A comprehensive examination of research instruments utilized for assessing the attitudes of healthcare professionals towards the use of restraints in mental healthcare: A systematic review.

AIM: This systematic review aimed to identify, describe and evaluate questionnaires measuring health professionals' attitudes towards restraints in mental healthcare. DESIGN: A systematic review was undertaken in accordance with the COSMIN protocol for systematic review and the relevant sections of the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses. DATA SOURCES: OVID Medline, OVID nursing, Psychinfo, Embase and Cinahl were systematically searched from databases inception, with an initial search in December 2021 and updated in April 2022. REVIEW METHODS: The inclusion criteria compromised articles reporting on self-reported instruments of attitudes or perceptions, development or validation of instruments and the evaluation of one or more measurement properties. Articles using multiple instruments in one study or not published in English were excluded. Two researchers independently extracted the data and appraised the methodological quality using the COSMIN guidelines and standards (consensus-based standards for the selection of health measurement instrument). A narrative synthesis without meta-analysis was performed. The systematic review was registered in PROSPERO Protocol ID CRD42022308818. RESULTS: A total of 23 studies reporting ten instruments were included. The findings revealed a broad variation in the content of the questionnaires, the use of terms/constructs and the context in which the various instruments measure attitudes towards coercive measures. Many studies lacked sufficient details on report of psychometric properties. Finally, the results were not summarized and the evidence not GRADED. CONCLUSIONS: There is a need for updated and adapted instruments with origins in theory and clear joint definitions such that attitudes towards coercive measures can be reliably assessed regarding the validity and reliability of instruments, which will be of importance to facilitate the use of instruments in research and clinical settings. IMPACT: Reviews addressing surveys, self-reported attitudes towards restraints in mental healthcare and examination of psychometric properties seem limited. We highlight distinct complexity, psychometric limitations and broad variation in the context and content measuring attitudes towards coercive measures, and their various use of terms/constructs in the existing questionnaires. These findings contribute to further research regarding the development of questionnaires and the need of representing the concept well - carefully denoted by the indicators, likewise the importance of applying questionnaires with properly reported measurement properties in terms of validity and reliability to ensure the use in research and clinical settings.

Exploring Norwegian prison frontline workers' perceptions of inter professional collaboration - a pilot study.

PURPOSE: Interprofessional collaboration is necessary for handling the complex psychosocial needs of prisoners. This collaboration must be addressed to avoid high recidivism rates and the human and societal costs linked to them. Challenges are exacerbated by a linear approach to handling prisoners' problems, silo working between welfare agencies and professional boundaries between frontline workers. There are few adequate theoretical frameworks and tools to address these challenges in the prison context. The purpose of this study is to explore the perceptions that frontline staff working in Norwegian prison facilities have regarding interprofessional collaboration in providing mental health services for prisoners. DESIGN/METHODOLOGY/APPROACH: This study had a non-experimental, cross-sectional design to explore perceptions of interprofessional collaboration in a prison context. Descriptive and multifactorial analyses (exploratory factor analysis and confirmatory factor analysis) were used to explore the data. FINDINGS: The analysis showed that three factors, communication, organizational culture and domain, explained 95% of the variance. Results are discussed using relational coordination, as well as the conceptual PINCOM model, as a theoretical framework. ORIGINALITY/VALUE: Few studies explicitly explore collaboration between professionals in mental health and prison services despite its being a prerequisite to achieving sufficient services for prisoners. To our knowledge, this current study is one of the first in Norway to explore collaboration in a prison context by analysing quantitative data and focusing on frontline workers perception of the phenomenon.

Psychometric Properties of the German Version of the Perception of Interprofessional Collaboration Model-Questionnaire (PINCOM-Q).

