Étude qualitative de l’implémentation de la COP 13 dans une institution accueillant des personnes vivant avec un trouble psychotique sévère d’évolution lente

Qualitative study of the implementation of COP 13 instrument in an institution for people living with severe psychotic disorders of slow evolution

¹ Service de psychiatrie adulte, Centre hospitalier de Montauban, Montauban, France
² ESAP Lou Camin, Fondation John Bost, Montauban, France
³ Service universitaire de psychiatrie de l’adolescent, Centre hospitalier d’Argenteuil, Argenteuil, France
⁴ ECSTRRA Team, UMR-1153, Inserm, Université de Paris, Paris, France
⁵ Service de psychiatrie, psychothérapies et art-thérapie, Centre hospitalier universitaire de Toulouse, Toulouse, France
⁶ Service de psychiatrie et psychologie médicale, Centre hospitalier universitaire de Toulouse, Toulouse, France
⁷ Équipe de recherche sur les rationalités philosophiques et les savoirs (EA 3015), Université de Toulouse Jean-Jaurès, Toulouse, France

^* adrien.icher@gmail.com

Résumé

La COP 13 est une méthode d’évaluation des psychoses conçue pour objectiver des évolutions cliniques fines. Cette étude qualitative inspirée de l’IPA vise à explorer son déploiement au sein d’une institution spécialisée dans la prise en charge des troubles psychotiques sévères et persistants. Des entretiens semi-dirigés ont été réalisés auprès des soignants puis analysés. Les résultats montrent que la COP 13 s’est implantée progressivement dans la pratique clinique de l’équipe. Son utilisation s’est révélée cohérente avec les pratiques de soin institutionnel déjà en place. Certains participants ont identifié la COP 13 comme un repère dans le temps pour aider à objectiver l’évolution clinique des patients pris en charge. D’autres y ont vu un instrument de dialogue et de mise en débat. D’autres enfin, s’en sont saisi comme d’une nouvelle grille de lecture pour penser le quotidien. En enrichissant le travail de narrativité indirecte et en suggérant la possibilité d’une évolution clinique, la COP 13 s’inscrit dans une perspective de rétablissement.

Abstract

Introduction: The identification of fine clinical evolutions of psychoses is a challenge for contemporary psychiatry. This study aims to explore the deployment of COP 13 instrument as an assessment tool within an institution specializing in the care of severe and persistent psychotic disorders.

Material and method: The study was carried out in a mental health unit, “Lou Camin” (LC) in Montauban, France. Caregivers regularly participating in clinical summary meetings were recruited. The semi-structured individual interviews were conducted with the help of a guide. A phenomenological qualitative methodology inspired by the Interpretational Phenomenological Analysis was used to analyze the interviews.

Results: 19 professionals were included in the study. The results show that COP 13 gradually took hold in the clinical practice of Lou Camin’s caregivers. The tool, by its novelty, its complexity, its specific vocabulary and its quantitative aspect, could have worried during the first uses. An apprenticeship was necessary. The analysis of the interviews provided several elements to explain the success of its deployment. The use of COP 13 is consistent with institutional work. The clinical field explored is wide. The assessment is based on specific and evocative “clinical features” that anchor the tool in practice. The caregivers were directly involved in the scoring exercise and in the reflection around the tool. They found meaning in its use in their work. Some participants identified the COP 13 as a benchmark over time to help objectifying the clinical evolution of patients treated. Others saw it as an instrument for dialogue and debate. Finally, others have taken it up as a new reading grid for thinking about everyday life.

Discussion: By punctuating the time and providing additional clinical material, COP 13 feeds the work of indirect narrativity. Here we find the main determinants of recovery in psychosis highlighted by service users in qualitative studies : hope and narrativity. We can then suggest the potential effect of the implementation of COP 13 in recovery oriented practice.