Open Dialogue is a resource-oriented approach (i.e. an approach focused on individuals’ and networks’ potentials) to provide care to people experiencing a mental health crisis. The client is involved in periodical treatment meetings together with his/her family- and social network and mental health professionals. All treatment decisions are made collaboratively.
Open Dialogue, developed in northern Finland, has shown excellent results there: 84% of persons experiencing a first episode psychosis returned to an active social life, and only 33% were exposed to neuroleptic medications. In usual care, almost everyone diagnosed with psychosis receives neuroleptic medication at the outset, and only a minority of them is symptom-free after 5 years. Since these results were published, the Open Dialogue approach has been adopted in several other countries. It remains to be seen, however, if it works equally well in different cultures and mental health care systems.
84% of persons experiencing a first episode psychosis returned to an active social life, and only 33% were exposed to neuroleptic medications
HOPEnDialogue has been designed to connect the Open Dialogue research projects emerging worldwide
A first randomized control trial: ODDESSI
The overall aim of the ODDESSI (Open Dialogue – Development and Evaluation of a Social network intervention for Severe mental Illness) study, which started in 2017 in the UK, is to assess clinical- and cost-effectiveness of Open Dialogue interventions as compared to Treatment as Usual (TAU). The trial is going to involve about 600 patients over a 3-year period. Still, it is unclear if ODDESSI results can be generalized outside the UK.
A first international trial: HOPEnDialogue
ODDESSI represents a rigorous, large-scale trial, highly resource-demanding such that few teams around the world could set up a similar study in their country. The international collaborative study HOPEnDialogue has been designed to connect the Open Dialogue research projects emerging worldwide to the rigorous framework provided by ODDESSI. HOPEnDialogue will:
- produce consistent documentation of Open Dialogue practices across study sites to further our understanding of how to advance Open Dialogue practices;
- assess the fidelity of Open Dialogue principles (i.e, how closely the care provided in each site follows these principles).
HOPEnDialogue employs a selection of the ODDESSI tools, to show if ODDESSI’s outcomes can be generalized to other countries.
One grant, two goals
In February 2019, the US Foundation for Excellence in Mental Health Care awarded a research grant to the Italian National Research Council that allowed HOPEnDialogue to start. HOPEnDialogue has two purposes. First, it investigates the effectiveness of Open Dialogue in different contexts. Second, it aims to connect and support the Open Dialogue Learning Community in centers that adopt Open Dialogue with fidelity.
Work plan: 4 Steps
HOPEnDialogue has been launched with a Kickoff Workshop held in Rome on 2nd July 2019. The Institute of Cognitive Sciences and Technologies of the National Research Council in Italy coordinates the project in close collaboration with an International Advisory Board. HOPEnDialogue is organized into four work packages:
1. Mapping and connecting the sites
In the first year, an online survey is proposed to all interested centers practicing Open Dialogue worldwide, to examine how they are organized (e.g. number of referrals per month, referral pathways, number and type of professionals involved, etc.). A global map of sites will describe their organizational characteristics. Based on this survey, a selection of centers with excellent organizational fidelity will be invited to participate in the next phase of the research. Researchers, practitioners, and peers interested in Open Dialogue will meet online on June 21st – 23rd, 2021.
2. Assess adherence and define the protocol
In the second year, HOPEnDialogue will invite the selected centers to record their clinical work. Through the recordings, researchers will assess the conduct of the treatment meetings, to check their adherence to the clinical principles of Open Dialogue. Based on this evaluation, researchers will select the sites that will participate in the subsequent feasibility study. Furthermore, the research protocol will be defined. HOPEnDialogue aims to utilize a streamlined ODDESSI protocol. All the centers, including the ones not selected, will receive advice for improving their adherence and for implementing a basic system of data collection for routine practice.
3. Pilot study
During the third year, a pilot study will be carried out to control if the research protocol works as intended (e.g. participants are recruited in adequate numbers, not too many leave the study, relevant data are collected, etc.).
4. Longitudinal study
If the study proves to be feasible, in the subsequent years the selected sites will participate in a longitudinal cohort study which is currently scheduled to start in April 2022 and last for 4 years. The main study will produce scientific data and evidence about Open Dialogue feasibility and its effectiveness in the different contexts, and how users, carers and other professionals experience this approach.
