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Zomer L, van der Meer L, van Weeghel J, Widdershoven G, Voskes Y. From Model to Practice: A Qualitative Study on Factors Influencing the Implementation of the Active Recovery Triad (ART) Model in Long-Term Mental Health Care. J Clin Med 2024; 13:3488. [PMID: 38930017 PMCID: PMC11205107 DOI: 10.3390/jcm13123488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/17/2024] [Accepted: 06/09/2024] [Indexed: 06/28/2024] Open
Abstract
Background: The Active Recovery Triad (ART) model provides a framework for recovery-oriented care in the long-term mental health setting. The aim of this study is to gain insight into factors influencing the implementation process of the ART model. Methods: Focus groups were conducted with fourteen multidisciplinary teams that were in the process of implementing the ART model. Data were thematically analyzed. Results: Three phases of implementation were identified. In the first phase, getting started, support from both the top of the organization and the care workers, sufficient information to care workers, service users, and significant others, and creating momentum were considered crucial factors. In the second phase, during implementation, a stable team with a good team spirit, leadership and ambassadors, prioritizing goals, sufficient tools and training, and overcoming structural limitations in large organizations were seen as important factors. In the third phase, striving for sustainability, dealing with setbacks, maintaining attention to the ART model, and exchange with other teams and organizations were mentioned as core factors. Conclusions: The findings may support teams in making the shift from traditional care approaches towards recovery-oriented care in long-term mental health care.
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Affiliation(s)
- Lieke Zomer
- Department of Ethics, Law and Humanities, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands
- Altrecht GGZ, 3705 WC Zeist, The Netherlands
| | - Lisette van der Meer
- Department of Clinical & Developmental Neuropsychology, University of Groningen, 9712 TS Groningen, The Netherlands
- Department of Rehabilitation, Lentis Psychiatric Institute, 9470 AC Zuidlaren, The Netherlands
| | - Jaap van Weeghel
- Tranzo Scientific Center for Care and Wellbeing, Tilburg University, 5037 DB Tilburg, The Netherlands
| | - Guy Widdershoven
- Department of Ethics, Law and Humanities, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands
| | - Yolande Voskes
- Department of Ethics, Law and Humanities, Amsterdam University Medical Centers, 1081 HV Amsterdam, The Netherlands
- Tranzo Scientific Center for Care and Wellbeing, Tilburg University, 5037 DB Tilburg, The Netherlands
- Impact Care Group, GGz Breburg, 5017 JD Tilburg, The Netherlands
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Harkko J, Sipilä N, Nordquist H, Lallukka T, Appelqvist-Schmidlechner K, Donnelly M, Kouvonen A. External context in individual placement and support implementation: a scoping review with abductive thematic analysis. Implement Sci 2023; 18:61. [PMID: 37946209 PMCID: PMC10636871 DOI: 10.1186/s13012-023-01316-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/15/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Context including the external context may considerably affect the adoption, implementation, sustainment, and scale-up of evidence-based practices. We investigated external contextual features by conducting a scoping review of empirical research regarding the implementation of an evidence-based psychiatric or mental health vocational rehabilitation service called Individual Placement and Support (IPS). METHODS The protocol for the scoping review was registered with the Open Science Framework. We used the methodology by Joanna Briggs Institute for conducting the scoping review and reported it according to the PRISMA-ScR checklist. We searched 12 databases for research regarding 'Individual Placement and Support' or 'Evidence-Based Supported Employment'. We retained peer-reviewed empirical studies investigating external contextual factors and their impact on IPS implementation outcomes. We extracted data from the eligible articles and conducted descriptive and thematic analyses. RESULTS Fifty-nine original research papers met our eligibility requirements and were retained after reviewing 1124 titles and abstracts and 119 full texts. The analysis generated two main themes: (1) external contextual determinants of service delivery and (2) external systems influencing the evidence-to-practice process. The first main theme encompassed policies and laws, financing, and administratively instituted support resources, and organizational arrangements associated with external stakeholders that may facilitate or hinder the local implementation. The second main theme comprised strategies and actions used by different stakeholders to facilitate implementation locally or scale-up efforts at a system level. DISCUSSION Our scoping review illustrates the important role that external contextual factors play and how they may facilitate or hinder the implementation and scale-up of the IPS model across mental health services in different countries. Consideration of these factors by decision-makers in mental health and welfare services, planners, providers, and practitioners is likely to facilitate the development of effective strategies for bridging the evidence-practice gap in implementing the EBPs. Finally, the scoping review identified gaps in knowledge and offered suggestions for future research. TRIAL REGISTRATION Open Science Framework.
