Family Services Research Center, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC 29425, USA.
Adm Policy Ment Health. 2010 Mar;37(1-2):71-80. doi: 10.1007/s10488-010-0278-z.
The industrialization of health care, underway for several decades, offers instructive guidance and models for speeding access of children and families to clinically and cost effective preventive, treatment, and palliative interventions. This industrialization--i.e., the systematized production of goods or services in large-scale enterprises--has the potential to increase the value and effects of care for consumers, providers, and payers (Hayes and Gregg in Integrated behavioral healthcare: Positioning mental health practice with medical/surgical practice. Academic Press, San Diego, 2001), and to generate efficiencies in care delivery, in part because workforce responsibilities become more functional and differentiated such that individuals with diverse educational and professional backgrounds can effectively execute substantive clinical roles (Rees in Clin Exp Dermatol, 33, 39-393, 2008). To date, however, the models suggested by this industrialization have not been applied to children's mental health services. A combination of policy, regulatory, fiscal, systemic, and organizational changes will be needed to fully penetrate the mental health and substance abuse service sectors. In addition, problems with the availability, preparation, functioning, and status of the mental health workforce decried for over a decade will need to be addressed if consumers and payers are to gain access to effective interventions irrespective of geographic location, ethnic background, or financial status. This paper suggests that critical knowledge gaps exist regarding (a) the knowledge, skills, and competencies of a workforce prepared to deliver effective interventions; (b) the efficient and effective organization of work; and (c) the development and replication of effective workforce training and support strategies to sustain effective services. Three sets of questions are identified for which evidence-based answers are needed. Suggestions are provided to inform the development of a scientific agenda to answer these questions.
医疗保健的产业化已经进行了几十年，为加快儿童和家庭获得临床有效且具有成本效益的预防、治疗和姑息干预措施提供了有益的指导和模式。这种产业化——即大规模企业中商品或服务的系统生产——有可能提高医疗服务消费者、提供者和支付者的价值和效果（Hayes 和 Gregg，《综合行为健康护理：将心理健康实践与医疗/外科实践相结合》，学术出版社，圣地亚哥，2001 年），并提高护理服务的效率，部分原因是劳动力的责任变得更加职能化和差异化，使得具有不同教育和专业背景的个人能够有效地执行实质性的临床角色（Rees，《临床实验皮肤病学》，33，39-393，2008 年）。然而，到目前为止，这种产业化所提出的模式尚未应用于儿童心理健康服务。要全面渗透心理健康和药物滥用服务部门，需要政策、监管、财政、系统和组织变革的结合。此外，如果消费者和支付者要获得有效的干预措施，而不论地理位置、族裔背景或财务状况如何，那么需要解决十年来一直存在的关于心理健康劳动力的可用性、准备情况、功能和地位的问题。本文认为，在以下方面存在关键的知识差距：（a）准备提供有效干预措施的劳动力的知识、技能和能力；（b）工作的高效和有效组织；以及（c）发展和复制有效的劳动力培训和支持战略，以维持有效的服务。确定了三组需要有证据支持的答案的问题。提供了建议，以告知制定科学议程来回答这些问题。
