Magnus Johansson

Research questionsCan Feedback Informed Treatment (FIT) increase the effects of and prevent drop-outs in psychosocial interventions at social services while also increasing user participation? Does FIT increase cost-effectiveness of psychosocial efforts at social services?Data and methodWe will conduct a randomized controlled trial in social services´ outpatient care, addiction care and in residential treatment. In addition to direct effects of using FIT, cost-effectiveness, instrument psychiometrics and predictive value will be examined. In addition to the instruments used in FIT -- Outcome rating scale (ORS) which measures development and Session Rating Scale (SRS) which measures working alliance -- the project will include additional outcome measures for quality of life, behavior and symptoms which will be selected in collaboration with representatives of the users (social workers and clients). The project will also examine both clients´ and social workers´ experiences of giving and receiving feedback using FIT, as well as examine factors that influence implementation within social services.Social relevanceSocial services have an ambition to use evidence based practice, but there is a lack of methods that can help social workers and the social service to systematically follow and adapt the interventions based on the clients´ situation, context and preferences. FIT is an internationally proven system for doing this. If findings of the current project are positive, it can be spread within social services through an existing network of practitioners and with existing digital tools.PlanParticipating units with experience and interest in FIT will be recruited in collaboration with the Swedish FIT network and with already engaged municipalities and treatment units. The project will ensure that participating social workers have sufficient skills and that their workplace is ready to work with FIT. Clients who are granted treatment at the unit will be asked if they want to be included in a study where they can give feedback on the interventions they receive and help to follow their progress. After baseline, they will be randomized to treatment as usual or treatment with the addition of FIT. To support implementation, the therapists in the FIT group will be offered regular supervision. Follow-up will be at 3, 6 and 12 months. A number of clients and social workers will also be asked to participate in semi-structured interviews to explore experiences.

As much as every fifth adult Swede may present with a problematic use of alcohol, cannabis or gambling, yet few seek help and when they do, they are likely to meet a fragmented and often confusing care landscape with shared responsibility between social services/care (municipalities) and healthcare (regions) and large difference in treatment access over time and space. Digitalized care appears to be an attractive solution to these issues and recent years have seen an impressive development on the healthcare side, yet structural obstacles have hindered a similar development in social services. The proposed project aims to map, develop, implement and evaluate solutions to these well-known but standing issues. In Study I, we will use survey and complementary interviews with social services offices around the country to systematically map obstacles and opportunities for digitalizing addiction care

in parallel, a similar study will be conducted with individuals with addictions to reveal discrepancies between sought-after and provided care. Study II is a randomized controlled trial examining whether it is possible to address misconceptions about social services through a digital micro-intervention. Finally, in Study III, a cluster-randomized trial will examine the feasibility and effectiveness of offering digital addiction treatments – originally developed and evaluated in a healthcare setting – now within social services, as an add-on to typical care. A complementary qualitative study on user experiences is also included. In sum, these three studies will give valuable new insights into the well-known but standing societal problem of offering equal addiction care, and develop, implement and evaluate cost-effective, future-proof and sustainable solutions to this problem by taking full advantage of the benefits of digitalization.