Hanne Kilen Stuen

• Clausen, Hanne Kristin; Ruud, Torleif; Odden, Sigrun; Saltyte Benth, Jurate; Heiervang, Kristin S. & Stuen, Hanne Kilen [Vis alle 7 forfattere av denne artikkelen] (2020). Improved Rehabilitation Outcomes for Persons With and Without Problematic Substance Use After 2 Years With Assertive Community Treatment—A Prospective Study of Patients With Severe Mental Illness in 12 Norwegian ACT Teams. Frontiers in Psychiatry. ISSN 1664-0640. 11. doi: 10.3389/fpsyt.2020.607071. Fulltekst i vitenarkiv Vis sammendrag

  Background: Persons with severe mental illness often face difficulties in accessing and receiving adequate services enabling them to live independently. Many have co-occurring substance use problems that increase the risk of adverse outcomes. Community-based service models have been implemented around the world, including assertive community treatment (ACT), but the knowledge of rehabilitation outcomes in different subgroups is limited. We aimed to explore rehabilitation outcomes among patients suffering severe mental illness with and without substance use problems who had received ACT services for at least 2 years. Additionally, we compared differences in changes between the two groups. Methods: A total of 142 patients who received services for 2 years from the first 12 Norwegian ACT teams were included. Eighty-four (59%) had problematic substance use, while 58 (41%) did not. Data regarding housing, activity, symptoms, functioning, and subjective quality of life were collected upon enrollment into ACT and at 2 years of follow-up. Clinician-rated scales and self-report questionnaires were used. Changes within the two groups and differences in change between the groups were assessed using generalized linear mixed models. Results: Both groups were more likely to have good housing, higher level of functioning, and less anxiety and depressive symptoms after 2 years. The odds of good housing among participants with problematic substance use increased only after adjusting for age and gender. Participants with problematic substance use had less severe symptoms, particularly negative and manic symptoms, while participants without problematic substance use reported improved satisfaction with life in general. Neither group experienced a change in having a meaningful daily activity, positive symptoms, practical and social functioning, or subjective quality of life. The reduction of manic symptoms in the substance use group was the only difference between the groups. Conclusion: After 2 years, patients with and without problematic substance use experienced improvements in several important domains. Furthermore, the improvements were similar in both groups for most outcomes. This may suggest that ACT has a place in the continued effort toward integrated and comprehensive community services empowering patients with severe mental illness to achieve and sustain an independent life, including marginalized groups with severe substance use. Keywords: activity; assertive community treatment; co-occurring substance use; functioning; housing; psychiatric symptom; quality of life; severe mental illness. Copyright © 2020 Clausen, Ruud, Odden, Benth, Heiervang, Stuen and Landheim.

• Odden, Sigrun; Landheim, Anne; Clausen, Hanne Kristin; Stuen, Hanne Kilen; Heiervang, Kristin Sverdvik & Ruud, Torleif (2019). Model fidelity and team members' experiences of assertive community treatment in Norway: A sequential mixed-methods study. International Journal of Mental Health Systems. ISSN 1752-4458. 13(65), s. 1–12. doi: 10.1186/s13033-019-0321-8. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background: Assertive community treatment (ACT) is an evidence-based treatment for people with severe mental illness, and this model is used widely throughout the world. Given the various adaptations in different contexts, we were interested in studying the implementation and adaptation of the ACT model in Norway. The first 12 Norwegian ACT teams were established between 2009 and 2011, and this study investigated the teams’ model fidelity and the team members’ experiences of working with ACT. Methods: To investigate implementation of the ACT model, fidelity assessments were performed 12 and 30 months after the teams started their work using the Tool for Measurement of Assertive Community Treatment (TMACT). Means and standard deviations were used to describe the ACT teams’ fidelity scores. Cohen’s effect size d was used to assess the changes in TMACT scores from the first to second assessment. Qualitative focus group interviews were conducted in the 12 teams after 30 months to investigate the team members’ experiences of working with the ACT model. Results: The fidelity assessments of the Norwegian teams showed high implementation of the structural and organizational parts of the ACT model. The newer parts of the model, the recovery and evidence-based practices, were less implemented. Four of the six subscales in TMACT improved from the first to the second assessment. The team members experienced the ACT model to be a good service model for the target population: people with severe mental illness, significant functional impairment, and continuous high service needs. Team members perceived some parts of the model difficult to implement and that it was challenging to find effective ways to collaborate with existing health and social services. Conclusion: The first 12 Norwegian ACT teams implemented the ACT model to a moderate degree. The ACT model could be implemented in Norway without extensive adaptations. Although the team members were satisfied with the ACT model, especially the results for their service users, inclusion of the ACT team to the existing service system was perceived as challenging. Keywords: Assertive community treatment, Model fidelity, Team members, Tool for Measurement of Assertive Community Treatment (TMACT), Implementation

