The challenges of successful

implementation

Implementing change of practice in mental health care for adults in Northern Norway

Charlotte Reedtz and Camilla Lauritzen, November 2010

Children of mentally ill parents

• Changes in existing legislation January 2010

• The changed Health Personnel Act (§ 10 a) states that

health professionals should help to meet the needs for

information and necessary follow-up for children under

18 years who have parents that receive health care for

mental illnesses, substance abuse disorders or serious

somatic illness or injury.

Guidelines (IS-5/2010)

• The guidelines published by Norwegian authorities provide

thorough descriptions of the expectations and the

intention behind the legislation amendments

• A somewhat overwhelming document, listing a number of

new tasks and responsibilities that health care workers

now have

How do we successfully implement the

amended legislation?

• Implementation of skills

• Implementation of new practice

Definition: Implementation is a specified set of activities

designed to put into practice an activity or program of

known dimensions (Fixsen et. Al 2005)

Project: Children of Mentally ill Parents –

implementing and evaluating changes of

practice within mental health care for adults

• In this project RBUP North focuses on what changes of

practice that will occur within mental health services for

adults as a result of the amendments in legislation as of

2010;

- Implementation of new routines and interventions

- How to achieve systematic changes of practice that can

be maintained over time

Our approach to implementation:

• A perspective on innovation

• A focus on the actions of those who convert innovation into

practice

• The essence of implementation is behavior change

• Ideas behind innovations are not self-executive!

Implementation model :

Phase 1: Initiate change; network planning/analysis and

mobilize support and partnerships

Phase 2: Adoption. Preparing the organization. Informing

the total staff about the program and research.

Develop schedules for executing change of practice.

Phase 3: Effectuate change of practice

Phase 4: Maintenance and consolidation

(Barry & Jenkins, 2008)

Phase 1 - Initiate change;

Project: Children of mentally ill in UNN

A. Descriptive studies of what is needed within the

organization, in this case The University Hospital of

Northern Norway - UNN

B. Description of the local context; Cooperation and dialogue

with participants within UNN.

C. Choose interventions and activities; E.g. check out the

database Youngmind (Ungsinn) at www.ungsinn.uit.no

D. Mobilize support, initiate and formalize cooperation.

Contract. The contract based on the needs within the

organization/UNN. Establish project group. Cooperation

meetings.

E. Establish project group and project management. Set aside

personnel responsible for particular tasks within the

project.

Phase 2 - Adoption. Preparing the

organization.

Project: Children of Mentally ill Parents in UNN

A. Informing the total staff about the program and the

research. Develop schedules for executing change of

practice - regarding both research and intervention.

Describe routines and responsibilities.

B. The intervention ”Child Talks” - Training/education

Phase 3 - Effectuate change of practice.

Project: Children of Mentally ill Parents in UNN

A. Implementation of registration form

B. Implementation of Child Talks

C. Monitoring the implementation and practice of Child Talks

and registration form. Logbook.

D. Evaluation of training, peer coaching and coaching via

program owner (VFB).

Phase 4 - Maintenance and consolidation.

Project: Children of Mentally ill Parents in UNN

A. Evaluation of change of practice within the organization.

B. Evaluation of maintenance of the new practice.

The next decade….

• Implementing change of practice is the greatest challenge

of them all (Hollin & McMurran, 2001).

• Innovation takes time!

• Researchers and health care workers need to join forces

in order to prevent health problems in children who have

mentally ill parents.

www.rbup.no/nord

www.ungsinn.uit.no