Flexible Assertive Community Treatment How is the model adapted and implemented in different Norwegian contexts?

In recent years, the Norwegian health authorities have allocated considerable funding to encourage the testing and innovation of collaborative models between primary and secondary health care. Flexible Assertive Community Treatment (FACT) is a collaborative model developed to provide integrated and comprehensive services for persons with mental illness, substance use disorders and a low functional level in many areas in life. The proposed study seek to answer the following aims: 1)to describe how the FACT model is translated and implemented in different contexts by using translation theory in analysing the data, and to identify important factors for successful implementation, 2)to investigate how establishment of FACT teams influences the local service system and to identify economic, structural and organizational barriers and enablers for achieving comprehensive and integrated services. 3)to investigate the outcome for patients and what are their experiences with the services, 4)to investigate how Information and Communication technology (ICT) should be designed to support FACT teams in rural regions in Norwegian 5)to analyse implications of findings from the different parts in the project for further improvement of the FACT model in Norway. Data will be collected from service users, team members, team leaders, partners in the municipalities and specialist services, health authorities, relevant documents and register data. Five FACT teams are included in the study, in both rural and urban regions. The research findings will be communicated back to the teams and partners during the project and will thus contribute to further enhancement of the services. The research will provide new knowledge about the FACT model internationally and how it works in different Norwegian contexts. The project is a collaboration between the following institutions in Norway: Norwegian National Center for Concurrent substance abuse and mental disorders, Innlandet Hospital Trust, National Resource Center for Community Mental Health (NAPHA), Norwegian Centre for eHealth Research, University of Tromsø, Inn University of Applied Sciences. Achieved results 2019-2022: -Three PhD students and a postdoctoral fellow started during the autumn of 2019. The PhD candidates are affiliated with the University of Tromsø, the University of the North and Inn University of Applied Sciences. -The project was presented to the Regional Ethical Committee (REK) in early February, and a response was received in July 2020 stating that the project is not subject to REK's mandate. The project and the individual sub-projects have been recommended by the personvernombudet (PVO) at Innlandet Hospital Trust (project responsible institution).Cooperation agreements with the FACT teams and their owners have been obtained. -There have been two meetings in the international advisory board. The first meeting was in Tromsø in January 2020 and the second in Svolvær in September 2022. International partners in the group: Niels Mulder: Erasmus University Medical Center, Department of Psychiatry, Netherlands, Helen Killaspy: University College London, Nigel Henderson: Mental Health Europe, Eleanor Westney: Sloan Business School, Massachusetts Institute of Technology and at Schulich Business School, Canada. Trish Reay: Business School, University of Alberta, Canada. Hanne Foss Hansen: Department of Political Science, University of Copenhagen, Stefan Heusinkveld: Vrije Universiteit, Amsterdam - Netherlands, Lisette Van Gemert-Pijnen: University of Twente, Faculty of Behavioral Management and Social Sciences Netherlands and Annika Lexen: Lund University Sweden. -Four papers have been published in peer-reviewed journals. -Two other papers are under peer-review. -Two papers are in process and will be sent for peer review during the spring 2023. - There have been 10 presentations at national and international conferences in 2021 and 2022. - There has been physical and digital meetings in the research group during the period.

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Background: There is a need to develop more comprehensive services for persons with severe mental illness and substance use disorders. In recent years, the Norwegian health authorities have allocated considerable funding to encourage the testing and innovation of collaborative models between primary and secondary health care. Flexible Assertive Community Treatment is a collaborative model devloped to provide integrated and comprehensive services for persons with mental illness, substance use disorders and a low functional level in many aeras in life. It is of great interest to examine how the FACT model developed in the Netherlands can be translated, adapted and implemented into the Norwegian context, in both urban and rural areas. Four work packages seek to answer the following questions: 1)How is the FACT model translated and implemented in different Norwegian contexts?(WP1, PhD1), 2)Do the FACT teams provide comprehensive and integrated care?(WP1, PhD2), 3)What is the outcome for patients and what are their experiences with the services?(WP2), 4)How should ICT be designed to support FACT teams in rural regions in Norwegian? (WP3), 5)What is the implications of findings in WP1-4 for further improvement of the FACT model in Norway?(WP4) R&D Challenges: Drop-out among patients and lack of motivation. This will be dealt with by including a sufficient number of participants, and a strong focus on the therapeutic alliance,which the teams are supposed to reach according to the model. Scientific significance: The project is highly innovative by looking at co-Production between service providers and service users. The research findings will be communicated back to the teams and partners during the project and will thus contribute to further enhancement of the services. The research will provide new knowledge about the FACT model internationally and how it works in a Norwegian context.