OBJECTIVE: The Perception of Interprofessional Collaboration-Model Questionnaire (PINCOM-Q) measures professionals' perceptions of interprofessional collaboration in the field of child and youth mental health. The aim of this study was to validate the PINCOM-Q in a sample of German child welfare and child and youth mental health professionals. METHODS: The PINCOM-Q was translated into German and its underlying factor structure was examined using exploratory and confirmatory factor analysis. RESULTS AND DISCUSSION: Findings from this study suggest four factors (Interprofessional Climate, Conflict, Role Expectancy and Shared Goals, and Motivation) capture the concept of perceptions of interprofessional collaboration between child welfare and child and adolescent psychiatry. CONCLUSION: The use of PINCOM-Q (German) can be recommended as a research tool, investigating professional groups working with children and young people with multiple and complex needs.

A conceptual model on reintegration after prison in Norway.

PURPOSE: Many offenders struggle when attempting to reintegrate into society after release from prison, and the conditions they face after release often lead to reoffending. The purpose of this paper is to present a conceptual model on reintegration after prison. The model has the potential to guide practitioners in their understanding of the relationships between welfare services and the agency of the offender. DESIGN/METHODOLOGY/APPROACH: The model was developed from a small-scale study in the Norwegian Criminal Justice system, which is well known for its emphasis on rehabilitation and crime prevention. Data collection aimed to explore the reintegration process from the perspective of the hard-to-reach and vulnerable population of serial offenders. Nine prisoners in two different prisons were interviewed. A thematic analysis identified two main themes that related, first, to the personal challenges the offenders faced in the rehabilitation and reintegration process and, second, to the factors in the welfare services that interacted with the prisoners' psychosocial issues in the reintegration process. FINDINGS: Findings suggest that the interaction between the psychosocial needs of the prisoners and the organization of the welfare services is complex and does not harmonize. The findings underpin the argument that the current reintegration strategies for certain groups of inmates need to be questioned and challenged. RESEARCH LIMITATIONS/IMPLICATIONS: The model is a conceptual model intended to provide a lens from which to reinterpret offenders' experiences of reintegration and applied to only the small and exploratory study described in this paper. As such, it requires further testing and substantiation, and the model and the study's findings should be regarded as tentative and cannot be generalized to a larger population. The prisoners were selected by the first author for convenience, and it is possible that this also influenced the findings. Other inmates may have presented other experiences. ORIGINALITY/VALUE: There are few studies looking into reintegration from the reoffenders' perspective, and this study also presents a model that serves as a reflective and analytical tool to developing new approaches to supporting offenders in their reintegration into society from prison in the future.

University teachers' views of interprofessional learning and their role in achieving outcomes - a qualitative study.

Over the past decade, there has been a rapid increase in higher education institutions offering opportunities for interprofessional learning (IPL) to their students. The literature presents a number of factors that contribute to effective IPL, including having trained facilitators that help optimise the learning process. Many of these IPL facilitators are university teachers and the literature provides us with some insight into their views of IPL. However, little is known about university teachers' views about IPL and their role in supporting students in achieving outcomes linked to IPL during their own teaching; this paper explores these areas. University teachers, working with students in Norway and England who contribute to patients' care pathway were purposively invited to join focus groups. Data collected from the teachers' conversations during these focus groups were analysed to elicit the main themes. Findings show that university teachers have a wide range of views about IPL, its potential to enhance collaborative practice and care, and their role in helping students achieve outcomes linked to IPL. A key challenge appears to be whether IPL is "worth the struggle," which emphasises the need for strong leadership in order to align pedagogical approaches in education and practice that strive to achieve agreed outcomes.

Making sense of interactions between mental health and criminal justice services: the utility of cultural historical activity systems theory.