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Affiliation(s)
- Jaakko Harkko
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland.
| | - Noora Sipilä
- The Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hilla Nordquist
- South-Eastern Finland University of Applied Sciences, Kotka, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | | | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
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3
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Eklund M, Argentzell E. Implementing an occupational therapy specific mental health intervention in a multi-professional context - the case of Balancing Everyday Life (BEL). Scand J Occup Ther 2023; 30:182-194. [PMID: 34739360 DOI: 10.1080/11038128.2021.1998608] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The occupation-based intervention Balancing Everyday Life (BEL) was found effective under controlled conditions but should also be studied in a natural clinical practice context. AIM The aim was to study the implementation process of BEL when provided in a multi-professional mental health team. The focus was particularly on how BEL was received and functioned. METHODS This qualitative study was based on manifest content analysis and used semi-structured telephone interviews with 13 occupational therapists and three managers. RESULTS Three themes were identified: '1 - Conditions and opportunities in the setting', '2 - Putting the BEL intervention into practice' and '3 - Experiences of practicing BEL'. BEL was a welcomed alternative, as stated by managers and occupational therapists. The team helped to recruit BEL participants, but the occupational therapists had to give rigorous information to team members and prospective participants for this to work. The social, physical and political contexts were essential for the implementation. CONCLUSIONS Successful implementation of an occupational therapy-specific intervention such as BEL requires a reasonable match between existing team policies and the underpinnings of the intervention. It is crucial to repeat information to all stakeholders and make the intervention a matter of urgency for the whole team.
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Affiliation(s)
- Mona Eklund
- Department of Health Sciences, Mental Health, Activity and Participation (MAP), Lund University, Lund, Sweden
| | - Elisabeth Argentzell
- Department of Health Sciences, Mental Health, Activity and Participation (MAP), Lund University, Lund, Sweden
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Hall A, Shoesmith A, Doherty E, McEvoy B, Mettert K, Lewis CC, Wolfenden L, Yoong S, Kingsland M, Shelton RC, Wiltsey Stirman S, Imad N, Sutherland R, Nathan N. Evaluation of measures of sustainability and sustainability determinants for use in community, public health, and clinical settings: a systematic review. Implement Sci 2022; 17:81. [PMID: 36514059 PMCID: PMC9746194 DOI: 10.1186/s13012-022-01252-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/19/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Sustainability is concerned with the long-term delivery and subsequent benefits of evidence-based interventions. To further this field, we require a strong understanding and thus measurement of sustainability and what impacts sustainability (i.e., sustainability determinants). This systematic review aimed to evaluate the quality and empirical application of measures of sustainability and sustainability determinants for use in clinical, public health, and community settings. METHODS Seven electronic databases, reference lists of relevant reviews, online repositories of implementation measures, and the grey literature were searched. Publications were included if they reported on the development, psychometric evaluation, or empirical use of a multi-item, quantitative measure of sustainability, or sustainability determinants. Eligibility was not restricted by language or date. Eligibility screening and data extraction were conducted independently by two members of the research team. Content coverage of each measure was assessed by mapping measure items to relevant constructs of sustainability and sustainability determinants. The pragmatic and psychometric properties of included measures was assessed using the Psychometric and Pragmatic Evidence Rating Scale (PAPERS). The empirical use of each measure was descriptively analyzed. RESULTS A total of 32,782 articles were screened from the database search, of which 37 were eligible. An additional 186 publications were identified from the grey literature search. The 223 included articles represented 28 individual measures, of which two assessed sustainability as an outcome, 25 covered sustainability determinants and one explicitly assessed both. The psychometric and pragmatic quality was variable, with PAPERS scores ranging from 14 to 35, out of a possible 56 points. The Provider Report of Sustainment Scale had the highest PAPERS score and measured sustainability as an outcome. The School-wide Universal Behaviour Sustainability Index-School Teams had the highest PAPERS score (score=29) of the measure of sustainability determinants. CONCLUSIONS This review can be used to guide selection of the most psychometrically robust, pragmatic, and relevant measure of sustainability and sustainability determinants. It also highlights that future research is needed to improve the psychometric and pragmatic quality of current measures in this field. TRIAL REGISTRATION This review was prospectively registered with Research Registry (reviewregistry1097), March 2021.
