Improving care and treatment for adults with a visual impairment and serious mental illness: from tacit knowledge to a logic model of current practice

Introduction. Adults with a visual impairment (VI) and serious mental illness (SMI) have diverse and complex needs, making the provision of care and treatment challenging. Within the Robert Coppes Foundation, a specialist care provision organisation in The Netherlands, knowledge about the care and treatment for these adults exists but only in tacit form, making it difficult to describe and communicate the key elements of its approach. This study aimed to identify the tacit knowledge of professionals regarding the care and treatment of this population and transform this knowledge into a logic model. Method. A participatory action research approach was used to integrate clinical expertise, service users values and best research evidence. By revealing the tacit knowledge of professionals, eliciting the experiences and expectations of service users and searching for available evidence relevant to care and treatment, a logic model was constructed. This model was then validated by presenting this model to a larger group of professionals and service users. Results. Adults with VI and SMI were described as being vulnerable and with complex needs, having fragile trust, lacking feelings of basic safety and problems in attachment. Three different phases in care and treatment were identified: build-up, stability and intervention. The importance of a specialised setting was revealed, with an emphasis on the relationship between the professional and service user and the way care is facilitated by the organisation. Professionals expressed a need for working towards more specific outcomes and developing a uniform approach within the phases. Discussion. A clear logic model of current practice could be established, revealing the key elements in the care and treatment for adults with VI and SMI and aspects that are still unclear or need further clarification. These form the basis for future research leading to improvements of the care and treatment for these adults.