Implementing Residential Integrated Treatment for Co-occurring Disorders
Implementing Residential Integrated Treatment for Co-occurring Disorders
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DOI：
10.1080/15504263.2013.807073
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发表时间：
2013-08-01
影响因子：
2.2
通讯作者：
Cormier, Catherine A.
中科院分区：
文献类型：
--
作者：
McKee, Shari A.;Harris, Grant T.;Cormier, Catherine A.
目的：现在，人们对同时发生的药物滥用和精神病问题的有效治疗已经有了很多了解，许多循证实践建议也得到了传播。在日常临床实践中实施这些推荐的干预措施更是一场斗争。本文介绍了成功实施的综合治疗共发生的疾病在一个小型住宅项目。研究方法：一个传统的28天的成瘾服务被转化为一个3个月的综合治疗计划，155名患有并发症的人同意参加其评估。这种转变需要一种全新的手动服务，对所有项目临床医生进行一些临床干预措施的培训，持续的临床监督，以及对客户背景、药物滥用、生活质量、心理健康症状、自尊和对项目满意度的正式测量。我们还获得了间接线人关于参与者症状、物质使用和生活质量的报告。对治疗模型的忠诚度以及参与者的知识和技能获得进行了持续评估。此外，评估了实施该计划对临床医生的士气和对循证实践的态度的影响，以及工作人员的流动率和每日费用。结果如下：尽管有非常有问题的临床和社会人口学史，但完成该计划的86名参与者表现出临床显着的心理健康症状改善，知识和技能的获得，以及对该计划的高度自尊和满意度。计划的忠诚度，临床医生的士气，承诺的程序，并对循证实践的态度是一致的高。取得这些成功的同时，保持了所有医院住院单位的最低住院日成本。结论：研究结果支持这样的论点，即循证综合治疗可以在常规临床实践中忠实地实施，以使参与者、工作人员和医院受益。我们的经验是，让一位科学家兼实践者作为该计划的工作人员领导实施是一个关键因素。今后的报告将侧重于物质使用和生活质量结果的长期随访。
Objective: Much is now known about effective treatment for co-occurring substance abuse and psychiatric difficulties and many evidence-based practice recommendations have been disseminated. Implementation of these recommended interventions in daily clinical practice has been more of a struggle. This article describes successful implementation of integrated treatment for co-occurring disorders in a small residential program. Methods: A traditional 28-day addiction service was transformed into a 3-month integrated treatment program and 155 individuals with co-occurring disorders agreed to participate in its evaluation. The transformation entailed a completely new manualized service, training in a number of clinical interventions for all program clinicians, ongoing clinical supervision, and formal measurement of clients' backgrounds, substance abuse, quality of life, mental health symptoms, self-esteem, and satisfaction with the program. We also obtained collateral informants' reports on participants' symptoms, substance use, and quality of life. Fidelity to the treatment model was continuously assessed, as were participants' knowledge and skill acquisition. In addition, impact of the implementation on the program clinicians' morale and attitudes toward evidence-based practices was assessed, as was staff turnover and per diem costs. Results: Despite very problematic clinical and sociodemographic histories, the 86 participants who completed the program showed clinically significant mental health symptom improvement, acquisition of knowledge and skill, and high self-esteem and satisfaction with the program. Program fidelity, clinician morale, commitment to the program, and attitudes toward evidence-based practice were uniformly high. These successes were achieved while maintaining the lowest per-inpatient day cost of all hospital inpatient units. Conclusions: The findings support the contention that evidence-based integrated treatment can be implemented with fidelity in regular clinical practice to the benefit of participants, staff, and the hospital. Our experience was that having a scientist-practitioner working as a staff member on the program to lead the implementation was a key element. Future reports will focus on longer-term follow-up of substance use and quality of life outcomes.