King's College London, Addictions Department, Institute of Psychiatry, London, UK.
BMC Psychiatry. 2013 Jun 13;13:167. doi: 10.1186/1471-244X-13-167.
Recovery has become an increasingly prominent concept in mental health policy internationally. However, there is a lack of guidance regarding organisational transformation towards a recovery orientation. This study evaluated the implementation of recovery-orientated practice through training across a system of mental health services.
The intervention comprised four full-day workshops and an in-team half-day session on supporting recovery. It was offered to 383 staff in 22 multidisciplinary community and rehabilitation teams providing mental health services across two contiguous regions. A quasi-experimental design was used for evaluation, comparing behavioural intent with staff from a third contiguous region. Behavioural intent was rated by coding points of action on the care plans of a random sample of 700 patients (400 intervention, 300 control), before and three months after the intervention. Action points were coded for (a) focus of action, using predetermined categories of care; and (b) responsibility for action. Qualitative inquiry was used to explore staff understanding of recovery, implementation in services and the wider system, and the perceived impact of the intervention. Semi-structured interviews were conducted with 16 intervention group team leaders post-training and an inductive thematic analysis undertaken.
A total of 342 (89%) staff received the intervention. Care plans of patients in the intervention group had significantly more changes with evidence of change in the content of patient's care plans (OR 10.94. 95% CI 7.01-17.07) and the attributed responsibility for the actions detailed (OR 2.95, 95% CI 1.68-5.18). Nine themes emerged from the qualitative analysis split into two superordinate categories. 'Recovery, individual and practice', describes the perception and provision of recovery orientated care by individuals and at a team level. It includes themes on care provision, the role of hope, language of recovery, ownership and multidisciplinarity. 'Systemic implementation', describes organizational implementation and includes themes on hierarchy and role definition, training approaches, measures of recovery and resources.
Training can provide an important mechanism for instigating change in promoting recovery-orientated practice. However, the challenge of systemically implementing recovery approaches requires further consideration of the conceptual elements of recovery, its measurement, and maximising and demonstrating organizational commitment.
康复在国际精神卫生政策中已成为一个日益突出的概念。然而，在向康复方向进行组织转型方面，缺乏指导。本研究通过在一个精神卫生服务系统中进行培训，评估了康复导向实践的实施情况。
该干预措施包括四个为期一天的研讨会和一个团队内部半天的关于支持康复的会议。它提供给了 22 个多学科社区和康复团队的 383 名工作人员，这些团队在两个相邻的地区提供精神卫生服务。采用准实验设计对干预进行评估，将工作人员的行为意向与第三个相邻地区的工作人员进行比较。行为意向是通过对随机抽取的 700 名患者（400 名干预组，300 名对照组）的护理计划中的行动要点进行编码来评估的，这些患者的护理计划是在干预之前和干预后三个月进行编码的。行动要点是根据预先确定的护理类别进行编码的：(a) 行动重点；和(b) 行动责任。采用定性探究方法，探索工作人员对康复的理解、在服务和更广泛系统中的实施情况，以及干预的预期影响。在培训后对干预组的 16 名团队负责人进行了半结构访谈，并进行了归纳主题分析。
共有 342 名（89%）工作人员接受了干预。干预组患者的护理计划发生了显著变化，表现为患者护理计划内容发生变化（OR 10.94，95%CI 7.01-17.07），详细行动的归因责任也发生了变化（OR 2.95，95%CI 1.68-5.18）。定性分析得出了九个主题，分为两个上位类别。“康复、个体和实践”描述了个人和团队层面上对康复导向护理的感知和提供。它包括关于护理提供、希望的作用、康复语言、所有权和多学科的主题。“系统实施”描述了组织实施，包括主题，如层次结构和角色定义、培训方法、康复措施和资源。
培训可以为推动康复导向实践的变革提供一个重要机制。然而，在系统地实施康复方法方面的挑战需要进一步考虑康复的概念要素、其测量方法，以及最大限度地提高和展示组织承诺。
