Follow-up of a training course in collaboration between social service and health care

Short introduction to the course

According to Swedish Law collaboration between health care providers and the municipal social service is mandatory. A template according to Collaborative Individual Plan (CIP) is available in the patient data system (“TakeCare” www.acceptus.se/journalsystem-take-care) for professionals in health care but not easily available for professionals in social service. A general feeling by politicians and managers was that collaboration occurs too infrequently and the reason was too little training in how to use the CIP-template and which patients need a CIP.                         

Course and context

To promote collaboration the local council for psychiatric collaboration decided to design a training course. Stockholm County Council together with County Association of Local Authorities (KSL) therefore developed a three-day CIP-course. The course consisted of both lectures and group discussions about authentic vignettes. Lectures were about the content in the CIP-method following the guide distributed to participants at the start: Initiative to establish a CIP, User participation, Informed consent, Preparing the CIP-meeting, Selecting and contacting participants, Conduct the meeting and Establish a CIP and follow-up.   Discussions were about how to organize the CIP- meeting, deciding about the competencies comprising the group, the responsibilities of participants and content according to the template. The course was given at 10 different places and 10 different occasions in a class-room environment.

Aim

The aim of the training was to implement a way to work with a method called Collaborative Individual Plan (CIP) that is supposed to improve the care of patients with complex needs such as dual diagnoses of substance addiction and mental health problems. 

Material and methods

I evaluated  if collaboration between municipal social service and health care instances improved after a training course. Assessments of outcomes were made before and one year after the training, eligible changes may be due to the course but even to other factors happening during the follow-up period. An untrained control group could have controlled for that but there were not resources to collect such a group.

The course was given at ten different occasions and places to ensure that professionals who should collaborate were trained together. This was because it should be as similar as possible to an inter-professional education and as much as possible avoiding dissemination of the course content to untrained staff. Since the professionals often have already developed work routines it was interesting to study if training in other routines can change those previous routines. The stakeholders in a more effective heath care were identified as the purchaser organization within Stockholm County Council, the patients who have complex needs and the tax-payers.   

Results

The result of the evaluation showed small and insignificant changes in self-reported number of CIP established one year after the training but a significant improvement in the self-reported working routines around the CIPs.  For example, a larger proportion of ever participating in CIP collaboration and a larger proportion of self-initiated CIPs after training were reported. Additionally a somewhat larger proportion reported meeting clients in need of a CIP in their work as well.

Discussion

Routines affecting how people collaborate in their work may be due to structural and personal factors. An explanation of the small changes in the number of established CIPs but significantly improved work routines may be due to the training that focused on structural sooner than personal factors.  Personal factors as different views on what is the source of the patient’s problems and what is the correct measure to be performed and who is responsible for performance, should be addressed in the early job training. The participants in our course had several years of experience and established beliefs. To change such beliefs is difficult. Training in CIP early in their job-training may prevent establishment of personal beliefs. Another way to improve collaboration is to have a clear initiative structure so that a person can see what’s in it for them.

Conclusion

It is important to implement CIP training early in the job training and to address personal factors as attitudes to different problems and treatments. Another important factor is personal reinforcement.

Practice Points

When designing a training course it is important to gather people from the relevant occupational training that are supposed to collaborate

The training has to be conducted in a context that is relevant for collaboration

The teachers should be of the same occupations as the students to promote role-identification 

A template should be available to all that are supposed to collaborate

Contact

Håkan Källmén
STAD
Centre for psychiatry research
Karolinska Institutet/Stockholm County Council

Centrum för psykiatriforskning
Karolinska Institutet/SLSO
E-mail: hakan.Kallmen@ki.se