Student, Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec.
Associate Professor, School of Rehabilitation, University of Montreal, Montreal, Quebec; Researcher, Centre d'études sur la réadaptation, le rétablissement et l'insertion sociale (CÉRRIS), Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montreal, Quebec.
Can J Psychiatry. 2014 Apr;59(4):178-86. doi: 10.1177/070674371405900402.
Providing comprehensive care to people with severe mental illness (SMI) involves moving beyond pharmacological treatment and ensuring access to a wide range of evidence-based psychosocial services. Numerous initiatives carried out in North America and internationally have promoted the widespread adoption of such services. Objectives of this rapid review were 3-fold: to identify these implementation initiatives, to describe the implementation strategies used to promote the uptake of psychosocial services, and to identify key issues related to the implementation of a broad range of services. Part 1 presents findings for objectives 1 and 2 of the review.
Searches were carried out in MEDLINE and PsycINFO for reports published between 1990 and 2012 using key words related to SMI, psychosocial practices, and implementation. Contacts with experts and reference list and reverse citation searches were also conducted.
Fifty-five articles were retained that identified more than a dozen major North American and international implementation initiatives. Initiative leaders employed diverse strategies at the planning, execution, and evaluation stages of the implementation process. Stakeholder meetings, training, ongoing consultation, and quality or fidelity monitoring were strategies consistently adopted across most initiatives, whereas theory-based approaches and organizational- and system-level strategies were less frequently described.
Insights from the initiatives identified in this review can help guide future efforts to implement a broad range of psychosocial services for people with SMI. However, such efforts will also need to be informed by more rigorous, theory-based studies of implementation processes and outcomes.
为严重精神疾病（SMI）患者提供全面护理不仅需要超越药物治疗，还需要确保他们能够获得广泛的基于证据的心理社会服务。在北美和国际上开展了许多举措，以促进广泛采用此类服务。本次快速审查的目的有三个：确定这些实施举措，描述用于促进心理社会服务采用的实施策略，以及确定与广泛实施服务相关的关键问题。第 1 部分介绍了审查目标 1 和 2 的调查结果。
在 MEDLINE 和 PsycINFO 中搜索了 1990 年至 2012 年期间发表的与 SMI、心理社会实践和实施相关的关键词报告。还与专家联系，进行了参考文献和反向引文搜索。
保留了 55 篇文章，这些文章确定了十多项主要的北美和国际实施举措。倡议领导者在实施过程的规划、执行和评估阶段采用了多样化的策略。利益相关者会议、培训、持续咨询和质量或保真度监测是大多数举措中一致采用的策略，而基于理论的方法和组织和系统层面的策略则较少描述。
本综述确定的举措提供的见解可以帮助指导未来为 SMI 患者实施广泛的心理社会服务的努力。然而，这些努力还需要更严格的、基于理论的实施过程和结果研究的指导。