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Affiliation(s)
- Alix Hall
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, Callaghan, NSW, Australia.
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia.
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia.
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia.
| | - Adam Shoesmith
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, Callaghan, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Emma Doherty
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, Callaghan, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Brydie McEvoy
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, Callaghan, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Kayne Mettert
- Kaiser Permanente Washington Health Research Institute, Seattle, USA
| | - Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, USA
- Department of Psychology, University of Washington, Seattle, USA
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, Callaghan, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Serene Yoong
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, Callaghan, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- School of Health Sciences and Social Development, Deakin University, Melbourne, Victoria, Australia
| | - Melanie Kingsland
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, Callaghan, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Rachel C Shelton
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, New York, USA
| | - Shannon Wiltsey Stirman
- Dissemination and Training Division, National Center for PTSD and Department of Psychiatry and Behavioural Sciences, Stanford Medicine, Stanford University, Palo Alto, California, USA
| | - Noor Imad
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- School of Health Sciences, Department of Nursing and Allied Health, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, Callaghan, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, The University of Newcastle, Locked Bag 10 Wallsend, Callaghan, NSW, Australia
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
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Bejerholm U, Allaskog C, Andersson J, Nordström L, Roe D. Implementation of the Recovery Guide in inpatient mental health services in Sweden-A process evaluation study. Health Expect 2022; 25:1405-1417. [PMID: 35340092 PMCID: PMC9327815 DOI: 10.1111/hex.13480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/27/2022] [Accepted: 03/05/2022] [Indexed: 12/31/2022] Open
Abstract
Background Involving service users in inpatient care and recovery planning has gained interest worldwide. Our purpose was to evaluate the process of implementation of a coproduced Recovery Guide (RG) intervention in 22 inpatient wards in Sweden, in terms of context, implementation process and mechanisms of impact over 12 months. Methods A mixed method design and a process evaluation framework were used to guide data collection and to deductively analyze perspectives and descriptive statistics of delivery from three stakeholder groups. Results Results showed that although initial contextual barriers were present (e.g., lack of resources, and interest, uncertainty in the organization, a dominant illness perspective), it was possible to implement the RG in 14 wards, where 53% of admitted service users received the intervention. Legitimacy of the intervention, engaged managers and staff, capacity of staff and ward organization, coproduction and continuous support from user organization were critical mediators. Mechanisms of impact concerned (1) a new perspective on mental health, well‐being and recovery, (2) capacity building of a recovery approach in inpatient settings and (3) a meaningful outlet for users' thoughts and feelings on recovery, sharing narratives and influencing care and goals. Conclusions The RG intervention has the potential to promote a recovery approach in inpatient mental health services (MHSs). Coproduction among stakeholders created trust and a sustainable implementation that made it possible for wards to resume implementation when contextual barriers had been resolved. Patient and Public Contribution The current study involved stakeholders including a service user organization, the public, first‐line managers and staff (including peer support workers) in inpatient and community MHS and researchers, who greatly contributed to the implementation programme, including codesign of the RG intervention as well as coproduction of the implementation in inpatient MHS. All authors have their own lived experiences of mental health problems as a service user or as a relative.
