Abstract
The objective was to determine the feasibility of an Open Dialogue-inspired approach in a metropolitan, public hospital setting with predominately African American participants. Participants were ages 18–35, experienced psychosis within the past month, and involved at least one support person in their care. We evaluated domains of feasibility including implementation, adaptation, practicality, acceptability, and limited-efficacy. An organizational change model (Addressing Problems Through Organizational Change) facilitated implementation. Clinicians received three trainings and ongoing supervision. Network meetings were successfully implemented with good self-reported fidelity to principles of dialogic practice. Some adaptations (less frequent meetings and no home visits) were necessary. A subset of individuals completed research assessments over 12 months. Qualitative interviews with participants suggested the intervention was acceptable. Symptom and functional outcomes were preliminary but trended toward improvement. Implementation was feasible with relatively brief training, organizational change processes, and context-specific adaptations. Lessons learned can assist in planning a larger research study.
This is a preview of subscription content, log in via an institution to check access.
References
Bergstrom, T., Seikkula, J., Alakare, B., Maki, P., Kongas-Saviaro, P., Taskila, J. J., & Aaltonen, J. (2018). The family-oriented open dialogue approach in the treatment of first-episode psychosis: Nineteen-year outcomes. Psychiatry Research, 270, 168–175. https://doi.org/10.1016/j.psychres.2018.09.039.
Bowen, D. J., Kreuter, M., Spring, B., Cofta-Woerpel, L., Linnan, L., Weiner, D., & Fernandez, M. (2009). How we design feasibility studies. American Journal of Preventive Medicine, 36(5), 452–457. https://doi.org/10.1016/j.amepre.2009.02.002.
Brabson, L. A., Harris, J. L., Lindhiem, O., & Herschell, A. D. (2020). Workforce turnover in community behavioral health agencies in the USA: A systematic review with recommendations. Clinical Child and Family Psychology Review, 23(3), 297–315. https://doi.org/10.1007/s10567-020-00313-5.
Buus, N., Ong, B., Einboden, R., Lennon, E., Mikes-Liu, K., Mayers, S., & McCloughen, A. (2021). Implementing open dialogue approaches: A scoping review. Family Process, 60(4), 1117–1133. https://doi.org/10.1111/famp.12695.
Byatt, N., Simas, M., Biebel, T. A., Sankaran, K., Pbert, P., Weinreb, L., & Allison, L., J (2018). PRogram in support of moms (PRISM): A pilot group randomized controlled trial of two approaches to improving depression among perinatal women. Journal of Psychosomatic Obstetrics & Gynecology, 39(4), 297–306. https://doi.org/10.1080/0167482x.2017.1383380.
Compton, M. T., & Shim, R. S. (2015). The social determinants of mental health. FOCUS, 13(4), 419–425. https://doi.org/10.1176/appi.focus.20150017.
Dixon, L. B., Holoshitz, Y., & Nossel, I. (2016). Treatment engagement of individuals experiencing mental illness: Review and update. World Psychiatry, 15(1), 13–20. https://doi.org/10.1002/wps.20306.
Flitter, A. S., Lubitz, S. F., Ziedonis, D., Stevens, N., Leone, F. T., Mandell, D., & Schnoll, R. A. (2019). A cluster-randomized clinical trial testing the effectiveness of the addressing Tobacco through Organizational Change model for improving the treatment of tobacco use in community mental health care: Preliminary study feasibility and baseline findings. Nicotine & Tobacco Research, 21(5), 559–567. https://doi.org/10.1093/ntr/nty239.
Florence, A. C., Jordan, G., Yasui, S., Cabrini, D. R., & Davidson, L. (2021). It makes us realize that we have been heard”: Experiences with open dialogue in Vermont. Psychiatric Quarterly, 92(4), 1771–1783. https://doi.org/10.1007/s11126-021-09948-1.
Florence, A. C., Jordan, G., Yasui, S., & Davidson, L. (2020). Implanting rhizomes in Vermont: A qualitative study of how the open dialogue approach was adapted and implemented. Psychiatric Quarterly, 91(3), 681–693. https://doi.org/10.1007/s11126-020-09732-7.
Gidugu, V., Rogers, E. S., Gordon, C., Elwy, A. R., & Drainoni, M. L. (2021). Client, family, and clinician experiences of open dialogue-based services. Psychological Services, 18(2), 154–163. https://doi.org/10.1037/ser0000404.
Gordon, C., Gidugu, V., Rogers, E. S., DeRonck, J., & Ziedonis, D. (2016). Adapting open dialogue for early-onset psychosis into the U.S. health care environment: A feasibility study. Psychiatric Services, 67(11), 1166–1168. https://doi.org/10.1176/appi.ps.201600271.
Guydish, J., Ziedonis, D., Tajima, B., Seward, G., Passalacqua, E., Chan, M., & Brigham, G. (2012). Addressing Tobacco through Organizational Change (ATTOC) in residential addiction treatment settings. Drug and Alcohol Dependence, 121(1–2), 30–37. https://doi.org/10.1016/j.drugalcdep.2011.08.003.
Hopper, K., Van Tiem, J., Cubellis, L., & Pope, L. (2020). Merging intentional peer support and Dialogic Practice: Implementation Lessons from Parachute NYC. Psychiatric Services, 71(2), 199–201. https://doi.org/10.1176/appi.ps.201900174.
Kinane, C., Osborne, J., Ishaq, Y., Colman, M., & MacInnes, D. (2022). Peer supported open dialogue in the National Health Service: Implementing and evaluating a new approach to Mental Health Care. Bmc Psychiatry, 22(1), 138. https://doi.org/10.1186/s12888-022-03731-7.
