The state policy context of implementation issues for evidence-based practices in mental health
The state policy context of implementation issues for evidence-based practices in mental health
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DOI：
10.1176/appi.ps.58.7.914
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发表时间：
2007-07-01
影响因子：
3.8
通讯作者：
Goldman, Howard H.
中科院分区：
文献类型：
--
作者：
Isett, Kimberley R.;Burnam, M. Audrey;Goldman, Howard H.
目的：本研究分析了与几个严重精神疾病的成年人，包括在国家示范项目的循证实践的实施问题。本调查中包括的五个循证实践是自信的社区治疗，家庭心理教育，疾病管理和康复，综合双重诊断治疗和支持就业。这项研究的目的是评估州精神卫生当局作为变革推动者的作用。研究方法：两人小组与州精神卫生当局、消费者、家庭、地方精神卫生当局的代表和其他相关州机构的代表进行了访谈，八个地点中每个地点有30多人。访谈在至少相隔一年的两个时间点进行，探讨了在州一级实施的促进者和障碍。对数据进行了定性评估，以确定各州与每种循证实践的领导力、培训和监管问题相关的共同趋势和问题。结果如下：这五种做法中的每一种都有不同的关键突发事件，需要在全州范围内实施，并需要独特的资产来解决州精神卫生当局的这些突发事件。应急资金与以下关键领域有关：筹资和规章、领导、培训和质量。结论：各州是实施循证实践的关键，但各州精神卫生当局应注意到，每种实践都需要不同的技能组合，并涉及不同的利益攸关方。因此，同时实施许多循证实践可能不会产生规模经济。
Objectives: This study analyzed implementation issues related to several evidence-based practices for adults with serious mental illness that were included in a national demonstration project. The five evidence-based practices included in this investigation are assertive community treatment, family psychoeducation, illness management and recovery, integrated dual diagnosis treatment, and supported employment. The objective of the study was to assess the role of state mental health authorities as agents of change. Methods: Two-person teams conducted interviews with state mental health authorities, consumers, families, representatives of local mental health authorities, and representatives of other relevant state agencies-more than 30 individuals at each of the eight sites. Interviews took place at two time points at least one year apart and probed the facilitators and barriers to implementation at the state level. Data were assessed qualitatively to identify common trends and issues across states related to leadership, training, and regulatory issues for each evidence-based practice. Results: Each of the five practices has different critical contingencies for statewide implementation and requires unique assets to address those contingencies by the state mental health authorities. The contingencies are related to these critical areas: financing and regulations, leadership, and training and quality. Conclusions: States are key to implementing evidence-based practices, but state mental health authorities should note that each of the practices requires different skill sets and involves different stakeholders. Thus implementing many evidence-based practices at once may not yield economies of scale.