Williams C H J
User Friendly Psychiatry Ltd, Northwich, Cheshire, UK.
J Psychiatr Ment Health Nurs. 2008 Dec;15(10):850-6. doi: 10.1111/j.1365-2850.2008.01332.x.
Assertive outreach is an evidence-based intervention, with over 30 well-designed randomized studies demonstrating its effectiveness, predominately in the USA. Assertive outreach teams have recently been implemented in the UK, and it has been recommended that teams should offer cognitive behaviour therapy (CBT) to service users; however, it has been reported that barriers exist in the routine delivery of CBT for psychosis (CBTp). The aim of the peer audit was to gauge current opinion from clinicians whether their experiences of barriers to implementation of CBTp reflected that outlined in the literature. A qualitative peer audit was undertaken at the National Forum for Assertive Outreach Annual Conference in 2006. The team representatives were invited to outline the barriers to the implementation of psychosocial interventions within their local areas. Teams identified organizational, managerial, supervision and local specific barriers to implementation. Specific comments included a lack of organizational investment, the structured nature of CBT, caseload issues, medication issues, application to people with sensory impairments, staff apathy and staff burnout. The analysis was limited by the metholodology employed; however, further recommendations are explored. It was evident from this peer audit that teams are experiencing barriers relating to the implementation of evidence-based therapy interventions and further research is required on the outreach model and the use of CBTp.
主动外展是一种基于证据的干预措施,有30多项精心设计的随机研究证明了其有效性,主要是在美国。主动外展团队最近在英国得到了应用,并且有人建议这些团队应该为服务对象提供认知行为疗法(CBT);然而,据报道,在常规提供针对精神病的认知行为疗法(CBTp)方面存在障碍。同行审核的目的是评估临床医生目前的看法,即他们在实施CBTp时遇到的障碍经历是否与文献中所述的一致。2006年在全国主动外展论坛年会上进行了一次定性同行审核。团队代表被邀请概述他们所在地区在实施社会心理干预措施时遇到的障碍。各团队确定了实施过程中的组织、管理、监督和当地特有的障碍。具体意见包括缺乏组织投入、CBT的结构化性质、工作量问题、药物治疗问题、对有感官障碍者的应用、工作人员冷漠和倦怠。分析受到所采用方法的限制;然而,进一步的建议正在探讨中。从这次同行审核中可以明显看出,各团队在实施循证治疗干预措施方面遇到障碍,需要对外展模式和CBTp的使用进行进一步研究。