Willy tore morch-integrated_services_in_primary_health_care_family_house

1. Integrated services in primary health
care
The family house
Implementation strategy
Professor Willy-Tore Mørch
University of Tromsø, Faculty of Health Sciences

2. Integrated services pyramide
• Treatment
• (Diagnosed)
Clinics
• Indicated
• Targeted
Municipalities
Prevention
Municipalities (health stations
Child protection, social services)
• Universal Screening
prevention

3. The Family’s House – a Family Centre
Model
Third floor/level – Indicated intervention
Children, adolescents and families with
particular needs
Second floor/level – Selective intervention
Children, adolescents and families with
individual needs
First floor/level – Universal intervention
All children and adolescents with families
Foundation
Professional infra-structure
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4. The Family’s House is an interdisciplinary municipal
service that is meant to support the mental and physical
health of expectant mothers, children and adolescents.
• The municipality’s primary healthcare and social measures
geared toward children, adolescents and their families are
coordinated, congregated and embedded locally.
• The central services that often constitute the Family’s
House are a healthcare clinic for children, including
pregnancy care, child welfare services, pedagogical-
psychological services, and an open kindergarten.
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5. The purpose of this collaboration is to promote good health and
welfare among children, adolescents and their families, while
strengthening the conditions in which children and adolescents
grow up (RKCCY, 2008). The objective may be reached through:
• making support and services readily available
• supporting and strengthening parents in their role as caregiver
and mentor
• assisting children, adolescents and their families in strengthening
social networks
• developing communication and work methods that encourage
children and parents to participate
• developing good, coordinated and interdisciplinary services for
consumers
• being available as a neighborhood gathering place
• distributing relevant information
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6. Activities - Family’s House project in Norway
• Research
 User satisfaction studies of parents in the Open Kindergarten
 Collaboration among professionals
 Survey of all Norwegian municipalities in order to determine
the number of Family’s Houses, content and organizational
structures.
• Information and support to municipalities
 Book (in English)
 Network and conferences for practitioners
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7. Activity plan for sound mental
health
Levels ,
Research and Development of sound mental health for children and adolescents
evidensbased practice
E.g. IY, ART, Family group conference, «What about us» (Families with children with reduced
level of functioning)
Implementation Stimulate to use reserach and evidensbased interventions
Evaluation Evaluate implementation of new interventions
Adjustment (implementation strategy)
Describe and justify Local health profile Prioritize Selection Organizing models in
interventions in use and Interventions of screening and use and future
potential interventions (Incidence and and practice assessment tools organizing models
prevalence of mental (e.g. IY, ART, Family (e.g. ECBI, SDQ etc) (e.g. from separated
health problems) group conference agencies to Family
House
Assessment Epidemiology and Science and evidens Validated screening Recommended
Standards of living based practice. and organization models
Practice in use Assessment
(present (e.g. Estonian norms) (E.g. Family house)
interventions)

8. Levels of services
• Treatment
Diagnosed disorder, above clinical cut-off
• Indicated prevention
Symptomes of disorders
• Targeted prevention
Presence of risk factors
• Universal prevention
No known risk factors or symptomes
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9. Implementation strategy
Dissemination
• The system model:
Formal organizational structures in both the purveyor’s and
the receiving organization’s are connected for safe
anchoring of the intervention.
Contact moves from a personel level to a system level in
order to prepare for formal political and administrative decisions.
The aim is to place the intervention as a part of the
municipality’s health policy
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10. Implementation strategy
Adaptation:
• Assessment of the characteristics of the municipality and
the needs for the intervention
Prevalence of individuals with the targeted problems,
incidence rate of the problems, existing interventions etc.
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11. Implementation strategy
Adaptation
• Agency readyness assessment
Acceptability for the intervention in the agencies
(agreement) Motivation for implementation, ideological
compatibility between the agency and the intervention (e.g.
theory, manual based intertvention)
Identification of eary adopters, late adopters and
refusers (Roberts, 1995)
Identification of agency characteristics (number of
employees)
Allocation of resources for the intervention, both
human, time and monetary
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12. Implementation strategy
Implementation:
Selection of target population (e.g. adolescents with
conduct disorder)
Selection of service level (treatment,
indicated/targeted and/or universal prevention)
Training of personell by sertified mentors (program
content, progression and methods, ethics,
refinement/education, respect people’s needs and
problems, integrity)
Supervision and coaching, longlasting supervision
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13. Sustainability
Organizational detoriation
Prevention of organizational «amnesia» (shift of
leadership, new ideas)
Development of systems preventing close-down of the
intervention due to resignments, pregnancies,
illness etc
Fidelity detoriation
Drift in program content, dose, target population,
implementation evaluatuion
Competence detoriation
Sertification, resertification, supervision, «super-
days», annual conferences
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14. Thanks!