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      Staff’s experiences of implementing patient-initiated brief admission for adolescents from the perspective of epistemic (in)justice

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          Abstract

          Background

          The implementation of Patient-Initiated Brief Admission (PIBA) in child and adolescent psychiatry (CAP) in Sweden is ongoing. This intervention enables adolescents between the ages of 13–17 and with complex mental health problems to initiate a short care period for relief and support rather than the care apparatus being controlling in this process. Offering it is likely to promote epistemic agency, an exchange of knowledge and recovery from mental health problems.

          Aim

          The aim of this study was to explore staff’s perspectives of PIBA for adolescents with complex mental health problems, and what facilitates or hinders its implementation.

          Methods

          Twenty seven employees, 21 women and six men, with various professions in CAP were interviewed and the material was analyzed thematically.

          Results

          Two overall themes emerged: “Staff’s Experiences of PIBA” and “Managing Clinical PIBA Work.” The results were discussed in relation to the theoretical frameworks of epistemic injustice and Normalization Process Theory (NPT). The main findings indicate that PIBA was generally viewed in a positive way, but that obstacles arose when it was actually put into practice. Findings also point at an overall lack of agency among staff when implementing this new way of working, at the same time as the need to adapt PIBA from an adult psychiatric intervention to one for adolescents in CAP is addressed.

          Conclusion

          This article offers insights into the views of psychiatric staff regarding the implementation of PIBA. If staff wish to support epistemic agency and recovery among adolescents, their agency may be an important aspect in the continued implementation. Furthermore, in order for PIBA to become normalized in a sustainable way, we suggest that the continued implementation should be characterized by a youth-friendly framework.

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          Most cited references45

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          Using thematic analysis in psychology

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            Epistemic Injustice

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              Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis.

              No systematic review and narrative synthesis on personal recovery in mental illness has been undertaken. To synthesise published descriptions and models of personal recovery into an empirically based conceptual framework. Systematic review and modified narrative synthesis. Out of 5208 papers that were identified and 366 that were reviewed, a total of 97 papers were included in this review. The emergent conceptual framework consists of: (a) 13 characteristics of the recovery journey; (b) five recovery processes comprising: connectedness; hope and optimism about the future; identity; meaning in life; and empowerment (giving the acronym CHIME); and (c) recovery stage descriptions which mapped onto the transtheoretical model of change. Studies that focused on recovery for individuals of Black and minority ethnic (BME) origin showed a greater emphasis on spirituality and stigma and also identified two additional themes: culturally specific facilitating factors and collectivist notions of recovery. The conceptual framework is a theoretically defensible and robust synthesis of people's experiences of recovery in mental illness. This provides an empirical basis for future recovery-oriented research and practice.
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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                15 December 2022
                2022
                : 13
                : 1054028
                Affiliations
                Department of Social Work, Stockholm University , Stockholm, Sweden
                Author notes

                Edited by: Julian Schwarz, Brandenburg Medical School Theodor Fontane, Germany

                Reviewed by: Edward Harcourt, University of Oxford, United Kingdom; Britt-Marie Lindgren, Umeå University, Sweden

                *Correspondence: Jennie Moberg, jennie.moberg@ 123456socarb.su.se

                This article was submitted to Public Mental Health, a section of the journal Frontiers in Psychiatry

                Article
                10.3389/fpsyt.2022.1054028
                9797670
                36590620
                43b7aa58-5b49-4a7a-ae04-5bd5811cde88
                Copyright © 2022 Moberg and Schön.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 26 September 2022
                : 22 November 2022
                Page count
                Figures: 0, Tables: 1, Equations: 0, References: 47, Pages: 12, Words: 9543
                Categories
                Psychiatry
                Original Research

                Clinical Psychology & Psychiatry
                agency,epistemic injustice,recovery,implementation,power,patient-initiated brief admission,child and adolescent mental health care,participation

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