Re-inventing care planning in mental health: stakeholder accounts of the imagined implementation of a user/carer involved intervention
Re-inventing care planning in mental health: stakeholder accounts of the imagined implementation of a user/carer involved intervention
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DOI：
10.1186/s12913-015-1154-z
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发表时间：
2015-10-30
影响因子：
2.8
通讯作者：
Rogers, Anne
中科院分区：
文献类型：
--
作者：
Brooks, Helen;Sanders, Caroline;Rogers, Anne
背景资料：尽管增加了心理健康创新，旨在增加服务用户和照顾者参与服务，有证据表明，服务用户和照顾者仍然相对边缘化。本研究的目的是确定关键的线人与知识的政策和实践有关的未来模式的精神卫生管理，以探讨潜在的去执行现有的护理规划和可能性，旨在实施一个新的用户和照顾者参与和集中的过程中的精神卫生保健规划的培训计划的引入。方法：13个半结构化的采访进行了从一系列相关的学科背景和专业角色，谁是参与当地和国家的政策，实践和研究的关键线人。访谈的目的是探讨他们对当代安排护理规划程序和过程的观点，并确定可能促进或抑制常规纳入用户/照顾者主导的规划的因素。调查结果进行了比较，来自服务用户，照顾者和专业人士的数据，照亮address.Results：主要利益相关者确定的元素，目前的护理规划的背景下，可能会影响以用户为中心的护理规划的可实施性。与其他利益相关者一样，关键的信息提供者认为，拟议的干预措施与用户参与的日益正常化相结合，是适当和可取的。参与者通过阐明组织官僚主义的必要性以及在实施过程中要考虑的先前精神卫生政策和历史实践的遗产来补充现有数据。所有利益攸关方都认为，系统内的适当关系对于成功实施至关重要，关键的信息提供者讨论了如何通过实践标准化的尝试以及服务部门内目前的连通性和文化来削弱这种关系。这项研究表明，将不直接参与服务提供的利益攸关方的观点纳入旨在为干预提供信息的实施研究中，设计。他们的贡献集中于查明那些在系统内工作的人看来不明显的因素或来自政治和政策领域的因素，以及对其他利益攸关方提出的主题形成背景理解。
Background: Despite an increase in mental health innovations designed to increase service user and carer involvement in services, there is evidence that service users and carers are still relatively marginalised. This study aimed to identify key informants operating with knowledge of both policy and practice related to future models of mental health management in order to explore the potential de-implementation of existing care planning and possibilities for the introduction of a training programme designed to implement a new user and carer involved and focussed process of mental health care planning.Methods: 13 semi-structured interviews were carried out with key informants from a range of relevant disciplinary backgrounds and professional roles, who were involved locally and nationally in policy, practice and research. The aim of the interviews was to explore their perspectives on contemporary arrangements for care planning procedures and processes and to identify factors that might promote or inhibit the routine incorporation of user/carer led planning. Findings were compared to data derived from service users, carers and professionals to illuminate added value.Results: Key stakeholders identified elements of the current care planning context that were likely to impact on the implementability of user - focussed care planning. Like other stakeholders, key informants felt that the proposed intervention coalesced with the increasing normalisation of user involvement as appropriate and desirable. Participants added to existing data by illuminating the need for organisational bureaucracy and the legacy of prior mental health policy and historical practice to be considered in implementation. Adequate relationships within the system were considered by all stakeholders to be crucial to successful implementation and key informants discussed how this could be eroded through attempts at practice standardisation and current connectivity and culture within services.Conclusions: The study demonstrated the value of incorporating the perspective of stakeholders not directly involved in service delivery in implementation research designed to inform an intervention at the point of design. Their contribution centred on the identification of factors that appeared not be obvious to those working in the system or emanated from political and policy arenas as well as developing the contextual understanding of themes raised by other stakeholders.