Open Dialogue services around the world: a scoping survey exploring organizational characteristics in the implementation of the Open Dialogue approach in mental health services.

Objective: This cross-sectional study investigates the characteristics and practices of mental health care services implementing Open Dialogue (OD) globally. Methods: A structured questionnaire including a self-assessment scale to measure teams' adherence to Open Dialogue principles was developed. Data were collected from OD teams in various countries. Confirmatory Composite Analysis was employed to assess the validity and reliability of the OD self-assessment measurement. Partial Least Square multiple regression analysis was used to explore characteristics and practices which represent facilitating and hindering factors in OD implementation. Results: The survey revealed steady growth in the number of OD services worldwide, with 142 teams across 24 countries by 2022, primarily located in Europe. Referrals predominantly came from general practitioners, hospitals, and self-referrals. A wide range of diagnostic profiles was treated with OD, with psychotic disorders being the most common. OD teams comprised professionals from diverse backgrounds with varying levels of OD training. Factors positively associated with OD self-assessment included a high percentage of staff with OD training, periodic supervisions, research capacity, multi-professional teams, self-referrals, outpatient services, younger client groups, and the involvement of experts by experience in periodic supervision. Conclusion: The findings provide valuable insights into the characteristics and practices of OD teams globally, highlighting the need for increased training opportunities, supervision, and research engagement. Future research should follow the development of OD implementation over time, complement self-assessment with rigorous observations and external evaluations, focus on involving different stakeholders in the OD-self-assessment and investigate the long-term outcomes of OD in different contexts.

Development of the peer-supported open dialogue attitude and competence inventory for practitioners: A Delphi study.

Introduction: Peer-supported Open Dialogue (POD) is a novel approach to mental health care that is currently being practiced and researched in the United Kingdom. For POD to be successfully implemented, effective training must be provided to make sure trainees are prepared to deliver the approach as intended. Therefore, a specific instrument that can assess the development and competence of POD trainees, as well as the effectiveness of POD training is crucial. Therefore, the current study aimed to establish an inventory named the Peer-supported Open Dialogue Attitude and Competence Inventory (PODACI), measuring the changes in attributes and attitudes of trainees before and after training. Methods and Results: To generate the inventory, a four-round modified Delphi approach was used. We first identified the dimensions that are essential and specific to POD through an extensive literature review and individual interviews with practitioners (n = 8). After generating the items, we further refined the items through two rounds of questionnaires, asking practitioners to rate the relevance of each item from 1 (not essential) to 4 (highly essential; n = 21 and n = 10), and finalized the inventory via a focus group interview with POD trainers (n = 4). In total, 76 items were included in the PODACI. A good consensus on the items was reached: the median score of the items was all above 3.00 (essential) and achieved an agreement level greater than 85%. The Kendall coordination coefficient W was 0.36 and 0.28 in the two questionnaires employed, indicating a fair level of agreement between participants. Discussion: The PODACI provides a way to measure attitudinal and competency factors related to the treatment integrity of POD as well as the efficacy of the training courses being offered. This highly enriched instrument opens up a wide range of possibilities for POD research and application, facilitating the development of Open Dialogue services. The next step is to assess the psychometric properties of the inventory.

The community mental health team fidelity scale: A measure of program fidelity of social networks interventions for severe mental illness.

Open dialogue (OD) is a multi-component therapeutic and organizational intervention for crisis and continuing community mental health care with a therapeutic focus on clients' social networks. The development and implementation of this model of care in the United Kingdom requires considerable contextual adaptations which need to be assessed to support effective implementation. Program fidelity-the extent to which core components of an intervention are delivered as intended by an intervention protocol at all levels-is crucial for these adaptations. Aims: To develop, pilot, and implement a program fidelity measure for community mental health services providing OD and 'treatment as usual' (TAU) or standard NHS crisis and community care. Methods: Measure structure, content, and scoring were developed and refined through an iterative process of discussion between the research team and OD experts. Measure was piloted in the 6 OD and 6 TAU services participating in a large-scale research program. Results: Initial data suggests that the Community Mental Health Team Fidelity Scale (COM-FIDE) is a potentially reliable and feasible measure of the fidelity of community mental health services and specific OD components of such services.

Development and refinement of the open dialog adherence protocol in complex mental health care.

Introduction: Open dialog (OD) is a both a therapeutic practice and a service delivery model that offers an integrated response to mental health care through mobilizing resources within the service user's family and community networks through joint network meetings. Therapist adherence is a crucial to the effective delivery of interventions. A key way to measure this is through structured observation tools. Aims: The aim of this research project is to develop and refine the Dialogic Practice Adherence Scale, for use in OD research trials in the United Kingdom. Methods: This study was a mixed methods approach to the development of an OD practitioner adherence measure. Initial steps involved meetings and discussions with experts and a review of the literature. Content validation studies were completed using a modified Delphi technique. To assess reliability of the measure, OD network meetings were audio-recorded, and tapes were rated by two independent researchers. Inter-rater reliability and internal consistency were assessed through quantitative approaches assessing variance. Results: Results provide a description of how the OD Adherence Manual was developed in collaboration. Validation surveys showed high levels on consensus among experts in the field on the key elements of OD network meetings. Inter-rater reliability for the total score was excellent and internal consistency analyses suggest the scale is highly reliable. Discussion: The scale presented here is an initial attempt at rating practitioner adherence in OD network meetings. It provides encouraging evidence that this can be done with strong validity and reliability and can be completed by a range of raters with varying levels of clinical experience.

