Achieving horizontal and vertical integration in local services – creating sustainable mechanisms?

BackgroundThe coordination challenges for persons with concurrent drug dependence and mental health disorders (dual diagnosis) are constantly put to test in Norway as well other western countries. A key point of The Coordination Reform 2011 was a transfer responsibility from specialised hospitals municipalities self-governing authorities. Municipal organisation the services is diverse, including establishments units services, abuse treatment (or combination these), rehabilitation, community care, nursing homes social welfare offices. Some have established new FACT (Flexible Assertive Community Treatment teams) cooperation at hospital.In 2015, risk assessment carried out by Office Auditor General found that has not been strengthened line reduction specialist services; slightly increased their capacity expertise after introduction reform. Further, countrywide supervision 2017- 2018 held Board Health Supervision breaches legislation inadequacies two-thirds all municipalities. These were related allocation both within between different services.MethodsThe study draws on an ongoing research three Norway. We seek understanding actors’ experiences organisational professional integration. conducted interviews service providers (professionals managements) users (persons dual diagnosis). also studied relevant state-policy documents, reports Norwegian municipal government how planned structured. In analysis, we draw theory, especially when it comes structural cultural dimensions. Rainbow Model Integrated Care (Valentijn et al., 2013) be fruitful conceptual framework order place function primary care dimension integrated services. Discussion paper discuss expectations role local met andthe municipalities’ scope achieving horizontal vertical integration.Results Lessons learnedBy exploring organised illuminated mechanisms integration each municipality special attention why models considered sequential, parallel or integrated. Further results will presented conference.Limitations suggestions future researchThis in-depth study, using descriptive explorative design; consequently, possible derive generalization. However, can contribute better complexity