Integrated care delivery in a rural Norwegian FACT team: an explanatory sequential mixed-methods study

Area of Science:

• Mental Health Services Research
• Rural Health
• Integrated Care Models

Background:

• Fragmented healthcare systems pose challenges to integrated mental healthcare, especially in rural settings.
• Flexible Assertive Community Treatment (FACT) offers a multidisciplinary, community-based approach to reduce fragmentation.
• Limited evidence exists on rural FACT team service delivery and integration practices.

Purpose of the Study:

• To examine service distribution within a rural Norwegian FACT team.
• To identify coordination practices enabling integrated care in a rural context.

Main Methods:

• Explanatory sequential mixed-methods design.
• Prospective service mapping of 2,319 patient contacts over 12 weeks.
• Reflexive thematic analysis of team member focus groups.

Main Results:

• FACT teams delivered 80% of services directly, with 20% in collaboration with external partners.
• Service delivery included clinical contacts, interprofessional coordination, and daily life support.
• Key integration practices included collaborative alliance, information alignment, and safety valve thinking.

Conclusions:

• Integrated rural mental healthcare relies on extensive coordination and collaboration.
• Relational and adaptive practices are crucial for effective integration in rural FACT.
• Context-sensitive adaptations are vital for patient safety and care continuity.