Specialization in care and welfare services often leads to inflexible boundaries between organizations and professions, resulting in fragmented and ineffective care, not least in the areas of addiction and severe mental illness i.e. dual diagnosis. Studies have shown that help for social problems can make treatment for substance abuse more effective, and that personal economy, employment and housing and other social questions are important for the process of recovery from substance abuse and/or mental health problems.
Collaborative models such as case management, multidisciplinary teams and coordinated care plans are used in many countries to address this problem. In a parallel development, demands have been made for individual patients to have more influence over their own care, and research has shown that user involvement can support the recovery process. In Sweden, legislation requires the social service and health care to draw up Coordinated Individual Plans (CIP) to clarify responsibility, improve the care process and increase users’ involvement in their own care. The purpose of this legislation is to achieve effective collaboration for a larger number of individuals than is possible with case management and team-based models.
This presentation summarizes findings from a research project which had as its aim to study the impact of coordination of care and interventions for persons with addiction and mental health problems and user involvement in this context, using the Swedish CIP as an example. In two studies, social service case files which included CIPs have been examined to investigate what could be learned about the conditions for integrated care. Using a model which conceptualizes collaboration as a form of organizational integration, analysis of the findings indicated low to moderate levels of collaboration and few indications of user involvement.
In a follow-up study, 20 professionals in addiction and psychiatric clinics and social workers in the social service were interviewed concerning factors which influence the degree of collaboration when CIP was used. Interviewees were often positive to CIP, but also experienced hinders to successful collaboration with the CIP model. Two main themes concerned issues of responsibility and professional identity. Using domain theory for analysis, the researchers concluded that organizational support for CIP only partially compensated for conflicting organizational and professional logics. Concerning user involvement, findings show that professionals experience ambivalence. On the one hand, they support the user´s own demands of services and on the other hand, they correct the user´s demands to fit the range of services and organization of care. The user/patient’s position was expressed as vulnerable, caught between caregivers who often safeguard their organizational duties and economical restrictions.
Results of the project indicate that more distinct models with stronger organizational and, if necessary, legislative support are needed if collaboration around the target groups is to be successful.