Purpose Effective collaboration between mental health services (MHS) and criminal justice services (CJS) impacts on mental illness and reduces reoffending rates. This paper proposes the change laboratory model (CLM) of workplace transformation as a potential tool to support interagency collaborative practice that has potential to complement current integration tools used in this context. The purpose of this paper is to focus specifically on the theoretical dimension of the model: the cultural historical activity systems theory (CHAT) as a theoretical perspective that offers a framework with which interactions between the MHS and CJS can be better understood. Design/methodology/approach The structure and rationale behind future piloting of the change laboratory in this context is made. Then CHAT theory is briefly introduced and then its utility illustrated in the presentation of the findings of a qualitative study of leaders from MHS and CJS that explored their perspectives of the characteristics of collaborative working between MHS and prison/probation services in a Norwegian context and using CHAT as an analytical framework. Findings Leaders suggested that interactions between the two services, within the Norwegian system at least, are most salient when professionals engage in the reintegration and rehabilitation of the offender. Achieving effective communication within the boundary space between the two systems is a focus for professionals engaging in interagency working and this is mediated by a range of integration tools such as coordination plans and interagency meetings. Formalised interagency agreements and informal, unspoken norms of interaction governed this activity. Key challenges limiting the collaboration between the two systems included resource limitations, logistical issues and differences in professional judgments on referral and confidentiality. Originality/value Current tools with which MHS/CJS interactions are understood and managed, fail to make explicit the dimensions and nature of these complex interactions. The CLM, and CHAT as its theoretical underpinning, has been highly successful internationally and in other clinical contexts, as a means of exploring and developing interagency working. It is a new idea in prison development, none as yet being applied to the challenges facing the MHS and CJS. This paper addresses this by illustrating the use of CHAT as an analytical framework with which to articulate MHS/CJS collaborations and the potential of the CLM more widely to address current challenges in a context specific, bottom-up and fluid approach to interagency working in this environment.

Improving collaboration between professionals supporting mentally ill offenders.

Purpose Interprofessional collaboration is necessary when supporting mentally ill offenders but little is understood of these interactions. The purpose of this paper is to explore prison officers' perceptions of current and desirable levels of interprofessional collaboration (relational coordination (RC)) to understand how collaboration between these systems can be improved. Design/methodology/approach Gittell's RC scale was administered to prison officers within the Norwegian prison system ( n=160) using an adaptation of the instrument in which actual and desired levels of RC are evaluated. This differentiates between prison officers' expectations of optimum levels of collaboration with other professional groups, dependent on the role function and codependence, vs actual levels of collaboration. Findings Prison officers reported different RC levels across professional groups, the lowest being with specialist mental health staff and prison doctors and highest with nurses, social workers and other prison officers. Significant differences between desired and actual RC levels suggest expertise of primary care staff is insufficient, as prison officers request much greater contact with mental health specialists when dealing with the mentally ill offender. Originality/value The paper contributes to limited literature on collaborative practice between prison and health care professionals. It questions the advisability of enforcing care pathways that promote the lowest level of effective care in the prison system and suggest ways in which mental health specialists might be better integrated into the prison system. It contributes to the continued debate on how mental health services should be integrated into the prison system, suggesting that the current import model used in Norway and other countries, may not be conducive to generating the close professional relationships required between mental health and prison staff.

Collaborative practices between correctional and mental health services in Norway: Expanding the roles and responsibility competence domain.

Internationally, mental illness is high in prison populations. Collaboration between the correctional services (CS) and mental health services (MHS) is required to address this. Little is known of the collaborative processes in this context, however. This article presents the findings of a study exploring the characteristics of collaborative practices between the MHS and CS in a Norwegian context. A purposeful sample (n = 12) of MHS and CS leaders was recruited from one region in Norway. Taking a generic qualitative approach, semi-structured interviews with each participant explored specific structures that promoted collaboration, the nature of collaborative relationships, and factors that facilitated or constrained these. The study indicated that leaders are exercised by one dimension of collaborative practice in particular, namely the distribution of responsibility for the care of the offender across systems. This activity is mediated by highly complex external structures as well as the individual characteristics of the professionals involved. They speculate that professionals and organisations who fail to take responsibility for the offender as expected may be constrained from doing so by resource limitations, logistical issues, and poor attitudes towards the offender population. Based on these findings, this study suggests that the MHS and CS workforce would benefit from a great knowledgeability of the roles and responsibility domains of collaborative practice. Improving competence in the workforce in this area would achieve this. However, competency frameworks that address this domain are currently limited. Recommendations on how to extend the remit of this domain in light of the current findings are provided.

