Introduzione Il "dialogo aperto" è un approccio terapeutico orientato alla valorizzazione delle risorse delle persone con disagio psichico e della loro rete familiare e sociale. Gli studi condotti (Seikkula et al., 2011) hanno documentato l'efficacia di questo approccio in Lapponia occidentale, dove è stato sviluppato e- recentemente, altri studi ne stanno valutando l'applicabilità e gli esiti in altri contesti. Nel 2015, il Ministero della Salute ha finanziato un progetto per valutare la trasferibilità del dialogo aperto in otto dipartimenti di salute mentale, situati in sei città (Torino, Savona, Trieste, Roma, Modena, Catania). Il dipartimento di prevenzione della ASL di Torino ha coordinato il progetto e l'ISTC-CNR si è occupato della ricerca valutativa. Metodi In linea con le raccomandazioni sullo studio della diffusione delle innovazioni nelle organizzazioni (Greenhalgh, Robert, Macfarlane, Bate, & Kyriakidou, 2004), la ricerca ha utilizzato un approccio multi-metodo e partecipativo. Infatti essa è stata parte integrante delle attività del progetto, orientandone le scelte e le attività (Rossi, 2017). La ricerca è stata articolata in quattro fasi: 1. valutazione preliminare; 2. valutazione del training; 3. valutazione della aderenza e 4. studio pilota. Risultati Fase 1- I professionisti della salute mentale coinvolti nel progetto considerano il dialogo aperto una pratica compatibile con i propri valori professionali e con i principi della legge 180. Secondo questi professionisti, il dialogo aperto può promuovere auspicabili cambiamenti organizzativi nei dipartimenti di salute mentale in cui operano. Fase 2- La formazione sul dialogo aperto è stata efficace, sia rispetto alla soddisfazione dei partecipanti che ai livelli di apprendimento raggiunti. Fase 3- Il livello di aderenza della pratica clinica ai principi dialogici dopo 8 mesi di formazione è risultato soddisfacente, sebbene siano state riscontrate differenze tra i livelli di competenza acquisiti dagli operatori dei diversi dipartimenti. Fase 4- Alla luce dei risultati preliminari relativi allo studio pilota, il dialogo aperto risulta trasferibile nei dipartimenti di salute mentale italiani. Infatti, complessivamente, i dipartimenti sono riusciti a prendere in carico con il dialogo aperto il 69, 2% delle nuove richieste relative ai pazienti residenti nei territori selezionati per la sperimentazione del DA, superando il valore standard previsto dal progetto CCM (>66%). Inoltre, pazienti e familiari hanno espresso un alto livello di soddisfazione rispetto alla valutazione degli incontri dialogici. Conclusioni Il dialogo aperto risulta trasferibile nel contesto italiano, se sono disponibili adeguate risorse per la formazione e la supervisione, che nel contesto di questo studio sono state garantite dal finanziamento del Ministero. Si raccomanda di supportare il processo di implementazione e la ricerca avviati, per verificare l'efficacia del dialogo aperto nel contesto italiano.
Background Open dialogue is a compassionate and resource-oriented approach to cope with mental health issues, involving patients and significant persons of their social networks. Outcomes evaluation had proven the effectiveness of this approach in Wester Lapland- Finland (Seikkula et al, 2011), where it was developed, but other studies need to investigate the transferability of this approach in other contexts. In 2015, the CCM of the Italian Ministry of Health financed a national project to evaluate the transferability of OD in the context of 8 Italian mental health departments (MHDs), located in different regions and cities (Turin, Savona, Trieste, Rome, Modena, Catania). The Nation Research Council was involved in the evaluation research. This report presents the results of the evaluation. Methods The research was based on a multi-methods and participatory approach. The project was articulated in four main phases: preliminary evaluation, training evaluation, fidelity assessment and pilot study. Each phase of the project was related to specific research. Results of each phase were discussed in the coordination meetings of the project to inform decisions about the implementation of OD. Results 1. Professionals accept the OD practise and see it as compatible with their values and needs as well the ones of their organizations. Professionals consider OD transferability desirable and feasible. Solutions to solve possible obstacles to the implementation were identified. 2. Training was effective, with respect to trainees' reaction and learning. 3. Although there were differences in levels of adherence between the teams, the assessment of OD fidelity was mainly satisfactory. 4. According to the preliminary results of the ongoing pilot study, OD appears to be transferable clinically and organizationally in the Italian mental health departments. In fact, altogether, the MHDs succeed to treat the 69,2% of all new cases of a predefined area via the OD-approach- the standard of the project was at least 66%. Moreover, patients and family members expressed a high-level of satisfaction with respect to the evaluation of OD sessions. Conclusion According to our results, OD appears feasible to the Italian context if adequate resources are available for training and supervision. More research is needed to evaluate OD outcomes.
Evaluation of Open Dialogue transferability in the context of the Italian mental health services
2017
Abstract
Background Open dialogue is a compassionate and resource-oriented approach to cope with mental health issues, involving patients and significant persons of their social networks. Outcomes evaluation had proven the effectiveness of this approach in Wester Lapland- Finland (Seikkula et al, 2011), where it was developed, but other studies need to investigate the transferability of this approach in other contexts. In 2015, the CCM of the Italian Ministry of Health financed a national project to evaluate the transferability of OD in the context of 8 Italian mental health departments (MHDs), located in different regions and cities (Turin, Savona, Trieste, Rome, Modena, Catania). The Nation Research Council was involved in the evaluation research. This report presents the results of the evaluation. Methods The research was based on a multi-methods and participatory approach. The project was articulated in four main phases: preliminary evaluation, training evaluation, fidelity assessment and pilot study. Each phase of the project was related to specific research. Results of each phase were discussed in the coordination meetings of the project to inform decisions about the implementation of OD. Results 1. Professionals accept the OD practise and see it as compatible with their values and needs as well the ones of their organizations. Professionals consider OD transferability desirable and feasible. Solutions to solve possible obstacles to the implementation were identified. 2. Training was effective, with respect to trainees' reaction and learning. 3. Although there were differences in levels of adherence between the teams, the assessment of OD fidelity was mainly satisfactory. 4. According to the preliminary results of the ongoing pilot study, OD appears to be transferable clinically and organizationally in the Italian mental health departments. In fact, altogether, the MHDs succeed to treat the 69,2% of all new cases of a predefined area via the OD-approach- the standard of the project was at least 66%. Moreover, patients and family members expressed a high-level of satisfaction with respect to the evaluation of OD sessions. Conclusion According to our results, OD appears feasible to the Italian context if adequate resources are available for training and supervision. More research is needed to evaluate OD outcomes.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
