Background
The initiative for "Project Day Ward Network" was taken by the day treatment ward at Psychiatric ward B, Ullevål Hospital in Oslo. This day ward had existed since 1978 and since 1982 all patients had been followed up with systematic data collection. Gradually, it became clear that in order to move forward, you needed a better basis for comparison, a larger patient material and challenges from comparable departments. This led to discussions with other day treatment departments which in turn led to an application to the Norwegian Medical Association's quality assurance fund. The medical association chose to support the project, which enabled it to hire a day-to-day manager with expertise in project management and system development. The project was also submitted to the regional ethics committee and the Norwegian Data Protection Authority, which had no objections to a central database of anonymized data. The project phase then lasted from 1993 trough 1996.
In the period 1997-2007, the network was an independent project organization run by a chairman, general manager, and a board consisting of a representative from each associated treatment unit. Towards the end of this period, the network changed its name to "Day Treatment Network" (DN). The reason was that there were gradually fewer who referred to themselves as "Day Wards". The trend was to call themselves "Outpatient group units", etc. From 2008, DN went from being an independent project organization to being operated by the Unit for Day Treatment Network, under the Section for Personality Psychiatry and special outpatient clinics at Oslo University Hospital. Eventually it became clear that the name "Day treatment network" was not adequate for the network's activities and focus, so in 2018 the network changed its name to "Network for Personality Disorders" (the Network).
Organization
The network is operated from the separate unit; Network for Personality Disorders, at Section for Personality Psychiatry and special outpatient clinics, Clinic for Mental Health and Addiction, Oslo University Hospital HF. The network's leading body is the member group, consisting of a representative for each of the affiliated treatment units.
Aims
The purpose of the network is twofold. On the one hand, it must maintain research activities with a focus on understanding and treating personality-related disorders, as well as on measures and measurement methods related to this. Furthermore, with an overall focus on professional collaboration, the network units will be given assistance with regard to professional updating and quality assurance, so that they can maintain and further develop good treatment programs for their target group. The network engages in collaboration and professional development at both national and international level.
As a whole, the Network has a clear empirically oriented user perspective, and no limited theoretical reference frames. The reason is that the various treatment options and therapeutic approaches and techniques range widely across the treatment units. Nevertheless, each unit must have a pointed theoretical perspective in order to be able to justify its treatment programs. For a comprehensive and consistent treatment, where the staff agree on goals and methods, the units should have well-thought-out and clear expectations for connections between interventions, processes and treatment effect. It will mainly be the validity of these expectations that forms the basis for the network's various engagements, discussions and research activities.
Treatment within the Network
Treatment units associated with the Network (currently 20) represent a wide range of methods and approaches, both psychodynamic and cognitive. Mainly, combinations of group and individual treatment are offered over shorter and longer periods of time. The treatment options can therefore vary between and within each unit. Some have a more manualized program, such as Mentalization-Based Therapy (MBT), Dialectical Behavior Therapy (DBT), Schema Therapy (ST), Metacognitive Interpersonal Therapy (MIT), and/or more traditional Dynamic Group Psychotherapy. Mainly, the treatment offers will be individualized, with, for example, combinations of Image/Art/Expression therapy, Stabilization for trauma courses, Psychoeducational groups, to name a few. Nevertheless, the main focus is on the disorder (personality disorder), and not the method or the approach itself.
Patients at units connected to the Network will primarily receive a thorough assessment of their psychological problems and challenges. This takes place through a series of standardized conversations and questionnaires, where the patient actively participates in discussions and mutual feedback. During the treatment, standardized interviews and questionnaires will be completed at regular intervals. The results of these are then discussed in terms of recovery, expectations and alliance in the treatment process.
Data management and research
Data that is recorded locally at each unit will be used on a daily basis for the benefit of the unit itself. Each unit owns its own computer program and the data it records. At regular intervals, data from all units will be anonymized and collected in a larger database. In this database, or quality register, it will not be possible to identify which unit the data comes from. These data are thus only of research interest. As of today (2023), the central anonymized database comprises data from over 14,000 patients. Issues that wish to be elucidated via this central database will only take place in accordance with special agreements and guidelines. All research will satisfy the requirements for security and privacy in accordance with the Personal Information and Health Register Act, as well as guidelines from the Regional Ethics Committee and the Norwegian Data Protection Authority.
In the Network, there is a large focus on research close to the clinic. This means a mutual, close and ongoing collaboration between clinicians and researchers. In connection with the research activities carried out in the network, it is desirable that those particularly interested should participate in the various research projects. The prerequisite is that the person concerned fulfills the requirements for co-authorship of published works according to the Vancouver Convention: To be considered a co-author, a researcher must have contributed significantly to a) planning, design, acquisition of data or analysis and interpretation of data, b) preparation of the manuscript itself or critical revision of the content and c) approval of final manuscript version.
All research in the Network is done in collaboration with the Research Group for Personality Psychiatry at the University of Oslo and the Section for Personality Psychiatry and specialist outpatient clinics at Oslo University Hospital.
Contact
- General manager: Geir Pedersen (g.a.f.pedersen@medisin.uio.no / uxgepe@ous-hf.no).
- Academic supervisor: Elfrida Hartveit Kvarstein (e.h.kvarstein@medisin.uio.no / elfkva@ous-hf.no).
Reference
- Pedersen, G., Wilberg, T., Hummelen, B., & Kvarstein, E. H. (2022). The Norwegian Network for Personality Disorders – Development, contributions and challenges through 30 years. Nordic Journal of Psychiatry, 77, 512-520. https://doi.org/10.1080/08039488.2022.2147995
- Kvarstein, E. H., Frøyhaug, M., Pettersen, M., Carlsen, S., Ekberg, D. G. A., Fjermestad-Noll, J., Ulvestad, D. A., Gikling, E. L., Hjermann, E., Lindberget, K., Omvik, S., Eikenæs, I. U-M., Hummelen, B., Morken, K. T. E., Wilberg, T., & Pedersen, G. A. F. (2023). Improvement of Personality Functioning among People treated within Personality Disorder Mental Health Services. A Longitudinal, Observational Study. Frontiers in Psychiatry, 14. https://doi.org/10.3389/fpsyt.2023.1163347
- Karterud S, Pedersen G, Bjordal E, Brabrand J, Friis S, Haaseth Ø, Haavaldsen G, Irion T, Leirvåg H, Tørum E & Urnes Ø (2003). Day hospital treatment of patients with personality disorders. Experiences from a Norwegian treatment research network. Journal of Personality Disorders, 17(2), 173-193.
- Wilberg T, Karterud S, Pedersen G, Friis S, Brabrand J, Falkum LR, Leirvåg H & Urnes Ø (1998). Quality assurance of psychiatric day hospital treatment. III: Health Care System Level. Nordisk Psykiatrisk Tidsskrift, 52(5), 431-439.
- Karterud S, Wilberg T, Pedersen G, Friis S, Irion T & Urnes Ø (1998). Quality assurance of psychiatric day hospital treatment. II: Ward level. Nordisk Psykiatrisk Tidsskrift, 52(4), 327-335.
- Urnes Ø, Karterud S, Pedersen G, Irion T & Wilberg T (1998). Quality assurance of psychiatric day hospital treatment. I: Individual level. Nordisk Psykiatrisk Tidsskrift, 52(3), 251-262.
- Karterud S, Pedersen G, Friis S, Urnes Ø, Irion T, Brabrand J, Leirvåg H & Falkum LR (1998). The Norwegian network of psychotherapeutic day hospitals. Therapeutic Communities, 1(19), 15-28.