• Stuen, Hanne Kilen; Landheim, Anne; Rugkåsa, Jorun & Wynn, Rolf (2018). How clinicians make decisions about CTOs in ACT: a qualitative study. International Journal of Mental Health Systems. ISSN 1752-4458. 12:51, s. 1–10. doi: 10.1186/s13033-018-0230-2. Fulltekst i vitenarkiv Vis sammendrag

  Background The first 12 Norwegian assertive community treatment (ACT) teams were piloted from 2009 to 2011. Of the 338 patients included during the teams’ first year of operation, 38% were subject to community treatment orders (CTOs). In Norway as in many other Western countries, the use of CTOs is relatively high despite lack of robust evidence for their effectiveness. The purpose of the present study was to explore how responsible clinicians reason and make decisions about the continued use of CTOs, recall to hospital and the discontinuation of CTOs within an ACT setting. Methods Semi-structured interviews with eight responsible clinicians combined with patient case files and observations of treatment planning meetings. The data were analysed using a modified grounded theory approach. Results The participants emphasized that being part of a multidisciplinary team with shared caseload responsibility that provides intensive services over long periods of time allowed for more nuanced assessments and more flexible treatment solutions on CTOs. The treatment criterion was typically used to justify the need for CTO. There was substantial variation in the responsible clinicians’ legal interpretation of dangerousness, and some clinicians applied the dangerousness criterion more than others. Conclusions According to the clinicians, many patients subject to CTOs were referred from hospitals and high security facilities, and decisions regarding the continuation of CTOs typically involved multiple and interacting risk factors. While patients’ need for treatment was most often applied to justify the need for CTOs, in some cases the use of CTOs was described as a tool to contain dangerousness and prevent harm.

• Stuen, Hanne Kilen; Landheim, Anne; Rugkåsa, Jorun & Wynn, Rolf (2018). Responsibilities with conflicting priorities: A qualitative study of ACT providers’ experiences with community treatment orders. BMC Health Services Research. ISSN 1472-6963. 18(290). doi: 10.1186/s12913-018-3097-7. Fulltekst i vitenarkiv Vis sammendrag

  Background: Patients with severe mental illness may be subjected to Community Treatment Orders (CTOs) in order to secure that the patients adhere to treatment. Few studies have investigated the use of CTOs within an Assertive Community Treatment (ACT) setting, and little is known about how the tension between the patients’ autonomy and the clinicians’ responsibility to act in the patients’ best interest are resolved in practice. The aim of this study was to explore the service providers’ experiences with CTOs within an ACT setting. Methods: The study was based on reviews of case files of 15 patients, eight individual qualitative in depth interviews and four focus group interviews with service providers involved in ACT and decisions related to CTOs. A modified grounded theory approach was used to analyze the data. Results: The main theme ‘responsibility with conflicting priorities’ emerged from data analysis (case file reviews, individual interviews and focus group interviews). The balance between coercive approaches and the emphasis on promoting patient autonomy was seen as problematic. The participants saw few alternatives to CTOs as long-term measures to secure ongoing treatment for some of the patients. However, participants perceived the ACT model’s comprehensive scope as an opportunity to build rapport with patients and thereby better meet their needs. The team approach, the ACT providers’ commitment to establish supportive relationships and the frequent meetings with patients in their home environment were highlighted. The ACT approach gave them insight into patients’ everyday lives and, in some cases a greater sense of security when considering whether to take patients off CTOs. Conclusions: Many of the participants viewed CTOs as helpful in securing long-term treatment for patients. CTO decision-making was described as challenging and complex and presented the providers with many dilemmas. The ACT approach was considered as helpful in that it afforded comprehensive, patient-centered support and opportunities to build rapport.

