Implementing cognitive therapies into routine psychosis care: organisational foundations.
Implementing cognitive therapies into routine psychosis care: organisational foundations.
复制标题
DOI：
10.1186/s12913-015-0953-6
复制
发表时间：
2015-08-05
影响因子：
2.8
通讯作者：
Newman E
中科院分区：
文献类型：
--
作者：
Dark F;Whiteford H;Ashkanasy NM;Harvey C;Crompton D;Newman E
被诊断为精神病患者的治疗结果仍然不理想，部分原因是循证实践的系统应用有限(Adm Policy ment Health，36：1-7,2009)[1]。实施科学文献确定了在计划引入特定的EBP时需要考虑的许多组织因素。在服务改革开始之前对这些组织特征进行基线分析，可以确定后续执行计划的重点。这项研究调查了两个促进认知干预治疗精神病常规使用的服务中存在的组织基线因素。自那以后，其中一个被研究的部门进行了组织结构改革，以促进更多地采用循证实践(EBP)。这项研究的结果被用来设计一种实施策略，使认知疗法成为常规精神病护理的一部分。对澳大利亚两个大都市精神卫生服务机构的106名精神卫生工作人员进行了调查，以了解他们对精神病认知行为疗法和认知补救疗法的态度、能力和兴趣。此外，还使用组织文化概况(OCP)描述了对组织价值的看法。55名参与者被排除在外，因为他们完成了不到50%的调查。最终样本包括51名参与者。完成了48.1%的调查。超过50%的工作人员对CBTp和CRT治疗精神病感兴趣。工作人员知道现有的CBTp和CRT计划，但这些计划并不是在整个服务中统一提供的。14%的员工被确定为CBT治疗师，35%的员工是训练有素的CRT促进员。只有12%的工作人员接受了治疗的具体监督。基线的组织文化概况(OCP)显示，领导力、规划和人文主义工作场所领域得分最高，沟通得分最低，表明组织薄弱。分析与成功实施服务改革相关的因素有助于精神卫生服务的实施规划和资源的有效配置，将精神病的认知疗法引入常规临床护理。大多数工作人员对循证认知疗法持积极态度，从而将重点放在培训和监督以及发展辅助组织要素上。
Treatment outcomes for people diagnosed with psychosis remain suboptimal due in part to the limited systematic application of evidence based practice (Adm Policy Ment Health, 36: 1-7, 2009) [1]. The Implementation science literature identifies a number of factors organisationally that need to be considered when planning to introduce a particular EBP. Profiling these organisational characteristics at baseline, prior to commencement of service reform can determine the focus of a subsequent implementation plan. This study examined the organisational baseline factors existing in two services promoting the routine use of cognitive interventions for psychosis. One of the services studied has since undertaken organisational structural reform to facilitate the greater uptake of Evidence Based Practice (EBP). The results of this study were used to design an implementation strategy to make cognitive therapies a part of routine psychosis care. One hundred-and-six mental health staff from two metropolitan mental health services in Australia was surveyed to ascertain their attitudes, competencies and interest in Cognitive Behavioural Therapy for psychosis (CBTp) and Cognitive Remediation Therapy (CRT). In addition perceptions of organisational values were profiled using the Organisational Culture Profile (OCP). Fifty five participants were excluded because they completed less than 50 % of the survey. The final sample consisted of 51 participants. 48.1 % of surveys were completed. Over 50 % of staff were interested in CBTp and CRT approaches to psychosis. Staff were aware of existing CBTp and CRT programs but these were not uniformly available throughout the services. Fourteen percent of staff identified as CBT therapist and 35 % were trained CRT facilitators. Only 12 % of staff were receiving therapy specific supervision. The Organisational Culture Profile (OCP) at baseline revealed highest scores amongst leadership, planning, and humanistic workplace domains, with communication receiving the lowest rating indicative of organisational weakness. Profiling the factors associated with successful implementation of service reform informed the implementation planning and the efficient deployment of resources in a mental health service introducing cognitive therapies for psychosis into routine clinical care. The majority of staff had positive attitudes to the evidence based cognitive therapies allowing a focus on training and supervision and the development of supporting organisational elements.