Interprofessional collaborative practice in the Norwegian prison system: a case study exploration of front-line professionals at two transitional residences reintegrating inmates back into society.

Abstract

The Norwegian prison system has been debated to be one of the most exceptional in the world with a distinct welfare model and reoffending rates amongst the lowest, but practical concerns still present due to mental illness impacting on 92% of inmates. Addressing mental health in the prison population is listed as important for the purposes of their well-being, public safety and to reduce reoffending. Indications are that interprofessional collaborative practice (ICP) is essential to bring together service personnel from other disciplines to prevent, treat or reduce inmates’ mental health needs. ICP broadly encompasses integration which is the structural arrangements that prescribe the placement of services and their personnel, whereas collaboration is concerned with the relations and interactions among staff. Previous research called for further exploration of these practices in the Norwegian prison system specifically from the front-line perspective. As the primary aim, this study undertook an in-depth exploration of ICP at the final phase of the Norwegian prison system through explicit focus on the organisational work of front-line professionals with inmates’ mental health needs. The theoretical framework of Cultural Historical Activity Theory (CHAT) and its theoretical components underpinned the research (i.e. object, outcome, tools, subject, community, rules and division of labour). CHAT represented an analytical lens to describe the anatomy of a specific collective activity system and to theorise ICP. A qualitative case study approach was used to undertake an exploration of front-line staff at two transitional residences in eastern Norway. These residences are considered prisons as inmates served the remainder of a prison sentence at these units before being released. The sample included Contact Officers, Social Workers and a Nurse at case study one, and Contact Officers and Social Workers at case study two. The data collection incorporated shadowing, observations and semi-structured interviews through 2-months immersion at each case study site to capture the professionals’ insights and experiences. As a flexible analytical approach, Template Analysis was utilised with the use of a priori themes and the iterative development of a template resembling the key themes at each case study. Both case studies were characterised by a collective activity system that explores the organisational work at each prison to answer the research questions regarding the implementation of ICP. As three key findings, the study identified the structural arrangements of integration concerning the front-line staff at the two transitional residences and broadly across the Norwegian prison system. (1) The specialised services and personnel were segregated from these residences, and the front-line prison staff ensured inmates had progressive opportunities to rehearse behaviour in the community. (2) The closely integrated interprofessional teams at these residences established organisational coherence, shared tasks and a collective accountability. (3) Due to insufficiently integrated systems such as the digital tool KOMPIS and confidentiality procedures, a higher degree of integration was required for these systems to improve the sharing of information across different services and front-line staff. Furthermore, the study identified four key findings pertaining to the collaborative processes that noted the purposeful relations at the residences and across the prison system. (1) The front-line staff had low levels of collaboration with other services as inmates were encouraged to maintain this collaborative responsibility themselves, yet new collaborative initiatives or models were requested with NAV (the labour and welfare service) and other prisons to overcome communication challenges. (2) Having qualified and competent staff to work in these residences was demonstrated to be essential for the professionals to develop collaborative relations between different disciplines. (3) The staff valued the autonomous relationships with inmates to cultivate collaborative and participatory involvement. (4) The application of the professionals’ shared humane ideals stimulated collaborative outlooks amongst them. In combination, this study found that the integrative structures, collaborative processes and organisational culture informed the implementation of ICP at the transitional residences to reintegrate inmates back into society. The study has indicated that the front-line professionals held an organisational commitment toward the inclusive treatment and positive development of inmates’ wide range of needs, including mental health, to prepare them for release and a life outside of prison. Contributions from this research suggest that ICP is required to complement the demands of both front- line staff and inmates at the final phase of a prison system to endorse reintegration.