Open Dialogue Presented by Kristof Mikes-Liu Niels Buus The - - PowerPoint PPT Presentation

The University of Sydney

Open Dialogue

Presented by Kristof Mikes-Liu Niels Buus

The University of Sydney 2

• A brief introduction to the central elements of an Open Dialogue

approach, including the seven principles

• A live role play of network meeting
• Previous research of Open Dialogue
• A recent Danish study of outcomes in Open Dialogue
• A discussion of the ‘Open’ in Open Dialogue

Outline of presentation:

Introduction Network meetings Previous research Danish Outcomes Discussion

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• Grew out of the Finnish (optimistic and ressource-oriented) ‘needs-

adapted’ approach to treatment of schizophrenia

• They adopted early treatment meetings based on a systemic

family therapy approach

• The Finns felt that the systemic approach was not well suited the

more collaborative network meetings

• The approach was later used specifically in crises management
• Reorganisation of health care services including psychotherapeutic

education of all staff

Introduction: The origins in Western Lapland

Introduction Network meetings Previous research Danish Outcomes Discussion

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• 1. Immediate help
• 2. A social network perspective
• 3. Flexibility and mobility
• 4. Responsibility
• 5. Psychological continuity
• 6. Tolerance of uncertainty
• 7. Dialogism

The seven key principles

Integrated care Psychotherapeutic stance

Introduction Network meetings Previous research Danish Outcomes Discussion

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• 1. Immediate help
• 2. A social network perspective
• 3. Flexibility and mobility
• 4. Responsibility
• 5. Psychological continuity
• 6. Tolerance of uncertainty
• 7. Dialogism

The seven key principles

We suggest these as the ‘generic’ principles

Introduction Network meetings Previous research Danish Outcomes Discussion

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Care organised round a series of network meetings

All other types of care and treatment continue as usual Time Open ended (non-totalising) language use, need adapted and collaborative approach Inclusion of relevant parts of a person’s private and professional network Two therapists - transparent decision making Outreach when possible Network meeting Network meeting Network meeting Network meeting

Introduction Network meetings Previous research Danish Outcomes Discussion

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Opening: What is important for all participants to talk about? Dialogue: Effort to hear all the voices in the room Reflection among the clinicians in front of the family Family’s reflections on clinicians’ reflections Close: Planning collaborative actions and eventual next meeting

Structure of a network meeting - role play

This sequence can be repeated several times

Introduction Network meetings Previous research Danish Outcomes Discussion

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Structure of a network meeting

Rick: Boss Niels: OD practitioner Liz: Sister Henry: Person of concern K r i s t

• f

: O D p r a c t i t i

• n

e r

Introduction Network meetings Previous research Danish Outcomes Discussion

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The gradual implementation of open dialogue in Western Lapland in was not designed to be rigorously tested in a trial, but Seikkula and colleagues have published a number of descriptive post hoc studies drawing on data from the cohort of people receiving open dialogue throughout the implementation period “The treatment group fared better than the treatment-as-usual comparison group on days spent in the hospital, BPRS scores, number of relapses, and employment status. They also used less neuroleptic and had more family meetings” (Gromer 2012, p. 169-70)

Previous research on Open Dialogue

Introduction Network meetings Previous research Danish Outcomes Discussion

The University of Sydney 10

The gradual implementation of open dialogue in Western Lapland in was not designed to be rigorously tested in a trial, but Seikkula and colleagues have published a number of descriptive post hoc studies drawing on data from the cohort of people receiving open dialogue throughout the implementation period “The treatment group fared better than the treatment-as-usual comparison group on days spent in the hospital, BPRS scores, number of relapses, and employment status. They also used less neuroleptic and had more family meetings” (Gromer 2012, p. 169-70)

Previous research on Open Dialogue

But because of the basic before and after designs of these studies, the reliability of data, and the use of basic statistical methods, including the omission of adjusting for important confounding variables, it is not possible to draw strong conclusions about the effects of open dialogue

Introduction Network meetings Previous research Danish Outcomes Discussion

The University of Sydney 11

Aim: To examine whether a Danish adoption of Open Dialogue for young patients (14-19 years) in acute psychiatric crisis reduced the utilisation of health services and social services, compared to usual psychiatric treatment. Methods: A retrospective cohort (n = 503) of patients from Southern Denmark in 2000-2015 was compared to a matched group (n = 1509) from Central and Northern Denmark by linking clinical data with national social and health care registers. The comparison group was created using propensity score matching. Follow-up was at 1, 2, 5, and 10 years.

A Danish register linkage study (under publication)

Introduction Network meetings Previous research Danish Outcomes Discussion

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Less individualistic than conventional mental health care service delivery Different organisations of Open Dialogues in different social and cultural settings Power relationships in Open Dialogue is under-acknowledged, under-theorised and under-researched Peer support workers in Open Dialogue

Discussion: The “Open” in Open Dialogue

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The Centre for Family-Based Mental Health Care was established in early 2016 The aim was to develop and implement ‘upstream’ family and community interventions Implementation and research at St.Vincent’s Hospitals in Sydney, Nepean Blue Mountains LHD, and Illawarra Shoalhaven LHD and in Melbourne (Alfred Health) Development of new interdisciplinary ‘family work and open dialogue’ elective units of study at Sydney Nursing School Finnish three-year Open Dialogue psychotherapy and train-the- trainer courses commenced November 2017 in Sydney

The St. Vincent’s Open Dialogue Initiative

Introduction Network meetings Previous research Danish Outcomes Discussion

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Contact: kristof.mikesliu@sydney.edu.au niels.buus@sydney.edu.au Some additional ressources are available at: www.researchgate.net and www.youtube.com (search for Niels Buus)

Thank you for you attention

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• Bellingham, B., Buus, N., McCloughen, A., Dawson, L., Schweizer, R., Mikes-

Liu, K., Peetz, A., Boydell, K., River, J., 2018. Peer work in Open Dialogue: A discussion paper. Int J Ment Health Nurs. 27(5), 1574-1583.

• Buus, N., Bikic, A., Jacobsen, E. K., Muller-Nielsen, K., Aagaard, J., & Rossen,
• C. B., 2017. Adapting and Implementing Open Dialogue in the

Scandinavian Countries: A Scoping Review. Issues in mental health nursing, 38(5), 391-401.

• Eiterå, A., Hansen, L., Vind, B., Hansen, A., Castella, J., Sørensen, E., 2014.

Open Dialogue - key markers and their context. N/A, N/A.

• Gromer, J., 2012. Need-adapted and open-dialogue treatments:

empirically supported psychosocial interventions for schizophrenia and

• ther psychotic disorders. Ethical Human Psychology and Psychiatry, 14(3),

162-177.

Literature