Dr. Garety, Dr. Craig, Dr. Fornells-Ambrojo, Dr. Jolley, Dr. Landau, Dr. McCrone, Mr. Zala, and Dr. Waller are with the Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London. Dr. Garety, Dr. Fornells-Ambrojo, Dr. Jolley, and Dr. Waller are also with South London and Maudsley National Health Service (NHS) Foundation Trust, London, where Ms. Iredale, Dr. Basit, Mr. Halkoree, and Dr. Tunnard are affiliated.
Psychiatr Serv. 2018 Jan 1;69(1):9-11. doi: 10.1176/appi.ps.201700268.
Improving access to psychotherapies in psychosis requires workforce expansion in resource-challenged systems. The GOALS feasibility randomized controlled trial assessed training and implementation of an evidence-based intervention by frontline workers, targeting recovery goals. Training uptake and therapy fidelity were good. Case managers with crisis management responsibilities were less likely than clinical assistants to deliver therapy. Participants receiving "sufficient therapy" achieved goals, but therapy was usually provided by clinical assistants. This is consistent with implementation science principles, that training must be combined with supportive organizational structures, such as by focusing on roles that already include therapy delivery or developing stronger organizational supports for case managers.
改善精神障碍患者获得心理治疗的机会需要在资源有限的系统中扩大劳动力。GOALS 可行性随机对照试验评估了一线工作人员对以康复目标为导向的循证干预措施的培训和实施，培训参与度和治疗保真度良好。具有危机管理职责的个案经理比临床助理更不可能提供治疗。接受“足够治疗”的参与者实现了目标，但治疗通常由临床助理提供。这与实施科学原则一致，即培训必须结合支持性组织结构，例如通过关注已经包括治疗提供的角色，或者为个案经理发展更强有力的组织支持。
