Dit onderzoek betreft de eerste fase van de proeftuinen betreft waarbij de voortgang bij cliënten in de proeftuinen met gebiedsteams wordt vergeleken met FACT teams waarbij nog niet gebiedsgericht gewerkt werd. De eerste resultaten van de tussenevaluatie zijn binnen, namelijk dat: 1. Er bij alle cliënten (in de proeftuinen en tevens in gewone FACT teams) tussen 2015 en 2017 een afname is van beperkingen in het functioneren en van onvervulde zorgbehoeften en een toename van kwaliteit van leven. Dit verandert dus ten goede maar ongeveer evenveel in proeftuinen gebiedsgericht werken als in overige FACT teams. 2. Echter de gemiddelde duur van de opnames in gebiedsgerichte proeftuinen is wel korter en dit is een significant gunstig verschil met de andere FACT teams. 3. Meer mensen stromen bovendien uit naar de eerste lijn vanuit de proeftuinen met gebiedsgerichte FACT-teams dan uit de andere FACT teams. Stabilisering van symptomen en terugval risico lijkt daarbij verkleind. 4. Aanvullende kwalitatieve interviews met cliënten duiden tenslotte op een beter vangnet functie vanwege het gebiedsgericht werken. Cliënten zijn over de grotere nabijheid van de zorg zeer te spreken en waarderen het dat ze met verschillende vragen op één plek terecht kunnen. Er wordt volgens cliënten zelf vanwege het grotere gevoel van veiligheid minder gebruik gemaakt van het bed op recept (https://www.f-actnederland.nl/f-act-congres-2018-f-act-harvest-oogsten-uit-de-proeftuinen-van-nieuwe-pioniers/).
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Bijdrage FACT congres 20 september 2018: Presentatie over Gebiedsgericht werken aan herstel Eerste onderzoeksuitkomsten
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Vaktherapie maakt deel uit van het behandelaanbod voor mensen met een licht verstandelijke beperking (LVB) binnen de gespecialiseerde GGZ-instellingen. In de praktijk valt op dat mensen met een LVB en bijkomende problematiek binnen hun eigen leefomgeving nauwelijks beroep kunnen doen op vaktherapie. Om vaktherapie toegankelijker te maken in de eigen leefomgeving werd een kader voor samenwerking met ambulante behandelteams ontwikkeld en in een pilot onderzocht. In onderstaand artikel wordt ingegaan op de werkwijze van samenwerking en hoe deze van invloed was op de vaktherapeutische behandeling voor de cliënt, de indicatiestelling en op de keuze voor de locatie om behandeling aan te bieden.
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Background: There is still limited evidence on the effectiveness and implementation of smoking cessation interventions for people with severe mental illness (SMI) in Dutch outpatient psychiatric settings. The present study aimed to establish expert consensus on the core components and strategies to optimise practical implementation of a smoking cessation intervention for people treated by Flexible Assertive Community Treatment (FACT) teams in the Netherlands. Design: A modified Delphi method was applied to reach consensus on three core components (behavioural counselling, pharmacological treatment and peer support) of the intervention. The Delphi panel comprised five experts with different professional backgrounds. We proposed a first intervention concept. The panel critically examined the evolving concept in three iterative rounds of 90 min each. Responses were recorded, transcribed verbatim and thematically analysed. Results: Overall, results yielded that behavioural counselling should focus on preparation for smoking cessation, guidance, relapse prevention and normalisation. Pharmacological treatment consisting of nicotine replacement therapy (NRT), Varenicline or Bupropion, under supervision of a psychiatrist, was recommended. The panel agreed on integrating peer support as a regular part of the intervention, thus fostering emotional and practical support among patients. Treatment of a co-morbid cannabis use disorder needs to be integrated into the intervention if indicated. Regarding implementation, staff’s motivation to support smoking cessation was considered essential. For each ambulatory team, two mental health care professionals will have a central role in delivering the intervention. Conclusions: This study provides insight into expert consensus on the core components of a smoking cessation intervention for people with SMI. The results of this study were used for the development of a comprehensive smoking cessation program.
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Nieuwe wetgeving voor jeugdzorg in Nederland heeft geleid tot de implementatie van teams, die geïntegreerde eerstelijns jeugdzorg bieden. Belangrijke doelen van de nieuwe Jeugdwet waren meer geïntegreerde, tijdige zorg en minder gebruik van intensieve vormen van zorg. Het doel van dit onderzoek was het bestuderen van veranderingen in het gebruik van jeugdzorg in de tijd en de rol van nieuw ingevoerde wijkgerichte ondersteuningsteams hierin. Patronen van jeugdzorggebruik veranderden naar meer lokaal geleverde primaire jeugdzorg, iets minder gespecialiseerde en iets meer residentiële jeugdzorg. Bovendien nam het jeugdzorggebruik onder jongere kinderen toe in de tijd. Deze trends komen deels overeen met de trends die de Jeugdwet beoogt. Er is weinig bewijs gevonden voor de rol van specifieke teamkenmerken op veranderingen in jeugdzorggebruik in de tijd.
