with multifaceted problems. This study aims to describe the Early Assessment Team, a novel method of organizing intake assessments for the outpatient mental health service in a community mental health center. Method: During the first two years of EAT, 1,034 cases were included in a descriptive quality assurance study. Patient population, method of work, re-referrals and patient satisfaction were evaluated. Results: After contact with EAT, two-thirds of patients were assessed as not in need of further treatment in the outpatient clinic. The assessment was performed during one to three sessions in 90% of cases. Fewer than 20% of cases that were screened out by EAT were re-referred to the CMHC within six months. Patients expressed satisfaction with the service. Implications: The results indicate that intake assessment by an early assessment team may be an alternative in clinical practice, though further controlled studies are needed. Keywords: community mental health center (CMHC), health service development, intake assessment, general mental health

Ny tilnærming for vurdering og planlegging av behandling i poliklinisk psykisk helsevern

Background: Mental health care services are facing challenges due to the increasing number of referrals of patients with multifaceted problems. This study aims to describe the Early Assessment Team (EAT), a novel method of organizing intake assessments for the outpatient mental health service in a community mental health center (CMHC). Method: During the first two years of EAT, 1,034 cases were included in a descriptive quality assurance study. Patient population, method of work, re-referrals and patient satisfaction were evaluated. Results: After contact with EAT, two-thirds of patients were assessed as not in need of further treatment in the outpatient clinic. The assessment was performed during one to three sessions in 90% of cases. Fewer than 20% of cases that were screened out by EAT were re-referred to the CMHC within six months. Patients expressed satisfaction with the service. Implications: The results indicate that intake assessment by an early assessment team may be an alternative in clinical practice, though further controlled studies are needed.

The Trauma and Development Education Monitor (TANDEM): et nytt instrument for å måle traumekompetanse

There is a need to assess whether the resources invested in building trauma competence in services actually lead to higher levels of competence. For this purpose, we have developed an instrument called the Trauma and Development Education Monitor (TANDEM). The present article presents the process behind developing the instrument and an initial study of its psychometric properties. The tested version consisted of 59 items distributed across the domains of readiness, agency, reflexivity, knowledge, practice and culture at work. Based on responses from 415 professionals in relevant services, concept and criterion validity was examined through reliability analyses, factor analyses and regression analyses. Based on the analyses, the tested version was reduced to 54 items in the final version, distributed across the same six domains. As dimensions, the domains generally showed good scale reliability, and for the final version factor analyses confirmed a one-dimensional model for all domains. The instrument discriminated between respondents who reported more versus less previously received trauma competence building and showed specificity as a measure of trauma versus more general competence. The results indicate that TANDEM has the potential to become a useful tool in endeavours to implement trauma competence in services, as well as in research activities in this field. Keywords: trauma, competence, instrument, validity

PANDAS: behov for nasjonale retningslinjer

Background: Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) was introduced in 1998. The hypothesis that acute tics and/or symptoms of obsessive-compulsive disorder (OCD) might be triggered by streptococcal infection lacks scientific support. Patients are seen by several specialists, and treatment depends on knowledge and acceptance of the condition. This article provides an overview of literature investigating proposed treatments. Method: We performed a literature search in PubMed and Cochrane Library between 1 June 2019 and 17 July 2021. Results: 14 reviews were included. Suggested treatments comprised psychiatric treatment, antibiotics, tonsillectomy and immune modulating therapy. Recommendations were largely based on case reports and uncontrolled studies. Conclusion: Few studies have been conducted on PANDAS treatment, and none were evidence-based. Cooperation between different professions and establishment of national guidelines on how to approach these children are crucial. Keywords: PANDAS, post-infectious autoimmunity, neuropsychiatry, interdisciplinary

Utredning av autismespekterforstyrrelser i BUP – hvor godt samsvar er det mellom instrumenter og endelig klinisk diagnose?

Background: The Developmental, Dimensional and Diagnostic Interview (3Di) and the Autism Diagnostic Observation Schedule (ADOS-2) may be useful when assessing autism spectrum disorder (ASD), but the accuracy of the Norwegian 3Di is not known. Method: We investigated the classification accuracy of the 3Di and the ADOS-2 in identifying clinically diagnosed ASD in 130 participants (mean age 11 years). Results: We found acceptable accuracy in identifying ASD with both the 3Di and ADOS-2 (sensitivities/specificities > 70 %), and highest accuracy (positive likelihood ratio = 17.12) when combining the two instruments, but this gave lower sensitivity (54 %). Conclusions: The 3Di is useful when assessing ASD, and most accurate when combined with information from the ADOS-2. Clinicians should be aware that some children with ASD may be missed by requiring endorsement from both instruments. Keywords: Autism Diagnostic Observation Schedule, inter-rater reliability, sensitivity, specificity, Developmental, Dimensional and Diagnostic Interview

Foreldre underrapporterer om konflikter og utfordringer i forkant av mekling. En evaluering av familievernets differensieringsverktøy

Background: In 2016, the Norwegian family counselling service implemented differentiated mediation to give cumstomized help. The differentiation tool (i.e., questionnaire) has never been evaluated. Method: Using a sample of 761 parents, we compared parent responses given over the phone to the family counselling service and anonymously to an electronic version of the questionnaire. Results: One-third of the parents underreported their challenges to the family counselling service, and only 15% of parents who, in the electronic questionnaire reported substanse abuse or violence in the relationship, revealed this to the service. Underreporters had higher interparental conflict and more symptoms of anxiety and depression. Parents who underreported problems with substanse abuse and violence had more physically violent conflicts. Conclusions: There is a need to improve the validity of the differentiation tool. We suggest that parents need information and a safe environment when completing the questionnaire. Electronic administration of the questionnaire may serve this purpose. Keywords: parental mediation, differentiated mediation, parental conflict, partner violence