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Tutkimus ja kehitys
 
02.06.2015
Co-operation, further education and complimentary training of the staff supports patient centred approach in mental health and social and welfare services
 
The “out of home” placements of youngsters is a growing trend – a sign of increased mental health disorders?
The increase of poor mental health among adolescents and the lack of preventative measures for adolescent social exclusion have been discussed in the Parliament of Finland and received wide media coverage. In spite of this wide discussion about increased mental health problems among young people there are, thus so far, none epidemiological studies published showing any signs of increase in the incidence of mental health disorders among minors in Finland. However, some really extreme violent acts made by young people such as school shootings in Jokela, 2007, were naturally widely reported in the media and started discussions centred on youths’ mental problems and the state of mental health promotion and preventative care and as a matter of fact the possibilities for young people to enter psychiatric services has improved a lot during last 15 years.

Even though, there is no evidence about increasing mental health problems and disorders of young people, the number of minors placed in substitutive care in Finland has increased merrily during last 10 years. Especially out of home placements have increased among the 15–17-year-old youngsters. This increase might be a result of resource cuts in preventive social and health care, for example in the provision of home care for the families with small children.

However, a report by the Finnish Ministry of Social Affairs and Health examined some societal changes, which affect the well-being of children, from the perspective of child protection services in 2013. The report found the strain on child protective services to be continuous and the reasons for the goals not being met were a lack of adequately trained staff and a lack of staff in general. Nevertheless, the exhaustion of child social and welfare workers has been widely discussed in the Finnish media during these last few years. In addition, there is an acute need to improve the co-operation between child protection and mental health services in order to provide sufficient care and treatment for young people and their families.
 
RESME project
The RESME project (On the Borders between Residential Child Care and Mental Health Treatment), coordinated by TUAS’ faculty of Health and Well-being, aimed to clarify the means of co-operation and communication between operators working with children and adolescents in need of mental health and social and welfare services. The project studied the cross-disciplinary cooperation between the mental health systems and welfare systems in five EU countries; Lithuania, Germany, Spain, Scotland, Finland and Denmark.

By researching and describing the challenges of cooperation between the two sectors or systems in the five EU countries, RESME aims to create a better understanding of the deeper logic in these challenges – and to promote change through educational programmes and conferences that will focus on the challenges and present ‘best practices’ between the participating countries. Under the RESME project, interviews were conducted to examine the current practices of cooperation between mental health and residential care providers. Attended by staff in youth mental health care and residential care, to gain knowledge from their work experiences, these interviews were transcribed and the transcriptions were used as source material for inductive content analysis.
 
Well-functioning and non-functioning practices, and the patient-centred approach, results of the content analysis of Finnish data
The results of the content analysis show practices that are functioning well between the operators: customer-centred cooperation, already established networks, professional respect among the operators and the ability to consult experts.

Among the practices which do not work well, a trend of policies which increase the workload of these operators and diminishes the effectiveness of care for youth is observed; lack of resources adequate staff and full understanding of how the other operator conducts protocols. In addition, there are rushed care decisions for children without adequate knowledge of the issues at hand and factors which affect the use of the patient-centred systems.
 
Need for education for residential care workers and psychiatric staff
The ideas of the interviewees to improve current practices were clearly staff education and resource-orientation; allocating education towards understanding the laws and protocols related to their own field and each other’s fields, mental health education for residential care workers to improve their possibilities to handle youth with mental health problems, a focus on early interaction with children in need of both services – preventative care.

The results show the problems are within the systems and structures, but there is also a lack of knowledge of the inner workings of the other organisation, which can lead to hinders in communication and therefore cooperation.

Both operators work for the best of the child, which means a patient-centred approach, but the aspect of care each operator provides is slightly different; the psychiatry professionals’ angle is clinical – the treatment of an illness – whereas the residential care workers’ focus is educational. This is why joint education for both these operators could be beneficial.

The suggestions on focusing on the education made by the interviewees, such as problem- and case-based learning and common studies of laws and protocols conducted by both operators, should be inspected. When these education models can be provided, Bachelor’s level education, Master’s degree programmes or in-service training should be determined.
 
Earlier preventive action and multiagency cooperation especially to social and health care fields
Working life consists increasingly of multiagency cooperation and multiprofessional teams in all fields, but this applies especially to social and health care fields. Further education and complimentary training for people working with children and adolescents help to support a patient-centred approach to care. Networking between agencies help set clear and common policies, familiarise with other institutions’ practices and produce clarity with information referral.

Resources deferred to preventative action for children and adolescents in residential care settings and in need of mental health services are key in dismantling the requirements set on these services. Earlier action would prevent a need for psychiatry inpatient ward visits. In-patients psychiatric has been shown to be quite ineffective as the treatment for most mental health problems manifested in youth cared in residential care services.
 
Linkit
 
Kirjoittaja(t):
Ada-Maria Ahlgren, Ba-student in DP Nursing & Heikki Ellilä RN, PhD, Principal Lecturer, Turku University of Applied Sciences, Health and Wellbeing.