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Affiliation(s)
- Ulrika Bejerholm
- Department of Health Sciences, Centre of Evidence-Based Psychosocial Interventions, CEPI, Lund University, Lund, Sweden.,Department of Research, Development and Education, Division of Psychiatry and Habilitation, Lund, Sweden
| | - Conny Allaskog
- The Swedish Partnership for Mental Health, NSPH, Skåne, Sweden
| | | | - Linda Nordström
- The Swedish Partnership for Mental Health, NSPH, Skåne, Sweden
| | - David Roe
- Department of Health Sciences, Centre of Evidence-Based Psychosocial Interventions, CEPI, Lund University, Lund, Sweden.,Department of Community Mental Health, University of Haifa, Haifa, Israel.,Department of Clinical Medicine, Psychiatry, Aalborg University, Aalborg, Denmark
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6
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Miranda AAV, Murta SG. Difusão de Programas Preventivos em Saúde Mental: Notas Teóricas. PSICOLOGIA: TEORIA E PESQUISA 2022. [DOI: 10.1590/0102.3772e38421.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Resumo Transtornos mentais causam incapacidades e mortes prematuras, além de representarem custos psicológico, social e econômico elevados. Embora programas de prevenção e promoção em saúde mental com evidências de efetividade estejam disponíveis, são pouco difundidos mundo afora e, em particular, no Brasil. Este artigo tem o propósito de discutir a difusão de programas de prevenção e promoção em saúde mental, segundo as lentes da Teoria da Difusão de Inovações e os desdobramentos contemporâneos. Ênfase será dada às etapas de disseminação, adoção, implementação e sustentabilidade. Implicações para o ensino, a pesquisa e a gestão são discutidas.
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Moe C, Brinchmann B, Rasmussen L, Brandseth OL, McDaid D, Killackey E, Rinaldi M, Borg M, Mykletun A. Implementing individual placement and support (IPS): the experiences of employment specialists in the early implementation phase of IPS in Northern Norway. The IPSNOR study. BMC Psychiatry 2021; 21:632. [PMID: 34930203 PMCID: PMC8690340 DOI: 10.1186/s12888-021-03644-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For decades there has been a continuous increase in the number of people receiving welfare benefits for being outside the work force due to mental illness. There is sufficient evidence for the efficacy of Individual Placement and Support (IPS) for gaining and maintaining competitive employment. Yet, IPS is still not implemented as routine practice in public community mental health services. Knowledge about implementation challenges as experienced by the practitioners is limited. This study seeks to explore the experiences of the front-line workers, known as employment specialists, in the early implementation phase. METHODS Qualitative data were collected through field notes and five focus group interviews. The study participants were 45 IPS employment specialists located at 14 different sites in Northern Norway. Transcripts and field notes were analysed by thematic analyses. RESULTS While employment specialists are key to the implementation process, implementing IPS requires more than creating and filling the role of the employment specialist. It requires adjustments in multiple organisations. The new employment specialist then is a pioneer of service development. Some employment specialists found this a difficult challenge, and one that did not correspond to their expectations going into this role. Others appreciated the pioneering role. IPS implementation also challenged the delegation of roles and responsibilities between sectors, and related legal frameworks related to confidentiality and access. The facilitating role of human relationships emphasised the importance of social support which is an important factor in a healthy work environment. Rural areas with long distances and close- knit societies may cause challenges for implementation. CONCLUSION The study provides increased understanding on what happens in the early implementation phase of IPS from the employment specialists' perspective. Results from this study can contribute to increased focus on job satisfaction, turnover and recruitment of employment specialists, factors which have previously been shown to influence the success of IPS. The greatest challenge for making "IPS efficacy in trials" become "IPS effectiveness in the real world" is implementation, and this study has highlighted some of the implementation issues.
