Frontline staff experiences of bridging dual diagnosis treatments – Determinants for implementing a cross-sectoral collaboration model

BACKGROUND: It is estimated that 30-70% of patients in psychiatry have co-existing psychiatric disorders and substance use disorders, also called dual diagnosis. This condition often results in a complex clinical condition that affects the treatment trajectory and outcomes. Although the two conditions are intertwined, they are handled in two different sectors in Denmark, and therefore mostly treated separately. To overcome this divide, a coordination model was developed, with the aim of coordinating treatment between psychiatric outpatient FACT teams and municipal substance use treatment facilities for patients with dual diagnosis. The aim of this study was to assess the barriers and facilitators to a cross-sectoral coordination model as perceived by frontline staff during implementation. METHODS: 24 semi-structured interviews with frontline staff were performed in both sectors. The interview guide and analysis are based on the Consolidated Framework for Implementation Research (CFIR) in combination with Qualitative Content Analysis. RESULTS: During implementation of the coordination model, frontline staff perceived barriers and facilitators in outpatient psychiatry and substance use treatment centers within all domains of CFIR, yet overall, participants were positive about the benefits and potentials of the model. During implementation they experienced an improvement in coordination practices, although patients were still rejected despite use of implementation strategies aimed at knowledge and skills, staff in both sectors did not feel competent to treat the target group and called for more training and concrete action plans. The flexibility required by this target group was considered hard to attain due to a lack of time and staff resources. CONCLUSION: According to frontline staff, a sustainable effort and stronger cross-sector collaboration calls for extensive management support, an ongoing focus on culture- and behavior changes, and enhancement of competences associated with addressing, detecting, and treating dual diagnosis.