Abstract Many contemporary mental health care programs rely on cross-agency models of service delivery. In these models, staff from different organizations provide care for the same clients, and this requires negotiation around role boundaries. In Australia, cross-agency programs have been developed to promote collaboration between government and not-for-profit community groups to meet the needs of those with serious mental health problems. Policy makers need to be aware of how staff in these roles conceptualize the boundaries and interconnection of their work with others to ensure that program goals are achieved. This study examined the division of labor that emerged between support workers (employed by the not-for-profit sector) and government health workers within a cross agency supported housing program for people with serious mental illness at risk of homelessness and self-neglect. Interviews were conducted with 40 government health workers and 37 staff from non-government agencies that shared clients in a supported housing program. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. While the division between clinical and non-clinical work was accepted and co-produced, tensions arose in defining the boundaries between them. These tensions resulted from poor communication on the part of both groups, perceived lack of clinical intervention by case managers, high caseloads of case managers, role ambiguity, and support workers feeling their input and feedback were not valued by government health workers. Divisions of labor in cross-agency programs need to be critically evaluated to assess whether they serve program goals. Tensions are inevitable when dividing the tasks involved in care of a single client between different organizations. Co-location of multidisciplinary teams that include health professionals, support workers and peer workers may lead to more effective recovery oriented care. The findings have implications for the future development of recovery oriented mental health services.

中文翻译：

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在支持的住房计划中谈判临床和非临床工作之间的界限

摘要许多当代精神卫生保健计划都依赖跨机构的服务提供模型。在这些模型中，来自不同组织的员工为相同的客户提供服务，这需要围绕角色边界进行协商。在澳大利亚，已经制定了跨机构计划，以促进政府与非营利性社区团体之间的合作，以满足患有严重精神健康问题的人们的需求。决策者需要意识到担任这些角色的员工如何概念化其工作范围和与他人的相互联系，以确保实现计划目标。这项研究调查了跨机构支持的住房计划中针对严重精神病患者的无家可归和自我忽视风险的支持工作者（由非营利部门雇用）和政府卫生工作者之间的分工。与40名政府卫生工作者和来自非政府机构的37名工作人员进行了访谈，他们共享了受支持的住房计划中的客户。对访谈进行录音，逐字记录并使用主题分析进行分析。尽管临床工作和非临床工作之间的划分被接受并共同产生，但在界定它们之间的界限时出现了紧张气氛。造成这种紧张关系的原因是两组之间沟通不畅，案件经理缺乏临床干预，案件经理的工作量高，角色模棱两可，和支持工作者感觉他们的投入和反馈没有被政府卫生工作者重视。需要认真评估跨机构计划中的分工，以评估它们是否达到计划目标。在不同组织之间划分照顾单个客户的任务时，紧张是不可避免的。包括卫生专业人员，支持人员和同伴人员在内的多学科团队在同一地点工作，可能会导致更有效的面向康复的护理。这些发现对面向康复的精神卫生服务的未来发展具有影响。在不同组织之间划分照顾单个客户的任务时，紧张是不可避免的。包括卫生专业人员，支持人员和同伴人员在内的多学科团队在同一地点工作，可能会导致更有效的面向康复的护理。这些发现对面向康复的精神卫生服务的未来发展具有影响。在不同组织之间划分照顾单个客户的任务时，紧张是不可避免的。包括卫生专业人员，支持人员和同伴人员在内的多学科团队在同一地点工作，可能会导致更有效的面向康复的护理。这些发现对面向康复的精神卫生服务的未来发展具有影响。