一线工作者实施家访服务时的研究支持干预与自由裁量权
Research-Supported Intervention and Discretion Among Frontline Workers Implementing Home Visitation Services.
作者信息
Willging Cathleen E, Trott Elise M, Fettes Danielle, Gunderson Lara, Green Amy E, Myers Roseann, Hurlburt Michael S, Aarons Gregory A
机构信息
Pacific Institute for Research and Evaluation, Behavioral Health Research Center of the Southwest, Albuquerque, NM, USA.
Child and Adolescent Services Research Center, University of California, San Diego, CA, USA.
出版信息
Res Soc Work Pract. 2017 Oct;27(6):664-675. doi: 10.1177/1049731515601897. Epub 2015 Sep 8.
OBJECTIVE
We examine how frontline workers and supervisors delivering a research supported intervention (RSI) to reduce child neglect negotiated system-related challenges, the pragmatics of RSI implementation, and their professional identities and relationships with clients.
METHODS
We conducted semi-structured interviews, small group discussions, and focus groups with frontline workers and supervisors in one large county over two time periods. We used iterative coding to analyze qualitative data.
RESULTS
Frontline workers navigated several aspects of RSI implementation and sustainment: (1) contract requirements and information dissemination, (2) fidelity, (3) competing demands and crises, (4) structure versus creativity, and (5) relationships with clients.
CONCLUSIONS
Workers dynamically negotiated multiple system- and provider-level (or outer- and inner-contextual) demands influencing RSI provision for clients with complex service needs. Results affirm the need to attend to the unintended consequences of implementing new contract, reimbursement, and other system organizational processes and to address the "committed work" supporting RSI delivery.
目的
我们研究了提供一项旨在减少儿童忽视的研究支持性干预措施（RSI）的一线工作人员和主管如何应对与系统相关的挑战、RSI实施的实际情况，以及他们的职业身份和与客户的关系。
方法
我们在一个大县分两个时间段对一线工作人员和主管进行了半结构化访谈、小组讨论和焦点小组访谈。我们使用迭代编码来分析定性数据。
结果
一线工作人员应对了RSI实施和维持的几个方面：（1）合同要求和信息传播，（2）保真度，（3）相互竞争的需求和危机，（4）结构与创造力，以及（5）与客户的关系。
结论
工作人员动态地协商了多个系统和提供者层面（或外部和内部背景）的需求，这些需求影响了为有复杂服务需求的客户提供RSI。结果证实，需要关注实施新合同、报销和其他系统组织流程的意外后果，并解决支持RSI交付的“承诺工作”。
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