Fidelity outcomes in the national implementing evidence-based practices project
Fidelity outcomes in the national implementing evidence-based practices project
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DOI：
10.1176/appi.ps.58.10.1279
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发表时间：
2007-10-01
影响因子：
3.8
通讯作者：
Finnerty, Molly T.
中科院分区：
文献类型：
--
作者：
McHugo, Gregory J.;Drake, Robert E.;Finnerty, Molly T.
目的：本文介绍了在国家实施循证实践项目中在常规公共心理卫生机构实施的五种循证实践的保真度结果。方法：在两年的时间里，八个州的53个社区精神卫生中心实施了五种循证实践中的一种：支持就业、自信的社区治疗、综合双重障碍治疗、家庭心理教育以及疾病管理和康复。实践传播干预模式指导实施。每个站点都使用人力资源（顾问-培训师）和物质资源（工具包）来帮助实践实现并促进组织变化。从基线到两年，外部评估人员每六个月评估一次对循证实践模型的忠实度。结果：超过一半的站点（53个站点中的29个，即55%）在两年后显示了高保真度的实现。基于证据的实践在保真度方面出现了显著差异。支持就业和自信的社区治疗在基线和跨时间具有更高的保真度得分。疾病管理和康复以及综合双重障碍治疗在整个过程中的平均得分较低。一般来说，基于证据的实践表明，从基线到12个月，保真度有所增加，得分在12至24个月之间趋于平稳。结论：大多数精神卫生中心以中等到高保真度实施这些循证实践。实施的关键时期约为12个月，此后几乎没有取得任何进展，尽管各地点在另一年里保持了已达到的循证实践忠实度水平。
Objective: This article presents fidelity outcomes for five evidence-based practices that were implemented in routine public mental health settings in the National Implementing Evidence-Based Practices Project. Methods: Over a two-year period 53 community mental health centers across eight states implemented one of five evidence-based practices: supported employment, assertive community treatment, integrated dual disorders treatment, family psychoeducation, and illness management and recovery. An intervention model of practice dissemination guided the implementation. Each site used both human resources ( consultant-trainers) and material resource ( toolkits) to aid practice implementation and to facilitate organizational changes. External assessors rated fidelity to the evidence-based practice model every six months from baseline to two years. Results: More than half of the sites ( 29 of 53, or 55%) showed high-fidelity implementation at the end of two years. Significant differences in fidelity emerged by evidence-based practice. Supported employment and assertive community treatment had higher fidelity scores at baseline and across time. Illness management and recovery and integrated dual disorders treatment had lower scores on average throughout. In general, evidence-based practices showed an increase in fidelity from baseline to 12 months, with scores leveling off between 12 and 24 months. Conclusions: Most mental health centers implemented these evidence-based practices with moderate to high fidelity. The critical time period for implementation was approximately 12 months, after which few gains were made, although sites sustained their attained levels of evidence-based practice fidelity for another year.