• Clausen, Hanne Kristin; Ruud, Torleif; Odden, Sigrun; Saltyte Benth, Jurate; Heiervang, Kristin Sverdvik & Stuen, Hanne Kilen [Vis alle 9 forfattere av denne artikkelen] (2016). Hospitalisation of severely mentally ill patients with and without problematic substance use before and during Assertive Community Treatment: an observational cohort study . BMC Psychiatry. ISSN 1471-244X. 16(125). doi: 10.1186/s12888-016-0826-5. Vis sammendrag

  Abstract Background Co-occurring substance use increases the risk of hospitalisation in people with severe mental illness, whereas Assertive Community Treatment (ACT) generally reduces hospitalisation in patients with severe mental illness and high inpatient service use. Because the superiority of ACT over standard services amongst patients with problematic substance use is uncertain, the present study examined inpatient service use amongst patients with and without problematic substance use in the 2 years before and the 2 years after they enrolled into ACT teams. Methods This naturalistic observational study included 142 patients of 12 different ACT teams throughout Norway. The teams assessed the patients upon enrolment into ACT using clinician-rated and self-reported questionnaires. We obtained hospitalisation data from the Norwegian Patient Register for the 2 years before and the 2 years after enrolment into ACT. We used linear mixed models to assess changes in hospitalisation and to explore associations between problematic substance use and changes in hospitalisation, controlling for socio-demographic and clinical characteristics. Results A total of 84 (59 %) participants had problematic substance use upon enrolment into the ACT teams. In the 2 years after ACT enrolment both participants with and without problematic substance use experienced a reduction in total inpatient days. Those with problematic substance use also had fewer involuntary inpatient days. Exploratory analyses suggested that symptom severity and functioning level interacted with problematic substance use to influence change in total inpatient days. Conclusion These findings may suggest that ACT teams successfully support people with complex mental health problems in the community, including those with problematic substance use, and thereby contribute to a reduction in inpatient service use.

• Clausen, Hanne Kristin; Landheim, Anne; Odden, Sigrun; Saltyte Benth, Jurate; Heiervang, Kristin Sverdvik & Kilen Stuen, Hanne [Vis alle 8 forfattere av denne artikkelen] (2016). Hospitalization of high and low inpatient service users before and after enrollment into Assertive Community Treatment teams: a naturalistic observational study. International Journal of Mental Health Systems. ISSN 1752-4458. 10(14). doi: 10.1186/s13033-016-0052-z.
• Kilen Stuen, Hanne; Rugkåsa, Jorun; Landheim, Anne & Wynn, Rolf (2015). Increased influence and collaboration: A qualitative study of patients' experiences of community treatment orders within an assertive community treatment setting. BMC Health Services Research. ISSN 1472-6963. 15(409). doi: 10.1186/s12913-015-1083-x. Fulltekst i vitenarkiv
• Clausen, Hanne Kristin; Landheim, Anne; Odden, Sigrun; Heiervang, Kristin Sverdvik; Kilen Stuen, Hanne & Killaspy, Helen [Vis alle 8 forfattere av denne artikkelen] (2015). Associations Between Quality of Life and Functioning in an Assertive Community Treatment Population. Psychiatric Services. ISSN 1075-2730. 66(11), s. 1249–1252. doi: 10.1176/appi.ps.201400376. Vis sammendrag

  Objective: Level of functioning is positively associated with subjective quality of life for people with severe mental illness, but a detailed relationship between functioning and satisfaction with various life domains is largely unknown, and this gap prompted this study. Methods: Demographic and clinical data were obtained from 149 patients engaged with 12 assertive community treatment teams in Norway. Multivariate regression analyses were used to explore associations between subjective quality of life and patient characteristics. Results: Analyses confirmed positive associations between quality of life and age, functioning, and weekly contact with family and friends and a negative association with anxiety and depressive symptoms. Positive associations between several areas of practical and social functioning and satisfaction with related life domains also were found. Conclusions: Although a causal direction of the associations between functioning and life satisfaction has not been determined in this study, the positive findings might indicate that programs aiming to improve functioning could affect patients’ quality of life.

