Heumann Kolja, Kuhlmann Mira, Böning Maike, Tülsner Helene, Pocobello Raffaella, Ignatyev Yuriy, Aderhold Volkmar, von Peter Sebastian
Integrated Working Group "Mental Health", Brandenburg Medical School, Brandenburg an der Havel, Germany.
Department of Psychology, University of Marburg, Marburg, Germany.
Front Psychol. 2023 Feb 9;13:1072719. doi: 10.3389/fpsyg.2022.1072719. eCollection 2022.
The Open Dialogue (OD) approach has been implemented in different countries worldwide. OD not only depends on therapeutic principles but also requires a distinct set of structural changes that may impede its full implementation. In Germany, OD is currently practiced in different mental health care settings across the country. Yet, full implementation of OD principles is limited due to the extreme structural and financial fragmentation of the German mental health care system. With this as a background, the aim of this study was to investigate the efforts, challenges and obstacles of OD implementation in Germany.
This article presents the German results from the international HOPEnDIALOGUE survey, supplemented with expert interview data. Thirty eight teams currently providing OD took part in the survey. Sixteen expert interviews were carried out with stakeholders from various care settings. Survey data were analyzed descriptively and the qualitative data were evaluated using a thematic analysis approach.
While having to adapt to the fragmented German health care system, OD has been mainly implemented from outpatient service providers and stand-alone services. About half of the teams implemented OD under the conditions of cross-sectoral model contracts and, thus, are considerably limited when it comes to OD implementation. Altogether, OD is not implemented to its full extent in each of the institutions surveyed. Similarly, the expert interviews revealed various challenges that mainly relate to the realization of OD's structural principles, whereas the implementation of its therapeutic benefits remains less affected. However, these challenges have managed to lead to great commitment by single teams and a certain level of implementation of OD-related concepts.
OD in Germany can currently only be fully implemented under the cross-sectoral care model contract system that is often temporary, thus significantly hindering its continuous development. Any evaluation of OD's effectiveness in Germany thus needs to take into account the fragmented nature of the country's health care system and control for the multiple barriers that impede implementation. Reforms of the German health care system are also urgently needed to create more favorable conditions for the implementation of OD.
开放式对话（OD）方法已在全球不同国家实施。OD不仅依赖于治疗原则，还需要一系列独特的结构变革，而这些变革可能会阻碍其全面实施。在德国，OD目前在全国不同的精神卫生保健机构中得到实践。然而，由于德国精神卫生保健系统在结构和财政方面极度分散，OD原则的全面实施受到限制。在此背景下，本研究旨在调查德国OD实施过程中的努力、挑战和障碍。
本文呈现了国际HOPEnDIALOGUE调查的德国结果，并辅以专家访谈数据。目前提供OD服务的38个团队参与了此次调查。对来自不同护理机构的利益相关者进行了16次专家访谈。对调查数据进行描述性分析，对定性数据采用主题分析方法进行评估。
尽管必须适应分散的德国医疗保健系统，但OD主要由门诊服务提供者和独立服务机构实施。约一半的团队在跨部门模式合同的条件下实施OD，因此在OD实施方面受到很大限制。总体而言，在所调查的每个机构中，OD都没有得到充分实施。同样，专家访谈揭示了各种挑战，这些挑战主要与OD结构原则的实现有关，而其治疗益处的实施受影响较小。然而，这些挑战促使单个团队做出了巨大努力，并在一定程度上实施了与OD相关的概念。
目前，德国的OD只有在通常是临时性的跨部门护理模式合同系统下才能得到充分实施，这严重阻碍了其持续发展。因此，对德国OD有效性的任何评估都需要考虑该国医疗保健系统的分散性质，并控制阻碍实施的多重障碍。德国医疗保健系统的改革也迫切需要，以便为OD的实施创造更有利的条件。
