The nursing home as a hub: boundary work as a key to community health promotion.

This article considers ways in which a nursing home can come to serve as a hub for community health promotion. Inspired by the term 'boundary crossing' (Akkerman and Bakker. Boundary crossing and boundary objects. Rev Educ Res 2011;81:132-69), we suggest the notion of 'boundary work' to illustrate how a nursing home arranges community activities and includes a wide range of participants. In health research, a 'hub' refers to a space in which activities and expertise are 'bound together' over time. The concept of the hub indicates that health organizations have the power to become centres for health promotion by initiating new collaborations and opening up initiatives in two-way processes with the local community. The term 'boundary work' supports a perspective that dissolves organizational, professional and conceptual boundaries and directs attention towards social inclusion as a key to community health promotion in and beyond institutionalized elderly care. The article is based on a 4-year-long practice-based study of social innovation in elderly care in Norway and Denmark. Empirical illustrations show boundary work in which a nursing home comes to serve as a hub. We discuss a flexible framework for understanding, mapping and planning participatory approaches for health and wellbeing (South et al. An evidence-based framework on community-centred approaches for health: England, UK. Health Promot Int 2019;34:356-66) and briefly connect these approaches to the concept of social innovation as a possible future research path.

Perspectives on Coordinating Health Services for Individuals with Serious Mental Illness - A Qualitative Study.

Purpose: Individuals with serious mental illness (SMI) might require coordinated health services to meet their healthcare needs. The overall aim of this study was to describe the perspectives of professionals (registered nurses, medical doctors, social educators, and social workers) on care coordination and measures to ensure proper and coordinated follow-up of the healthcare needs of individuals with SMI. More specifically, we investigated which measures are taken by employees in municipal health and care services to prevent the deterioration of health conditions and which measures are taken in cases where deterioration occurs despite preventive efforts. Method: The study comprised individual qualitative interviews with professionals employed in municipal health and care services in two Norwegian municipalities. The interview material was analyzed using systematic text condensation. Results: Three categories and seven subcategories were created in the data analysis: 1) Maintain a stable and meaningful home life, including ensuring proper housing and access to services and assistance in receiving healthcare; 2) Measures to prevent deterioration of the health condition, including close monitoring of symptoms, emergency psychiatric care plans and emergency room calls and visits; and 3) Inpatient care to stabilize acute and severe symptoms, including municipal inpatient care, returning home after inpatient care and a need for shared responsibility for treatment and care. Conclusion: Professionals employed in municipal health and care services coordinate health services to ensure proper and coordinated follow-up of the healthcare needs of individuals with SMI by ensuring housing services and access to the required healthcare. Measures taken when deterioration occurs include monitoring symptoms, use of emergency psychiatric care plans, emergency room contacts, or inpatient care.

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.

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.

Interprofessional collaboration - a matter of differentiation and integration? Theoretical reflections based in the context of Norwegian childcare.

This paper presents a selection of theoretical approaches illuminating some aspects of interprofessional collaboration, which will be related to theory of contingency as well as to the concepts of differentiation and integration. Theories that describe collaboration on an interpersonal as well as inter-organizational level are outlined and related to dynamic and contextual factors. Implications for the organization of welfare services are elucidated and a categorization of internal and external collaborative forms is proposed. A reflection model is presented in order to analyse the degree of integration in collaborative work and may serve as an analytical tool for addressing the linkage between different levels of collaboration and identifying opportunities and limitations. Some implications related to the legal mandate(s) given to childcare agencies are discussed in relation to the context of childcare in Norway.

Leadership in interprofessional collaboration - the case of childcare in Norway.

This study addresses leadership in interprofessional collaboration in childcare services (residential care). The aim was to explore the managers' (n = 6) experiences and present their views on how they exercised leadership in the residential institutions as well as how they organized and facilitated collaboration with relevant professionals and service users. Data was collected through open interviews. Qualitative content analysis was used to analyse the interviews, and three categories emerged; "external responsibility", "sustaining communication" and "internal responsibility". The overarching concept was identified as "facilitating interaction processes and ensuring cohesion". The main findings were related to the managers' experiences of linked processes of leadership and collaboration, perceptions of the structures of communication, their responsibility as well as the interaction processes. The managers exercised leadership in terms of self-governance and co-governance, and used strategies, such as governing images and influencing the voluntary aspect of collaboration.

Interprofessional collaboration with young people in residential care: some professional perspectives.

The article discusses interprofessional collaboration with young people experiencing psychosocial problems living in residential care in Norway. The professionals involved (n = 23) were social workers, psychologists, teachers, doctors/psychiatrists, unqualified graduates and other staff. The aim was to explore the professionals' contributions and grasp a sense of the wholeness of the collaboration process. A grounded theory approach was applied. During the analysis five categories emerged regarding professionals contributions; knowledge of own and others' agency/service, problem perception, priority, commitment and space for action. Three categories emerged regarding interprofessional interaction; building networks, developing trust and using flexibility. The core category was identified as 'readiness to act'. The findings show an apparent contradiction between health and social policy that encourages the standardisation of services and responding flexibly to the needs of young people for 'tailor made' solutions through access to a range of services. A further finding was extensive use of flexibility and willingness to go beyond boundaries leading to the distinction between routinized and radical coordination.