Se alle arbeider i Cristin

• Skotheim, Siv; Trane, Kristin; Clausen, Hanne Kristin; Hatling, Trond; Løvereide, Stine & Hjertø, Kristin Mjåset [Vis alle 10 forfattere av denne artikkelen] (2023). Youth flexible ACT in Norway-An overview of the national implementation strategy.
• Landheim, Anne Signe; Nord-Baade, Silje Louise; Johansen, Marthe; Jensen, Camilla Bergsve & Stuen, Hanne Kilen (2023). Research on Youth FACT in Norway.
• Stuen, Hanne Kilen; Landheim, Anne; Rugkåsa, Jorun & Wynn, Rolf (2017). Assessments of need for treatment and danger in decisions about community treatment orders. European psychiatry. ISSN 0924-9338. 41, s. S154–S155. doi: 10.1016/j.eurpsy.2017.01.2017.
• Kilen Stuen, Hanne; Wynn, Rolf; Landheim, Anne & Rugkåsa, Jorun (2014). Use of committed treatment orders in norwegian assertive community treatment (act) teams, seen from the service users‘perspective. European psychiatry. ISSN 0924-9338. 29. doi: 10.1016/S0924-9338(14)77852-6. Vis sammendrag

  Introduction Since 2007 14 ACT-teams have been established in Norway. Despite the lack of clear evidence for efficacy, CTOs are used as a tool for supporting patients with severe mental illness that are difficult to engage to promote medication adherence and early identification of relapse. There is not much literature about the use of CTOs in ACT-teams. Objectives This study explores the perceptions and experiences of users in Norwegian ACT-teams with recent experience of CTOs. According to the ACT-model establishing trust and a treatment alliance is of significant importance Beside exploring how CTOs influence upon the users‘life-situation and the relationship to the team-members, the study will also focus on the service users‘experience of whether their opinions and whishes are of importance to the treatment planning process. Methodology In-depth interviews with 18 selected users from three ACT-teams will be analyzed by using a modified grounded theory approach, based upon initial, focused and theoretical coding and constant comparison. Results The users perceive the uncertainty of the length of the CTO and the threat of being recalled to hospital if they don‘t comply with treatment difficult to accept. To receive support and respect from the ACT team has been important to increase their sense of safety and stability. Conclusions The results from this study can give useful information about how users‘perceive community treatment orders, which is important for how health personnel encounter ethical dilemmas and ambivalences that may accompany the use of committed community treatment.

• Kilen Stuen, Hanne; Wynn, Rolf; Landheim, Anne & Ruud, Torleif (2013). Committed treatment orders in Norwegian assertive community treatment (ACT) teams, seen from the patients' views and experience.
• Stuen, Hanne Kilen & Eriksen, Erik Oddvar (2008). Skjønn, rettssikkerhet og uførepensjon.
• Nord-Baade, Silje Louise; Marthe, Johansen; Stuen, Hanne Kilen; Jensen, Camilla Bergsve & Landheim, Anne Signe (2022). Evaluering av FACT ung-piloter. Nasjonal kompetansesenter for samtidig rusmisbruk og psykisk lidelse.
• Wynn, Rolf; Stuen, Hanne Kilen; Landheim, Anne & Rugkåsa, Jorun (2019). Community treatment orders in an Assertive Community Treatment setting: a qualitative study of experiences of patients, care providers and responsible clinicians. UiT Norges arktiske universitet. ISSN 978-82-7589-649-8.
• Landheim, Anne; Odden, Sigrun; Clausen, Hanne K.; Heiervang, Kristin Sverdvik; Stuen, Hanne Kilen & Ruud, Torleif (2014). Utprøving av ACT-team i Norge. Hva viste resultatene? Sykehuset Innlandet HF.

Se alle arbeider i Cristin