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Affiliation(s)
- Cathrine Moe
- Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway. .,Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway.
| | - Beate Brinchmann
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway ,grid.10919.300000000122595234Department of Community Medicine, UiT – The Arctic University of Norway, Tromsø, Norway
| | - Line Rasmussen
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway
| | - Oda Lekve Brandseth
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway
| | - David McDaid
- grid.13063.370000 0001 0789 5319Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Eóin Killackey
- grid.488501.0Orygen, Melbourne, Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Miles Rinaldi
- grid.439450.f0000 0001 0507 6811South West London and St George’s Mental Health NHS Trust, London, UK
| | - Marit Borg
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway ,grid.463530.70000 0004 7417 509XUniversity of South-Eastern Norway, Drammen, Norway
| | - Arnstein Mykletun
- grid.420099.6Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway ,grid.10919.300000000122595234Department of Community Medicine, UiT – The Arctic University of Norway, Tromsø, Norway ,grid.412008.f0000 0000 9753 1393Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway ,grid.418193.60000 0001 1541 4204Division for Health Sciences, Norwegian Institute of Public Health, Oslo, Norway
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8
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Allchin B, Weimand BM, O'Hanlon B, Goodyear M. Continued capacity: Factors of importance for organizations to support continued Let's Talk practice - a mixed-methods study. Int J Ment Health Nurs 2020; 29:1131-1143. [PMID: 32597013 DOI: 10.1111/inm.12754] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/15/2020] [Accepted: 05/27/2020] [Indexed: 12/31/2022]
Abstract
Sustainability is a desired outcome of implementation. Understanding how organizations support new practices after implementation is important for sustainability. Let's Talk about Children (hereby referred to as 'Let's Talk'), a family-focused intervention with parents with a mental illness, improves family, parent, and child outcomes. Little is understood about how organizations support sustained practice. The study aimed to (i) understand the implementation process that occurred in eight adult mental health services during a previous randomized controlled trial; (ii) establish their continued capacity to embed Let's Talk; and (iii) explore links between organizational capacity and sustained delivery by practitioners. This mixed method study used a questionnaire and individual interviews to collect data on the implementation process and current organizational capacity to support Let's Talk 12months after the randomized controlled trial. Links between organizational capacity and the adult mental health services with practitioners' continuing to use Let's Talk in the past 12 months were explored. Services with higher current organizational capacity scores had practitioners currently delivering Let's Talk. These services had all made changes to their organizational structures to support Let's Talk practice. All services experienced significant changes during and after implementation, influencing sustainability of Let's Talk. Addressing organizational capacity appears to be important to enable sustainability of Let's Talk implementation endeavours. Real-world settings are constantly changing systems requiring ongoing tracking and adjustments to understand and support sustainability. Internal service development staff appear to support the shaping of organizational capacity to support Let's Talk; however, broader organizational support is needed for change within a complex system.
