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2015-45: Forensic High and Intensive Care (FHIC) (Call 2015-45/2016-62)

The model Forensic High and Intensive Care (FHIC) has recently been developed in Dutch forensic psychiatric care as a response to certain changes and needs. Due to the strong focus on safety within forensic psychiatry, the field is often characterized by its controlling and coercive way of working. Consequently, coercive measures and especially seclusion are often used, especially in times of crisis. This goes against the knowledge that contact is more effective in maintaining safety compared to repression and control. In addition, international consensus exists to reduce the number of seclusion within (forensic) psychiatry due to the negative effects among patients and care providers and no proven therapeutic effect. Options to intensify care were underdeveloped in most Dutch forensic care settings.

FHIC offers a temporary admission in times of a (relational) crisis. The referring party remains in the lead during the admission to ensure continuity. Stepped care is also possible at the FHIC ward itself as the ward consist of a High Care and an Intensive Care unit between which active interchange is possible. By means of various best- and evidence-based practices in working routine and culture, there is a strong focus on safety by contact instead of control. For instance by the theory of limit setting. The objective of FHIC is to provide tools to prevent repression, (further) disruption, criminal recidivism and coercive measures. The model is inspired on the High and Intensive Care model, a widespread model in Dutch acute psychiatry.

The model has been developed in the first phase of the project and the next step is to focus on the implementation process of the model. In the current pilot, at least fourteen wards participate from different levels of security. Wards are supported with the implementation of the model by various platforms where knowledge, best-practices and experiences are exchanged. To further support wards with the implementation, a model fidelity scale has been developed, called the FHIC monitor. This instrument consists of 50 items to measure the quality and implementation of the model in practice. Research is performed to study the validity and reliability of this instrument. Next to the validation of the FHIC monitor, the implementation process of FHIC is studied and intended effects of FHIC are measured; for instance by gaining insight in the (experienced) safety on the ward. Outcomes are expected in 2019 and will also contribute to the further development of the FHIC model. 

Executive party

Fivoor / Altrecht Aventurijn (projectlead) in colaboration with all pilotorganizations.