The family as partner in child mental health care: problem perceptions and challenges to collaboration.

OBJECTIVE: The development of the health and social care system has made it increasingly specialized, decentralized and professionalized. Accordingly, demands of efficient approaches to collaboration and integration of services for children, adolescents and their family networks have emerged. The aim of this article is to present and analyze findings from a review of the literature on parents as collaboration partners with professionals. METHOD: A literature review was conducted in two databases. A multifaceted model was developed to depict and analyze collaboration complexity. RESULTS: Preliminary application of the multifaceted collaboration model suggests that first- and second-order therapy positions have different impact on collaborative relationships. CONCLUSION: It is suggested that professionals may want to acknowledge the different impact of first- and second-order positions in interprofessional collaboration involving parents. This may be accomplished by staging a routine requirement for discussion of meta-positions as an introductory theme in the opening stages and as a recurrent theme throughout the collaboration process.

A mixed method approach to clarify the construct validity of interprofessional collaboration: an empirical research illustration.

The rapid development of empirical studies in the field of interprofessional collaboration (IPC) calls for a wide array of scientific approaches ranging from recruitment and motivation to measurement and design questions. Regardless of whether researchers choose qualitative or quantitative approaches, they must substantiate their findings. We argue that more attention should be given to reliability and validity issues to improve our understanding of IPC as a phenomenon and practice. A mixed methods approach is presented as a relevant design format for the study of IPC. This paper aims to argue that a combination of methodologies may be a feasible way to enhance our understanding of IPC, with a special focus on reliability and validity issues; illustrate the application of different methodologies in an IPC research project; and emphasize the distinction between validity and validation to mitigate possible obstacles in integrating qualitative and quantitative research in the study of IPC.

A conceptual framework for assessing interorganizational integration and interprofessional collaboration.

The need for collaboration in health and social welfare is well documented internationally. It is related to the improvement of services for the users, particularly target groups with multiple problems. However, there is still insufficient knowledge of the complex area of collaboration, and the interprofessional literature highlights the need to develop adequate research approaches for exploring collaboration between organizations, professionals and service users. This paper proposes a conceptual framework based on interorganizational and interprofessional research, with focus on the concepts of integration and collaboration. Furthermore, the paper suggests how two measurement instruments can be combined and adapted to the welfare context in order to explore collaboration between organizations, professionals and service users, thereby contributing to knowledge development and policy improvement. Issues concerning reliability, validity and design alternatives, as well as the importance of management, clinical implications and service user involvement in future research, are discussed.

Perceptions of interprofessional collaboration within child mental health care in Norway.

The present study investigates professionals' perceptions of interprofessional collaboration (IPC) in the field of mental health care for children and adolescents. In this study, a 48-item questionnaire was developed to measure perceptions of interprofessional collaboration. A theoretical model (PINCOM) is presented and suggests that interprofessional collaboration is perceived at the individual-, group- and organizational level. The questionnaire was distributed to a sample consisting of 157 professionals in Western Norway. The results of this exploratory study show that the most prominent constructs of collaboration perceived by the professionals were: motivation, group leadership, social support and organizational culture. Furthermore, results indicate that women are more oriented than men toward IPC aspects of communication, coping and organizational domain. It is suggested that the questionnaire may be used to help improve interprofessional collaboration in clinical practice by indicating new ways to enhance dialogue between professionals and to investigate changes in perception of interprofessional collaboration over time. Limitations of the present study were identified and suggestions for future studies within the field are provided.

Testing the diagnosis of dissociative identity disorder through measures of dissociation, absorption, hypnotizability and PTSD: a Norwegian pilot study.

