Tools for follow-up – a core of successful implementation

A large-scale national dissemination of evidence based psychosocial interventions necessitates a new approach to data collection. Quantitative data is necessary to confirm successful implementation and equal access to treatment.

The Finnish National Mental Health Strategy 2020-2030 has two main goals concerning mental health services: improvement of access to and quality of services.

The ministry made some strategic decisions in the beginning. The resources would be used to train professionals in primary care. Furthermore, the psychosocial interventions should be evidence based and previously shown to prevent or treat some of the epidemiologically most common psychiatric symptoms.

By March 2023, more than 2,500 professionals from primary care have received a training in any of the selected psychosocial interventions for young people, mainly IPC-A for depressive symptoms and Cool Kids for anxiety. Moreover, over 2,000 professionals had received training for psychosocial interventions to be used with adults, including guided self-management.

From training to confirming health benefit

As the numbers of trained professionals and specific interventions are rapidly increasing, we need new tools for follow-up. First, the information has been collected on individuals in training, during the training. An optimal tool for follow-up should enable evaluating not only the number of professionals who already have been and are being trained, but also track those who use their skills. If delays in use or diminished fidelity after training can be recognized, the implementation team can provide support.

Second, to confirm that training is converted to health benefits, we should track patients receiving interventions. Information on symptom severity can show whether a selection of individuals for treatment is done as intended. Measurement of symptom severity can demonstrate the effectiveness of response at the individual and therapist levels.

The information on individuals in training and completed interventions should be integrated at the national level to some extent. Optimally, it would simultaneously enable organizational and national follow-up of the implementation process and strategic change.

The secondary analysis would enable evaluations such as that of equal access to treatment for different subgroups of population or based on sociodemographic or geographic characteristics of people.

Towards systematic data collection

So far, the collection of the follow-up data has not been systematic, and has been dependent on having project funding and personnel for reports. This is not a reliable method nor sustainable in the longer term, while information to confirm the long-term use of interventions is essential for the impact of training on wellbeing of people.

Finnish medical files are digital. Half of primary care and almost all psychiatric services are now using operational codes, which describe the content of each patient meeting.

By using operational codes for the type of intervention, such as IPC-A, the type and frequency of intervention and duration of treatment period can be defined from medical records. The data will be summarized in the existing THL portals to support decision making.

To complement the implementation of interventions, we will need a national implementation of operational codes. The elements of a large-scale data collection do exist. To succeed in integration of elements into reliable follow-up data, we will need to confirm user-friendly use of digital medical files, and real-time provision of data to professionals, decision makers, and stakeholders.

With existing digital medical files and registries, Finland should be an ideal country to succeed. This can provide a rich dataset and source of knowledge about factors affecting successful implementation of EB mental health services.

Further information

National Mental Health Strategy and Programme for Suicide Prevention 2020–2030

A National Implementation of Interpersonal Counselling, Adolescent version (IPC-A) in Finland

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