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Affiliation(s)
- Becca Allchin
- School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Eastern Health Mental Health Program, Melbourne, Victoria, Australia
| | - Bente M Weimand
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.,Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,School of Nursing and Midwifery, Queens Universitsy Belfast, Belfast, UK
| | - Brendan O'Hanlon
- The Bouverie Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Melinda Goodyear
- School of Rural Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Emerging Minds, Hilton, SA, Australia
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9
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Sustainability of innovations in healthcare: A systematic review and conceptual framework for professional pharmacy services. Res Social Adm Pharm 2020; 16:1331-1343. [DOI: 10.1016/j.sapharm.2020.01.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 12/13/2019] [Accepted: 01/26/2020] [Indexed: 01/11/2023]
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10
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Engdahl P, Svedberg P, Lexén A, Bejerholm U. Role of a Digital Return-To-Work Solution for Individuals With Common Mental Disorders: Qualitative Study of the Perspectives of Three Stakeholder Groups. JMIR Form Res 2020; 4:e15625. [PMID: 32936089 PMCID: PMC7527904 DOI: 10.2196/15625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 05/22/2020] [Accepted: 06/25/2020] [Indexed: 01/29/2023] Open
Abstract
Background Although effective return-to-work (RTW) interventions are not widely available for individuals with common mental disorders on sick leave, there is potential for transforming such interventions into a digital solution in an effort to make them more widely available. However, little is currently known about the viewpoints of different stakeholder groups, which are critical for successful development and implementation of a digital RTW intervention in health care services. Objective The aim of this study was to examine stakeholder groups’ perspectives on the role and legitimacy of a digital RTW solution called mWorks for individuals with common mental disorders who are on sick leave. Methods A purposeful snowball sampling method was utilized to recruit respondents. Semistructured individual and focus group interviews were conducted for stakeholder groups of service users, RTW professionals, and influential managers regarding their experiences, needs, and preferences for mWorks. Content analysis generated themes and categories that constituted the main findings. Results The legitimacy of a digital RTW solution was high among all stakeholder groups since such a tool was perceived to enable service users to take control over their RTW process. This was mainly a product of accessible support and promotion of service user decision making, which had the potential to empower service users. All respondents stressed the importance of fostering a positive user experience with usability and emphasis on service user resources and strengths, as opposed to various limitations and shortcomings. Stakeholder groups highlighted critical content to facilitate RTW, such as the need to clarify a back-to-work plan, accompanied by an accessible RTW network and strategies for handling mental health problems. Implementation challenges primarily involved influential managers’ concern of legislation incompatibility with innovative technology, and RTW professionals’ concern of the possibility that digital solutions may replace them to a certain extent. Conclusions This formative research emphasizes the importance of shifting power from RTW professionals to service users. mWorks can play a role in mediating service user control over the RTW process, and thereby increase their empowerment. A digital RTW solution may facilitate the circumvention of implementation barriers associated with introducing evidence-based RTW interventions in a traditional RTW context.
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Affiliation(s)
- Patrik Engdahl
- Mental Health, Activity and Participation, Department of Health Science, Lund University, Lund, Sweden
| | - Petra Svedberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Annika Lexén
- Mental Health, Activity and Participation, Department of Health Science, Lund University, Lund, Sweden
| | - Ulrika Bejerholm
- Mental Health, Activity and Participation, Department of Health Science, Lund University, Lund, Sweden
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11
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Prior S, Maciver D, Aas RW, Kirsh B, Lexen A, van Niekerk L, Irvine Fitzpatrick L, Forsyth K. An enhanced individual placement and support (IPS) intervention based on the Model of Human Occupation (MOHO); a prospective cohort study. BMC Psychiatry 2020; 20:361. [PMID: 32641009 PMCID: PMC7346406 DOI: 10.1186/s12888-020-02745-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 06/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Employment is good for physical and mental health, however people with severe mental illness (SMI) are often excluded from employment. Standard Individual Placement and Support (IPS) is effective in supporting around 55% of people with SMI into employment or education. Current research considers enhancements to IPS to improve outcomes for those requiring more complex interventions. Clinicians need to better understand who will benefit from these enhanced IPS interventions. This study offers a new enhanced IPS intervention and an approach to predicting who may achieve successful outcomes. METHODS This prospective cohort study included people with SMI who participated in an enhanced IPS service and had prolonged absence from employment. Secondary data analysis was conducted of data gathered in routine clinical practice. Univariate analysis coupled with previous research and clinical consultation was used to select variables to be included in the initial model, followed by a backward stepwise approach to model building for the final multiple logistic regression model with an outcome of successful or unsuccessful goal attainment (employment or education). RESULTS Sixty-three percent of participants in the enhanced IPS successfully attained employment or education. Significant relationships from bivariate analyses were identified between outcomes (employment or education) and seven psychosocial variables. Adapting Routines to Minimise Difficulties, Work Related Goals, and Living in an Area of Lesser Deprivation were found to be significant in predicting employment or education in the final multiple logistic regression model R2 = 0.16 (Hosmer-Lemeshow), 0.19 (Cox-Snell), 0.26 (Nagelkerke). Model χ2(7) = 41.38 p < .001. CONCLUSION An enhanced IPS service had a 63% rate success in achieving employment or education, higher than comparable studies and provides an alternative to IPS-Lite and IPS-standard for more complex populations. Motivational and habitual psychosocial variables are helpful in predicting who may benefit from an enhanced IPS intervention supporting people after prolonged absence from employment. TRIAL REGISTRATION NCT04083404 Registered 05 September 2019 (retrospectively registered).
