Implementation of integrated dual disorders treatment: A qualitative analysis of facilitators and barriers
Implementation of integrated dual disorders treatment: A qualitative analysis of facilitators and barriers
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DOI：
10.1176/appi.ps.59.9.989
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发表时间：
2008-09-01
影响因子：
3.8
通讯作者：
McHugo, Gregory J.
中科院分区：
文献类型：
--
作者：
Brunette, Mary F.;Asher, Dianne;McHugo, Gregory J.
目的：大约一半患有严重精神疾病的人在一生中的某个时候会经历共同发生的物质使用障碍。综合双重疾病治疗，一个方案，以治疗患有并发症的人，改善结果，但在公共精神卫生环境中并不广泛。本报告描述了在何种程度上，这种干预措施是由11个社区精神卫生中心参与了一项大型研究的实践实施。介绍了实施的促进因素和障碍。方法：经过培训的实施监测员在两年内定期进行现场访问。在访问期间，监测员采访了主要的信息提供者，对执行工作进行了人种学观察，并评估了对实践模式的忠实程度。对这些数据进行了编码，并将其作为总结执行过程的详细现场报告的基础。作者审查了这些报告，并提炼出每个网站的三大促进因素和障碍。确定了最突出的跨站点促进因素和障碍。结果：两个站点达到高保真度，六个站点达到中等保真度，三个站点在两年内保持低保真度。突出的促进者和障碍，以执行中度至高度忠诚的行政领导，咨询和培训，主管掌握和监督，长期的工作人员流动，和财务。结论：共同的促进者和障碍，以实施综合双重疾病治疗出现跨网站。评估结果证实了在执行模式中使用咨询培训员的重要性，以及需要在多个层面开展密集活动以促进执行。需要进一步研究服务的执行情况，包括但不限于澄清克服障碍的战略。
Objective: Approximately half of the people who have serious mental illnesses experience a co-occurring substance use disorder at some point in their lifetime. Integrated dual disorders treatment, a program to treat persons with co-occurring disorders, improves outcomes but is not widely available in public mental health settings. This report describes the extent to which this intervention was implemented by 11 community mental health centers participating in a large study of practice implementation. Facilitators and barriers to implementation are described. Methods: Trained implementation monitors conducted regular site visits over two years. During visits, monitors interviewed key informants, conducted ethnographic observations of implementation efforts, and assessed fidelity to the practice model. These data were coded and used as a basis for detailed site reports summarizing implementation processes. The authors reviewed the reports and distilled the three top facilitators and barriers for each site. The most prominent cross-site facilitators and barriers were identified. Results: Two sites reached high fidelity, six sites reached moderate fidelity, and three sites remained at low fidelity over the two years. Prominent facilitators and barriers to implementation with moderate to high fidelity were administrative leadership, consultation and training, supervisor mastery and supervision, chronic staff turnover, and finances. Conclusions: Common facilitators and barriers to implementation of integrated dual disorders treatment emerged across sites. The results confirmed the importance of the use of the consultant-trainer in the model of implementation, as well as the need for intensive activities at multiple levels to facilitate implementation. Further research on service implementation is needed, including but not limited to clarifying strategies to overcome barriers.