Lennon, E., Hopkins, L., Einboden, R., McCloughen, A., Dawson, L., & Buus, N. (2022). Organizational change in complex systems: Organizational and leadership factors in the introduction of open dialogue to mental health care services. Community Mental Health Journal. https://doi.org/10.1007/s10597-022-00984-0.
Masters, G. A., Brenckle, L., Sankaran, P., Moore Simas, T. A., Person, S. D., Allison, J., & Byatt, N. (2021). Development of the Practice readiness to evaluate and address Perinatal Depression (PREPD) assessment. Psychiatry Research, 302, 114032. https://doi.org/10.1016/j.psychres.2021.114032.
Olson, M. E., Seikkula, J., & Ziedonis, D. (2014). The key elements of dialogic practice in Open Dialogue. Retrieved from https://www.umassmed.edu/globalassets/psychiatry/open-dialogue/keyelementsv1.109022014.pdf
Oluwoye, O., Stiles, B., Monroe-DeVita, M., Chwastiak, L., McClellan, J. M., Dyck, D., & McDonell, M. G. (2018). Racial-ethnic disparities in first-episode psychosis treatment outcomes from the RAISE-ETP study. Psychiatric Services, 69(11), 1138–1145. https://doi.org/10.1176/appi.ps.201800067.
Overall, J. E., & Gorham, D. R. (1962). The brief psychiatric rating scale. Psychological Reports, 10, 799–812.
Paksarian, D., Mojtabai, R., Kotov, R., Cullen, B., Nugent, K. L., & Bromet, E. J. (2014). Perceived trauma during hospitalization and treatment participation among individuals with psychotic disorders. Psychiatric Services, 65(2), 266–269. https://doi.org/10.1176/appi.ps.201200556.
Rober, P. (2005). The therapist’s self in dialogical family therapy: Some ideas about not-knowing and the therapist’s inner conversation. Family Process, 44(4), 477–495. https://doi.org/10.1111/j.1545-5300.2005.00073.x.
Rosen, K., & Stoklosa, J. (2016). Finland in Boston? Applying open dialogue ideals on a psychotic disorders inpatient teaching unit. Psychiatric Services, 67(12), 1283–1285. https://doi.org/10.1176/appi.ps.201600340.
Seikkula, J., Aaltonen, J., Alakare, B., Haarakangas, K., Keränen, J., & Lehtinen, K. (2006). Five-year experience of first-episode nonaffective psychosis in open-dialogue approach: Treatment principles, follow-up outcomes, and two case studies. Psychotherapy Research, 16(2), 214–228. https://doi.org/10.1080/10503300500268490.
Seikkula, J., Aaltonen, J., Alakare, B., Holma, J., Rasinkangas, A., & Lehtinen, V. (2003). Open dialogue approach: Treatment principles and preliminary results of a two-year follow up on first episode schizophrenia. Ethical Human Sciences and Services, 5, 1–20.
Seikkula, J., Alakare, B., & Aaltonen, J. (2011). The comprehensive open-dialogue approach in western Lapland: II. Long-term stability of acute psychosis outcomes in advanced community care. Psychosis, 3(3), 192–204. https://doi.org/10.1080/17522439.2011.595819.
von Peter, S., Aderhold, V., Cubellis, L., Bergström, T., Stastny, P., Seikkula, J., & Puras, D. (2019). Open dialogue as a Human Rights-Aligned Approach. Frontiers In Psychiatry, 10, 387. https://doi.org/10.3389/fpsyt.2019.00387.
World Health Organization (2010). Measuring health and disability: manual for WHO Disability Assessment Schedule (WHODAS 2.0) / edited by T.B. Üstün, N. Kostanjsek, S. Chatterji, J.Rehm. Geneva: World Health Organization. Retrieved from https://apps.who.int/iris/handle/10665/4397
Wusinich, C., Lindy, D. C., Russell, D., Pessin, N., & Friesen, P. (2020). Experiences of parachute NYC: An integration of open dialogue and intentional peer support. Community Mental Health Journal, 56(6), 1033–1043. https://doi.org/10.1007/s10597-020-00556-0.
Ziedonis, D. M., Wang, X., Li, T., Kim, S. S., Tonelli, M. E., Li, S., & Kalman, D. (2012). Addressing Tobacco through Organizational Change in a hospital-based mental health center in China: The intervention and lessons learned in a pilot implementation project. Journal of Dual Diagnosis, 8, 148–157.
Ziedonis, D. M., Zammarelli, L., Seward, G., Oliver, K., Guydish, J., Hobart, M., & Meltzer, B. (2007). Addressing tobacco use through organizational change: A case study of an addiction treatment organization. Journal of Psychoactive Drugs, 39(4), 451–459. https://doi.org/10.1080/02791072.2007.10399884.
Acknowledgements
We wish to thank the networks for their participation, our trainers, and the professionals who were a part of the project. We are grateful for the support of Grady Health System and the Georgia Department of Behavioral Health and Developmental Disabilities.
Funding
The study was funded by the Foundation for Excellence in Mental Health Care, the John and Polly Sparks Foundation, and the Betty and Davis Fitzgerald Foundation.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
Outside of this work, Dr. Cotes has received research funding from Otsuka, Lundbeck, Alkermes, and Roche. He is a consultant to the American Psychiatric Association and Saladax Biomedical, and a speaker for Clinical Care Options. The remaining authors have nothing to disclose.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Cotes, R.O., Palanci, J.M., Broussard, B. et al. Feasibility of an Open Dialogue-Inspired Approach for Young Adults with Psychosis in a Public Hospital System. Community Ment Health J 59, 1428–1435 (2023). https://doi.org/10.1007/s10597-023-01120-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10597-023-01120-2