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Affiliation(s)
- Susan Prior
- Queen Margaret University, Edinburgh, EH21 6UU, UK.
| | - Donald Maciver
- grid.104846.fQueen Margaret University, Edinburgh, EH21 6UU UK
| | - Randi W. Aas
- Faculty of Health Sciences, University of Stavanger & Oslo Metropolitan University, Oslo, Norway
| | - Bonnie Kirsh
- grid.17063.330000 0001 2157 2938Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Annika Lexen
- grid.4514.40000 0001 0930 2361Department of Health Sciences/Mental Health Activity and Participation (MAP), Lund University, Lund, Sweden
| | - Lana van Niekerk
- grid.11956.3a0000 0001 2214 904XDivision of Occupational Therapy, University Stellenbosch, Stellenbosch, South Africa
| | - Linda Irvine Fitzpatrick
- Mental Health and Wellbeing, City of Edinburgh Health and Social Care Partnership, Waverley Court, Edinburgh, EH8 8BG UK
| | - Kirsty Forsyth
- grid.104846.fQueen Margaret University, Edinburgh, EH21 6UU UK
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12
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Johanson S, Markström U, Larsson ME, Bejerholm U. Implementation of a novel return-to-work approach for persons with affective disorders in a traditional vocational rehabilitation context: a case study. Int J Ment Health Syst 2020; 14:22. [PMID: 32206085 PMCID: PMC7079353 DOI: 10.1186/s13033-020-00355-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 03/10/2020] [Indexed: 11/18/2022] Open
Abstract
Background The person-centred Individual Enabling and Support (IES) model is a novel return-to-work (RTW) intervention for people with affective disorders that was developed from evidence-based supported employment for persons with severe mental illness. Typically, supported employment is integrated into mental healthcare and provides a network around the service user and close collaboration with employment and insurance services and employers. Introducing integrated models into a highly sectored welfare system that includes traditional mental healthcare and vocational rehabilitation is challenging. Greater knowledge is needed to understand how facilitating or hindering factors influence this introduction. The aim of this study was to investigate essential components in implementation of the IES model. Methods A case-study was conducted and included four mental healthcare services. Data collection was comprised of semi-structured interviews with 19 key informants, documentation from meetings, and reflection notes. Analyses were performed according to directed content analysis, using the components of the Consolidated Framework of Implementation Research (CFIR) as a guiding tool. Fidelity assessments were performed at 6 and 12 months. Results Anticipating RTW support for the target group, and building collaborative relationships and a network with employment specialists that engaged staff in every organization were components that resulted in the greatest facilitation if IES implementation. Barriers consisted of difficulty in integrating employment specialists into the mental healthcare teams, insufficient engagement of first line managers, reorganization and differing perceptions of the IES model fit into a traditional vocational context. Delivery of the IES model had good fidelity. Conclusions The IES model can be implemented with good fidelity, several model advantages, and context adaptation. Team integration difficulties and negative perceptions of model fit in a traditional vocational rehabilitation context can be overcome to a certain degree, but this is insufficient for sustainable implementation on a larger scale. Policy and guidelines need to promote integrative and person-centred RTW approaches rather than a segregated stepwise approach. Further implementation studies in the traditional vocational rehabilitation context are needed.