Dialogue as a Response to the Psychiatrization of Society? Potentials of the Open Dialogue Approach.

In recent decades, the use of psychosocial and psychiatric care systems has increased worldwide. A recent article proposed the concept of psychiatrization as an explanatory framework, describing multiple processes responsible for the spread of psychiatric concepts and forms of treatment. This article aims to explore the potentials of the Open Dialogue (OD) approach for engaging in less psychiatrizing forms of psychosocial support. While OD may not be an all-encompassing solution to de-psychiatrization, this paper refers to previous research showing that OD has the potential to 1) limit the use of neuroleptics, 2), reduce the incidences of mental health problems and 3) decrease the use of psychiatric services. It substantiates these potentials to de-psychiatrize psychosocial support by exploring the OD's internal logic, its use of language, its processes of meaning-making, its notion of professionalism, its promotion of dialogue and how OD is set up structurally. The conclusion touches upon the dangers of co-optation, formalization and universalization of the OD approach and stresses the need for more societal, layperson competencies in dealing with psychosocial crises.

Narratives of natural recovery: youth experience of social inclusion through green care.

The aim of this study has been to investigate the effects of Green Care services for youth in vulnerable situations risking social exclusion. Green Care enterprises represent alternative arenas in which people can work with animals, agriculture and other tasks related to nature. We interviewed nine persons, aged 17-27, working in three different places, two or more times over a two-year period. We looked at essential beneficial factors in order to better understand how the "green" element could add to more traditional recovery factors. We found that the youth described core success factors corresponding to well-known recovery factors such as recognition, supportive relationships, motivation, meaning, positive coping, self-esteem, confidence and hope. The effective factors can be described as: (a) The leader's ability to create a good group atmosphere, (b) the varied tasks which allow step-wise increases in self-efficacy, and (c) experiences with animals and in nature that provide comfort for youth who lack trust in people and need safe situations to recover a positive sense of self. We followed a process in which several persons gradually regained self-respect and the motivation for further education or a job outside the Green Care enterprise. The study illustrates that Green Care can be an important supplement in helping people back to a satisfying life and meaningful roles in society.

Inter-agency work in Open Dialogue: the significance of listening and authenticity.

The article explores what professionals regard as important skills and attitudes for generating inter-agency network meetings involving intra- and interprofessonal work. More specifically, we will examine what they understand as promoting or impeding dialogue and how this is related to their professional backgrounds. The professionals participated in a project using an open dialogue approach in order to increase the use of inter-agency network meetings with young people suffering from mental health problems. In this explorative case study, empirical data was collected through interviews conducted with two focus groups, the first comprising healthcare professionals and the second professionals from the social and educational sectors. Content analysis was used, where the main category that emerged was dialogue. To illustrate the findings achieved in the focus groups, observations of inter-agency network meetings are included. The findings describe the significance and challenges of listening and authenticity in the professionals' reflections. The healthcare workers expressed worries concerning their capacities for open and transparent dialogues, while the other professionals' emphasized the usefulness of particular techniques. Inter-agency network meetings may be improved if more awareness is placed on the significance of meeting atmosphere, dwelling on specific topics, dealing with silence and understanding how authentic self-disclosure in reflections can promote the personal growth of the participants.

Open Dialogues in social networks: professional identity and transdisciplinary collaboration.

AIM: The aim of this article is to explore the challenges connected to the transformation and emergence of professional identity in transdisciplinary multi-agency network meetings and the use of Open Dialogue. INTRODUCTION: The empirical findings have been taken from a clinical project in southern Norway concerning multi-agency network meetings with persons between 14 and 25 years of age. The project explores how these meetings are perceived by professionals working in various sectors. METHODOLOGY: Data was collected through three interviews conducted with two focus groups, the first comprising health care professionals and the second professionals from the social and educational sectors. Content analysis was used to create categories through condensation and interpretation. The two main categories that emerged were 'professional role' and 'teamwork'. These were analysed and compared according to the two first meeting in the two focus groups. RESULTS AND DISCUSSION: The results indicate different levels of motivation and understanding regarding role transformation processes. The realization of transdisciplinary collaboration is dependent upon the professionals' mutual reliance. The professionals' participation is affected by stereotypes and differences in their sense of belonging to a certain network, and thus their identity transformation seems to be strongly affected. To encourage the use of integrated solutions in mental health care, the professionals' preference for teamwork, the importance of familiarity with each other and knowledge of cultural barriers should be addressed.