189 Summary and General discussion 7 The next challenge was to adapt the intervention procedures to forensic psychiatric outpatients, as several meetings with stakeholders, as well as experiences from patients and volunteers who participated in a pilot, uncovered important barriers contributing to the failure of forensic patients to access and use informal interventions (Biegel et al., 1995; van der Tier & Potting, 2015). First, as discussed above, the integration between formal and informal care needed to be enhanced (van Bochove et al., 2019). To address this, two project coordinators (i.e., one in formal care and one in informal care) were appointed to provide a link between institutions. The formal care coordinator monthly participated in teammeetingswithprofessionals to recruit patients and to answer questions. Presentations were given to spread knowledge about the project. Furthermore, a complementary training was developed by formal and informal care to inform new volunteer coaches about forensic psychiatric care and to facilitate the provision of coaching among forensic psychiatric outpatients. Second, the enrollment of patients was of concern. Before the project, patients often did not show up at intakes with the informal care coordinator and were difficult to reach. Therefore, the enrollment procedure of patients was formalized, which included a written consent of patients to the exchange of information between care institutes about the enrollment and volunteer-coaching processes. Enrollment included contact information and other background information that could help to reach a patient. If necessary, researchers or professionals could assist in organizing first appointments between patients and informal care staff. Lastly, the selection criteria of patients and volunteer coaches needed to be reconsidered. For example, forensic patients might not directly express internal motivation for care – an important condition of volunteer-linking in informal care. Therefore, this condition was less emphasized in this project. Besides, we considered which patients were eligible to participate to ensure safety of volunteer coaches. Discussion with stakeholders led to a set of criteria for the selection of patients and volunteer coaches considered eligible to participate in the informal social network intervention (chapter 3). Challenging implementation As mentioned, informal social network interventions have long been used in a wide range of populations (Mead et al., 2010; Siette et al., 2017). However, to the best of our knowledge, this is the first attempt to implement the intervention alongside forensic psychiatric care. Over an intended period of 12 months, the informal social network intervention was added to treatment as usual of forensic psychiatric outpatients. Patients were matched one-on-one to trained community volunteers with the aim of developing a supportive non-professional relationship – improving patients’ supportive social networks. Additional social network-related goals, such as enhancing the size and quality of social
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