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Affiliation(s)
- Suzanne Johanson
- 1Department of Health Sciences/Mental Health, Activity and Participation, Medical Faculty, Lund University, Lund, Sweden
| | | | - Maria E Larsson
- 3Department of Neuroscience and Physiology, Gothenburg University, Gothenburg, Sweden
| | - Ulrika Bejerholm
- 1Department of Health Sciences/Mental Health, Activity and Participation, Medical Faculty, Lund University, Lund, Sweden
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Complex Interventions and Interorganisational Relationships: Examining Core Implementation Components of Assertive Community Treatment. Int J Integr Care 2018; 18:11. [PMID: 30532665 PMCID: PMC6284138 DOI: 10.5334/ijic.3547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: There is increasing interest in implementing evidence-based integrated models of care in community-based mental health service systems. Assertive Community Treatment (ACT) is seen as an attractive, and at the same time challenging, model to implement in sectored service settings. This study investigates the implementation process of such an initiative. Methods: Interviews were conducted with ACT team members, the process leader, steering group members, and collaboration partners. The “Sustainable Implementation Scale” helped to identify critical implementation components, and these were further explored using the qualitative interview data. The “Tool for Measuring Assertive Community Treatment” addressed programme fidelity, and the initiative’s sustainability was assessed. Results: High-fidelity implementation of ACT in a sectored service setting is possible. Prominent components that facilitated implementation were careful preparations, team members’ characteristics, and efforts by the process leader and the steering group to improve networking. Implementation was hampered by conflicting goals among the involved authorities and a mismatch between the ACT model’s characteristics and existing organisational traditions and regulations. Discussion and Conclusions: Reducing the uncertainty caused by conflicting goals is an important step in improving the implementation of ACT. In order to facilitate implementation, the goals, regulations, and availability of resources should be aligned horizontally and vertically through the involved organisations.
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Abstract
BACKGROUND One goal within positive psychiatry is to support the personal recovery of persons with mental illness and providing opportunities for well-being. AIM The current article aims to introduce readers to the concept of personal recovery and the potential and importance of recovery-oriented services and measures. METHODS A literature review was conducted to help consider the domains of 'personal recovery', 'recovery-oriented services/interventions', and 'measures'. A database search was complemented with a web-based search. Both medical subject heading (MESH) terms and free-text search terms were used. RESULTS Literature from research journals, grey literature, and websites were included. Within this context, recovery does not refer to a cure but involves a process in which a person acts as an agent to develop new goals and meaning in life, despite and beyond limitations posed by the illness and its consequences. A positive focus on recovery is in sharp contrast to historical deterministic and pessimistic concepts of mental illnesses. Recovery-oriented services such as peer support, assertive community treatment, supported employment/education/housing, illness self-management, and decreasing self-stigma are highlighted. A review of 27 measures that focus on personal recovery and promotion of well-being are also discussed. CONCLUSIONS The literature overview presents perspectives and knowledge of how to develop positive psychiatry, how mental health services and their partner organizations may become more recovery oriented and help persons reach well-being and a better quality of life. This study is limited to a narrative review and may precede future systematic reviews.
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Affiliation(s)
- Ulrika Bejerholm
- a Department of Health Sciences/Mental Health, Activity and Participation , Lund University , Lund , Sweden.,b Center for Evidence-based Psychosocial Interventions (CEPI) , Lund University , Lund , Sweden
| | - David Roe
- c Department of Community Mental Health , University of Haifa , Haifa , Israel.,d Department of Medicine , Aalborg University , Aalborg , Denmark
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