About Early Intervention

Increasing numbers of older and younger people in need of assistance are creating strong pressure on local care services. The applications come directly from those who apply for assistance, or via relatives, GPs or hospitals. They are then assessed by the municipality's allocation office before a decision is made on approval or refusal.

Some municipalities have tried out new models with their own interdisciplinary assessment teams with early intervention before decisions are made.

In this project, we will compare the traditional and the new ways of proceeding to assess the need and allocate services. We will do research on the financial consequences for the municipalities, the consequences for the applicants and their relatives and the consequences for the employees. In addition, we will compare the models for the assessment and allocation of services in the Nordic countries. Are some service delivery models more promising than others?

The project is therefore about the gateway to the large care services in the municipalities, about the early interventions and efforts and about models for allocation of services. The entrance gate constitutes a particularly important and critical phase both for the users and the municipalities. This phase has not been much studied.

Researchers at HVL, NORCE, NTNU, FHI, VID, Roskilde University, Umeå University and University of Jyväskylä participate. Bergen, Askøy, Kvam and Oslo municipalities collaborate on the implementation of the research. Other important partners are KS, the USHTs in Oslo and Hordaland, the councils for the elderly in Oslo and Bergen, as well as the Council for Persons with Disabilities in Oslo.

The aim is to gain more knowledge about the entrance gate, and that this can benefit the users and the municipalities.

WP1: Effects on individual service use and costs to society

Method

  • Analyses of registry data from KPR, NPR, DÅR, and SSB, where municipalities with and without, and before and after, assessment teams are compared using a Difference-in-Differences (DiD) approach:

about

  • The probability of receiving services
  • Health effects for users and their families
  • Costs and economic impacts for municipalities

WP2: Health and welfare effects for applicants and their family

 

Leader: Oddvar Førland

Methods and researhers

Qualitative interviews:

  • PhD Candidate Silje Tollefsens, HVL.
  • Analysis of in-depth interviews with users and relatives: tensions between different understandings of needs.

Quantitative survey:

  • Research group including Hanne Tuntland, Karl Ove Hufthammer,
  • Oddvar Førland (HVL) and Lisa Victoria Burrell (NTNU).
  • Questionnaire to 500 new applicants/users of decision-based services in Bergen and Oslo at three points in time (baseline, 4 weeks, and 6 months) about:
    • Service evaluation
    • Health-related quality of life (EQ-5D-5L)
    • Control over everyday activities (ASCOT)
    • Changes from the first to the fourth week, and after six months.

WP3: Consequences and service provision and at employee level

 

Leader: Anette Fagertun,, HVL
Research group: Stein Erik Fæø (VID), Laila Tingvold (NTNU), Oscar Tranvåg (HVL), Oddvar Førland  (HVL), Ingrid Jerve Ramsøy (HVL), Frode Fadnes Jacobsen (HVL) og postdoc Audun Gabriel Løvlie (HVL).

Method

  • Interviews and fieldwork in municipalities with and without assessment teams.
  • Document analyses

about:

  • ‘Legitimation’ in the allocation of municipal health and care services.
  • Consequences for work organization and employees.
  • Changes and transitions between models.
  • How ideas about “needs,” distributive justice, and gender are understood and emphasized in municipal documents and practices.

WP4: Models of early interventions in Nordic countries

 

Leader: Professor Karen Christensen, RUC

  • Document analyses of political documents
  • Scoping review on Nordic service allocation models (Audun Gabriel Løvlie)

Similarities and differences between countries and over time.