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Abstract Background Smoking among people with severe mental illness (SMI) is highly prevalent and strongly associated with poor physical health. Currently, evidence-based smoking cessation interventions are scarce and need to be integrated into current mental health care treatment guidelines and clinical practice. Therefore, the present study aims to evaluate the implementation and efectiveness of a smoking cessation intervention in comparison with usual care in people with SMI treated by Flexible Assertive Community Treatment (FACT) teams in the Netherlands. Methods A pragmatic, cluster-randomised controlled trial with embedded process evaluation will be conducted. Randomisation will be performed at the level of FACT teams, which will be assigned to the KISMET intervention or a control group (care as usual). The intervention will include pharmacological treatment combined with behavioural counselling and peer support provided by trained mental health care professionals. The intervention was developed using a Delphi study, through which a consensus was reached on the core elements of the intervention. We aim to include a total of 318 people with SMI (aged 18–65 years) who smoke and desire to quit smoking. The primary outcome is smoking status, as verifed by carbon monoxide measurements and self-report. The secondary outcomes are depression and anxiety, psychotic symptoms, physical ftness, cardiovascular risks, substance use, quality of life, and health-related self-efcacy at 12months. Alongside the trial, a qualitative process evaluation will be conducted to evaluate the barriers to and facilitators of its implementation as well as the satisfaction and experiences of both patients and mental health care professionals. Discussion The results of the KISMET trial will contribute to the evidence gap of efective smoking cessation interventions for people treated by FACT teams. Moreover, insights will be obtained regarding the implementation process of the intervention in current mental health care. The outcomes should advance the understanding of the interdependence of physical and mental health and the gradual integration of both within the mental health care system. Trial registration Netherlands Trial Register, NTR9783. Registered on 18 October 2021.
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Abstract Background Smoking among people with severe mental illness (SMI) is highly prevalent and strongly associated with poor physical health. Currently, evidence-based smoking cessation interventions are scarce and need to be integrated into current mental health care treatment guidelines and clinical practice. Therefore, the present study aims to evaluate the implementation and effectiveness of a smoking cessation intervention in comparison with usual care in people with SMI treated by Flexible Assertive Community Treatment (FACT) teams in the Netherlands. Methods A pragmatic, cluster-randomised controlled trial with embedded process evaluation will be conducted. Randomisation will be performed at the level of FACT teams, which will be assigned to the KISMET intervention or a control group (care as usual). The intervention will include pharmacological treatment combined with behavioural counselling and peer support provided by trained mental health care professionals. The intervention was developed using a Delphi study, through which a consensus was reached on the core elements of the intervention. We aim to include a total of 318 people with SMI (aged 18–65 years) who smoke and desire to quit smoking. The primary outcome is smoking status, as verified by carbon monoxide measurements and self-report. The secondary outcomes are depression and anxiety, psychotic symptoms, physical fitness, cardiovascular risks, substance use, quality of life, and health-related self-efficacy at 12 months. Alongside the trial, a qualitative process evaluation will be conducted to evaluate the barriers to and facilitators of its implementation as well as the satisfaction and experiences of both patients and mental health care professionals. Discussion The results of the KISMET trial will contribute to the evidence gap of effective smoking cessation interventions for people treated by FACT teams. Moreover, insights will be obtained regarding the implementation process of the intervention in current mental health care. The outcomes should advance the understanding of the interdependence of physical and mental health and the gradual integration of both within the mental health care system. Trial registration Netherlands Trial Register, NTR9783. Registered on 18 October 2021.
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In the fall of 1999, an international integrated product development pilot project based on collaborative engineering was started with team members in two international teams from the United States, The Netherlands and Germany. Team members interacted using various Internet capabilities, including, but not limited to, ICQ (means: I SEEK YOU, an internet feature which immediately detects when somebody comes "on line"), web phones, file servers, chat rooms and Email along with video conferencing. For this study a control group with all members located in the USA only also worked on the same project.
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Sociaal werk staat sinds enige tijd in het brandpunt van de grote omwentelingen in de verzorgingsstaat die voor een ‘kanteling’ naar een ‘participatiesamenleving’ zouden moeten zorgen. Naast de Wmo en de daarmee verbonden praktijkvernieuwingen zoals die als ‘bakens’ in Welzijn Nieuwe Stijl zijn benoemd, gaat het om de zogenoemde transities op het domein van arbeid en inkomen (Participatiewet), het domein van de jeugdzorg (Wet op de jeugdzorg, passend onderwijs), de zorg voor kwetsbaren (ouderen die niet meer zelfstandig zijn, licht verstandelijk gehandicapten, psychiatrische patiënten, mensen met een beperking − oftewel zij die voorheen op ondersteuning en begeleiding via de Algemene Wet Bijzondere Ziektekosten (AWBZ) konden rekenen). Om deze grote verschuivingen soepel te laten verlopen speelt het sociaal beleid een cruciale rol. Het staat voor de uitdaging om vroegtijdig problemen op een breed terrein (armoede, schulden, opvoeding, sociaal isolement, werkloosheid) af te vangen, kwetsbare burgers ‘in hun kracht’ te zetten én op te vangen waar nodig en de veerkracht van de samenleving te versterken.
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Introduction F-ACT is a flexible version of Assertive Community Treatment to deliver care in a changing intensity depending on needs of individuals with severe mental illnesses (Van Veldhuizen, 2007). In 2016 a number of the FACT-teams in the Dutch region of Utrecht moved to locations in neighborhoods and started to work as one network team together with neighborhood based facilities in primary care (GP’s) and in the social domain (supported living, social district teams, etc.). This should create better chances on clinical, social and personal recovery of service users. Objectives This study describes the implementation, obstacles and outcomes for service users. The main question is whether this Collaborative Mental Health Care in the Community produces better outcome than regular FACT. Measures include (met/unmet) needs for care, quality of life, clinical, functional and personal recovery, and hospital admission days. Methods Data on care utilization regarding the innovation are compared to regular FACT. Qualitative interviews are conducted to gain insight in the experiences of service users, their family members and mental health care workers. Changes in outcome measures of service users in pilot areas (N=400) were compared to outcomes of users (matched on gender and level of functioning) in regular FACT teams in the period 2015-2018 (total N=800). Results Data-analyses will take place from January to March 2019. Initial analyses point at a greater feeling of holding and safety for service users in the pilot areas and less hospital admission days. Conclusions Preliminary results support the development from FACT to a community based collaborative care service.
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