Marshall Tina, Rapp Charles A, Becker Deborah R, Bond Gary R
Westat, 1650 Research Blvd., Rockville, MD 20850, USA.
Psychiatr Serv. 2008 Aug;59(8):886-92. doi: 10.1176/ps.2008.59.8.886.
This study examined strategies and barriers for implementing supported employment in routine mental health services.
Qualitative and fidelity data from a two-year period (2002-2004) were examined for nine sites participating in the National Evidence-Based Practices Project.
At baseline, none of the sites were providing high-fidelity supported employment. However, by the two-year follow-up, eight of the nine sites successfully implemented high-fidelity programs. Three factors, leadership, mastery, and attitudes, were identified as strongly influencing the implementation (both positively and negatively) across the nine sites.
The findings indicate the need for strong leadership on both the administrative and program levels, an in-depth understanding of the nature and level of training and consultation needed for program leaders and employment specialists, and the value of hiring staff with clinical or business skills. The study also demonstrated that employing staff who doubt and challenge the evidence-based model slows down the implementation process, suggesting the critical role of hiring staff who believe in recovery and supported employment principles.
本研究探讨了在常规心理健康服务中实施支持性就业的策略和障碍。
对参与国家循证实践项目的9个场所为期两年（2002 - 2004年）的定性和保真度数据进行了审查。
在基线时，没有一个场所提供高保真度的支持性就业。然而，到两年随访时，9个场所中的8个成功实施了高保真度项目。领导力、精通程度和态度这三个因素被确定为对9个场所的实施（包括积极和消极方面）有强烈影响。
研究结果表明，在行政和项目层面都需要强有力的领导，需要深入了解项目负责人和就业专家所需培训和咨询的性质及水平，以及聘用具有临床或业务技能的工作人员的价值。该研究还表明，聘用那些怀疑和质疑循证模式的工作人员会减缓实施过程，这表明聘用相信康复和支持性就业原则的工作人员具有关键作用。
