Bjørkquist Catharina, Hansen Gunnar Vold
Faculty of Health and Welfare, Østfold University College, Halden, Norway.
J Multidiscip Healthc. 2018 May 15;11:233-243. doi: 10.2147/JMDH.S157769. eCollection 2018.
The aim of this article is to study the coordination of comprehensive services for clients with concurrent substance abuse and mental health disorders (dual diagnosis), which is a very complex client group. In order to achieve comprehensive care and treatment, the service providers need to cooperate and coordinate, but the questions here, are how this is done and how appropriate the coordination is.
Data were collected from group interviews during a 1-day workshop with clients, relatives, and employees from the various services involved.
Information exchange between the services was generally in writing. Coordination between substance abuse and mental health services was experienced as fragmented. Employees had an unclear perception of the work and expertise of the other service providers involved. There were examples of disparity between the services a municipality could offer and client needs. A coordinator, if available, was emphasized by both clients and service providers as serving an important function in coordination and relationship building.
Predominantly written communication and unclear division of responsibilities and duties resulted in employees creating stereotypes of each other, both within specialist health services and between specialist and municipal health services. A coordinator was able to coordinate various inputs, often through informal contact, with a view to establishing appropriate services for individual clients. Coordination in interagency meeting points, such as "responsibility teams", was the most successful solution, but this will involve a greater degree of networking than is common today.
本文旨在研究为同时患有物质滥用和精神健康障碍（双重诊断）的客户提供综合服务的协调情况，这是一个非常复杂的客户群体。为了实现全面护理和治疗，服务提供者需要合作与协调，但这里的问题是，如何做到这一点以及这种协调的恰当程度如何。
数据收集自为期一天的研讨会期间与客户、亲属以及各相关服务机构员工进行的小组访谈。
各服务机构之间的信息交流一般以书面形式进行。物质滥用服务与精神健康服务之间的协调被认为是零散的。员工对其他相关服务提供者的工作和专业知识认识不清。存在市政当局能够提供的服务与客户需求之间不一致的情况。客户和服务提供者都强调，若有协调员，其在协调及建立关系方面发挥着重要作用。
主要以书面形式进行沟通以及职责划分不明确，导致员工在专科医疗服务内部以及专科医疗服务与市政医疗服务之间对彼此形成刻板印象。协调员能够协调各种投入，通常是通过非正式联系，以便为个体客户建立合适的服务。在跨部门交汇点，如“责任小组”进行协调是最成功的解决方案，但这将涉及比目前更广泛的网络联系。