A total of 14 women meeting criteria for dissociative identity disorder (DID) based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]) were compared to a group of women (n = 10) with other dissociative diagnoses and a group of normal controls (n = 14) with regard to dissociativity, absorption, trauma related symptoms and hypnotizability. Both of the clinical groups reported histories of childhood trauma and attained high PTSD scores. The DID group differed significantly from the group with other dissociative diagnoses and the non-diagnosed comparison group with regard to hypnotizability, the variety of dissociative symptomatology, and the magnitude of dissociative symptomatology. However, no significant differences between the two clinical groups were detected with regard to absorption, general dissociative level, or symptoms related to traumatic stress. Results support the notion that DID can be regarded as a clinical entity which is separable from other dissociative disorders. Results also indicated that hypnotizability is the most important clinical feature of DID.

Applying aspects of generalizability theory in preliminary validation of the Multifacet Interprofessional Collaboration Model (PINCOM).

OBJECTIVE: Empirical assessment of the Interprofessional Collaboration (IPC) model within the framework of Generalizability Theory (GT). DESIGN AND PARTICIPANTS: A multifacet data collection design served the purpose of examining the relationships between observed indicators representing a defined construct. Professionals working with children and adolescents (n=134), in the context of mental health care, completed a 48 item questionnaire addressing 12 aspects of interprofessional collaboration. RESULTS: Estimated variance components from two G-studies are presented. The relative impact of different sources of variance was estimated 1) for the full design, and 2) for three groups of informants (schools, primary care and specialist services). Differences between groups were found regarding the relative impact of the level - and context facets with respect to perception of IPC. CONCLUSIONS: The methodology of generalizability theory is well suited for data with a complex facet structure as displayed in the present study. We recommend researchers to give domain specifications thorough attention when measuring IPC.

Time used on interprofessional collaboration in child mental health care.

This study investigates a sample of professionals (N = 134) who work with children with mental health problems, in the western part of Norway. A 48-item questionnaire was designed to measure different aspects of interprofessional collaboration. Two demographic questions in the questionnaire focused on how much time professionals use on interprofessional collaboration on a regular working-day and results from these two questions are reported. How much time do professionals use on interprofessional collaboration within the context of helping children with mental health problems? Do professionals collaborate more within their own organization than with professionals from external organizations? The results show that professionals, on average, use about 40% of their time on collaboration activities. Professionals, as expected, collaborate more with professionals from their own organization than with professionals from other health care services.

Exploring perceptions of interprofessional collaboration in child mental health care.

PURPOSE: This paper proposes a tentative theoretical model (PINCOM) and a measure of mental health and school professionals' perception of interprofessional collaboration (IPC). THEORY: The model is based on twelve constructs derived from a pilot study, organizational and social psychology. The main aim of the model is to capture central aspects of IPC. METHOD: A forty-eight item self-report questionnaire (PINCOM-Q) was designed to explore professionals' perceptions of IPC. The sample (n=134) included professionals who worked in primary care, specialist services and in elementary schools. Exploratory factor analyses and reliability testing were conducted to reduce the large number of variables in the questionnaire. RESULTS: RESULTS INDICATE THAT CENTRAL ASPECTS OF IPC IN THE CONTEXT OF SERVICE DELIVERY AND CASE WORK ARE: interprofessional climate, organizational culture, organizational aims, professional power, group leadership and motivation. CONCLUSION: Preliminary empirical testing of the questionnaire demonstrated that it is possible to measure perceptions of IPC, with reasonable levels of construct validity and reliability. DISCUSSION: Further, revision of the questionnaire is discussed to make it fit for use in large scale studies with the purpose of enhancing (a) the validity of the PINCOM model, and (b) the quality of mental health services that are based on IPC.

Perceptions of interprofessional collaboration in relation to children with mental health problems. A pilot study.

The primary aim of this paper is to present some findings from a pilot study and to outline a tentative model of interprofessional collaboration. A second aim is to reflect on how to design a main study. Seven professionals from school psychology services (3), a children's psychiatric clinic (2) and an elementary school (2), participated in the study. Two methods were used: Semi-structured interview in combination with a vignette and the Sentence Completion Technique. Categorization was used as the central analyzing tool together with condensation and interpretations. The data analysis is supported by the software program Nud*Ist N6. The results are presented in three main sections: (a) interprofessional group variations, (b) the situation of the central actors, and (c) collaboration as a working method.