Implementation of a Family Intervention for Individuals with Schizophrenia
Implementation of a Family Intervention for Individuals with Schizophrenia
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DOI：
10.1007/s11606-009-1136-0
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发表时间：
2010-01-01
影响因子：
5.7
通讯作者：
Young, Alexander S.
中科院分区：
文献类型：
--
作者：
Cohen, Amy N.;Glynn, Shirley M.;Young, Alexander S.
家庭很少被纳入临床护理，尽管研究表明，家庭参与对精神分裂症患者有积极的影响，减少复发，改善工作功能和社会适应。（提高精神病护理质量），为这一人群实施家庭服务。在两个退伍军人管理局医疗中心，精神分裂症退伍军人和他们的临床医生分别在基线和15个月进行了访谈。实施了家庭干预，并对实施进行了过程评估。患有精神分裂症的退伍军人（n = 173）及其临床医生（n = 29）。获得了联系家庭的同意，发送了联系家庭的邮件，优先考虑家庭服务的高需求，并对工作人员志愿者进行了简短的三次家庭干预培训。在那些登记的人中，100人同意家庭参与。100人中有73人收到了一封邮件，让他们参与护理;没有人参与其中。向临床医生提供了关于他们病人的评估数据，并通知50名病人需要家庭服务。在这50个家庭中，6个家庭已经参与，34个从未联系过，10个已经联系过; 7个新的家庭参与了护理。没有家庭被转介到家庭心理教育计划。由于所有利益相关者的障碍，家庭干预措施的采用失败了。家庭没有回复邮件，患者担心隐私和家庭负担，临床医生对家庭-患者接触有误解，组织没有腾出时间或提供奖励来提供服务。如果要实现与患者和家庭的全面合作，就需要解决这些障碍，并需要临床医生及其组织支持家庭友好型环境。适用于家庭参与其他疾病进行了讨论。
Families are rarely included in clinical care despite research showing that family involvement has a positive effect on individuals with schizophrenia by reducing relapse, improving work functioning, and social adjustment.The VA QUERI study, EQUIP (Enhancing QUality of care In Psychosis), implemented family services for this population.At two VA medical centers, veterans with schizophrenia and their clinicians were interviewed separately at baseline and 15 months. A family intervention was implemented, and a process evaluation of the implementation was conducted.Veterans with schizophrenia (n = 173) and their clinicians (n = 29).Consent to contact family was obtained, mailers to engage families were sent, families were prioritized as high need for family services, and staff volunteers were trained in a brief three-session family intervention.Of those enrolled, 100 provided consent for family involvement. Seventy-three of the 100 were sent a mailer to engage them in care; none became involved. Clinicians were provided assessment data on their patients and notified of 50 patients needing family services. Of those 50, 6 families were already involved, 34 were never contacted, and 10 were contacted; 7 new families became involved in care. No families were referred to the family psychoeducational program.Uptake of the family intervention failed due to barriers from all stakeholders. Families did not respond to the mailer, patients were concerned about privacy and burdening family, clinicians had misperceptions of family-patient contact, and organizations did not free up time or offer incentives to provide the service. If a full partnership with patients and families is to be achieved, these barriers will need to be addressed, and a family-friendly environment will need to be supported by clinicians and their organizations. Applicability to family involvement in other disorders is discussed.