INNOFFARENA-Innovasjonsarena for stat og kommune

People with mental health disorders and/or substance abuse disorders are as a group typically found more often as victims of violence than perpetrators. Still, personnel providing services to this group can occasionally find themselves as victims of staff-directed aggression and violence. The impact of this can be devastating for the afflicted personnel, and service users often suffer negative consequences as well. We often observe a decline in the quality and continuity of service provision following episodes of staff-directed violent threats and violence. Surveys have shown that personnel request more competence in order to improve the prevention and management of unwanted situations. The Agency of Health in the Municipality of Oslo, have since 2010 targeted systematic competence development activities for personnel providing mental health or substance abuse services in service users homes. This far, 4,000 people have participated in the various competence development activities. The aim of this qualitative research project has been to explore how the competence development activities and supporting competence and practice development tools developed by the Agency of Health, Oslo Municipality, have contributed in developing competence and understanding of practice in the participating services. The research questions in this research project have been answered through interviews with participant in various courses and competence development activities offered by the Agency of Health and leaders of community mental health and substance abuse services that have participated in the competence development activities and have utilized supporting competence and practice development tools. In three substudies we have found that the understanding of practice is complex and varies substantially among community mental health and substance abuse staff. Conceptualizations vary in what extent they focus on observation of service user behaviours and the health organizations' responsibilities for ensuring employees? safety, personal assets and qualities in the prevention and management of staff-directed aggression and violence, the team as a resource and source of support in the development and execution of prevention and management strategies and involvement of the service user and his/her perspectives. In ours research we have found that the most apposite and impactful practice is associated with conceptualizations that embody all these factors and allow for an efficient and flexible movement between these dimensions for the employee who meet service users that can be threatening and/or violent. We have found the contribution from the Agency of Health's competence development activities to be moderate, but have shown significant for individual participants. Particularly, it seems that the contribution from the competence development activities have contributed the most in services from where there have been several participants simultaneously and where participation have been a part of a conscious and planned competence and practice development strategy. This has already had an impact on the Agency of Health by an increased focus on more targeted and locally based competence development activities, adjusted to the services' own requirements and goals. In the last of the substudies in this research project, we have found that managers of community mental health and substance abuse services have experienced the competence development activities and the supporting competence and practice development tools afforded by the Agency of Health have contributed in developing employees? awareness and understanding of violence and threats in their work. Additionally, competence development in their staff has contributed in levelling out power differentials in the mental health service system by staff being empowered in collaboration with other actors in the system. Lastly, the managers have found participation in competence development activities to contribute in adjusting the managers' own perceptions of assignments and responsibilities in relation to preventing and managing staff-directed aggression in their services. In this research project we have thrown light on employees perspectives and conceptualizations of practice in encounters with service user perceived to be threatening and/or violent. Aggression, violence, and threats in non-institutional community settings is a little researched area of practice that is marked by a significant lack of knowledge. In light of this, our research project has not only added not knowledge of the contribution from partaking in competence development activities aimed at municipal mental health or substance abuse service workers. It has also contributed in exploring and describing previously undescribed practices and conceptualizations of practice in the prevention and management of staff-directed aggression in community mental health and substance abuse services.

Med dette forskningsprosjektet har Helseetaten, Oslo kommune, oppnådd å utvikle kunnskap om betydningen av kurs og kompetansetiltak rettet mot ansatte i psykiske helsetjenester som samarbeider med brukere som kan være truende og/eller voldelige. Økt kunnskap om tilretteleggelse av læring og utvikling av praksis er også blitt oppnådd. I forskningen har vi også identifisert tilnærminger og praksiser som er forbundet med god og hensiktsmessig forebygging og håndtering av trusler og vold i kommunale psykiske helsetjenester. Denne kunnskapen vil danne grunnlaget for utviklingen og tilretteleggelsen av nye kompetansetiltak rettet mot ansatte i psykiske helsetjenester i Oslo kommune. Det er en stor kunnskapsmangel om trusler og vold i lokalbasert psykisk helsearbeid, nasjonalt og internasjonalt. Vi mener funnene fra dette forskningsprosjektet vil kunne få betydning og danne et utgangspunkt for senere forskning på vold og trusler i kommunale psykiske helse- og rustjenester.

Forskningsprosjektet søker å etablere kunnskap om hvordan deltakere og deres ledere vurderer praktisk nytte og utvikling av egen kompetanse etter, deltakelse på Helseetatens ulike kompetansetiltak om forebygging og håndtering av vold og trusler. Kompetansetiltakene omfatter generelle kurs rettet mot ansatte i kommunale hjemmebaserte tjenester rettet mot brukere med psykiske lidelser og/eller rusproblematikk, samt spesialiserte kurs, seminarer og videreutdanninger til ressurspersoner i tjenestene. Kompetansetilbudene gis også til spesialisthelsetjenesten i Oslo. Målgruppen for prosjektet er ansatte i Oslo kommune som arbeider i hjemmebaserte tjenester for mennesker med psykiske helseutfordringer eller rusmiddelproblematikk. Prosjektet er gitt et kvalitativt deskriptivt eksplorativt design. Det vil i tillegg bli samlet inn demografiske bakgrunnsvariabler fra deltakerne. Formålet med denne enkle metodetrianguleringen er å kunne benytte et bredt sammensatt datasett i analysen, og beskrive evt. sammenhenger og mønster i datamaterialet. Forskningsprosjektet søker med dette også å utvide det forskningsbaserte grunnlaget for hva som er virkningene av kurs-og kompetansetiltak i regi av kommuner. Perspektiver vedrørende samhandling med spesialisthelsetjenesten, vil også bli inkludert, for å undersøke eventuelle samhandlingseffekter av økt felles forståelse og kunnskapsgrunnlag om vold og trusler mot ansatte. De organisasjonsmessige effektene av kompetansetiltakene vil videre bli forsøkt belyst gjennom å inkludere ledere av tjenestene i bydelene som informanter. Forskningsspørsmålene vil bli søkt belyst gjennom individuelle intervjuer av deltakere på generelle kurs (før og etter kurs), to-stegs fokusgruppeintervjuer av ressurspersoner og to-stegs fokusgruppeintervjuer av ledere av hjemmebaserte bydelstjenester som har deltatt i kompetansetiltakene. Fokuset i intervjuene vil være på deltakernes vurderinger av betydning for egen praksis.