在社区心理健康中建立灵活性和管理复杂性：在一个大型城市中心的经验教训。
Building flexibility and managing complexity in community mental health: lessons learned in a large urban centre.
机构信息
Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, Toronto, ON, M5B 1W8, Canada.
Centre for Addiction and Mental Health, 100 Stokes Street, Toronto, ON, M6J 1H4, Canada.
出版信息
BMC Psychiatry. 2018 Jan 24;18(1):20. doi: 10.1186/s12888-018-1597-y.
BACKGROUND
Across many jurisdictions, adults with complex mental health and social needs face challenges accessing appropriate supports due to system fragmentation and strict eligibility criteria of existing services. To support this underserviced population, Toronto's local health authority launched two novel community mental health models in 2014, inspired by Flexible Assertive Community Team principles. This study explores service user and provider perspectives on the acceptability of these services, and lessons learned during early implementation.
METHODS
We purposively sampled 49 stakeholders (staff, physicians, service users, health systems stakeholders) and conducted 17 semi-structured qualitative interviews and 5 focus groups between October 23, 2014 and March 2, 2015, exploring stakeholder perspectives on the newly launched team based models, as well as activities and strategies employed to support early implementation. Interviews and focus groups were audio recorded, transcribed verbatim and analyzed using thematic analysis.
RESULTS
Findings revealed wide-ranging endorsement for the two team-based models' success in engaging the target population of adults with complex service needs. Implementation strengths included the broad recognition of existing service gaps, the use of interdisciplinary teams and experienced service providers, broad partnerships and collaboration among various service sectors, training and team building activities. Emerging challenges included lack of complementary support services such as suitable housing, organizational contexts reluctant to embrace change and risk associated with complexity, as well as limited service provider and organizational capacity to deliver evidence-based interventions.
CONCLUSIONS
Findings identified implementation drivers at the practitioner, program, and system levels, specific to the implementation of community mental health interventions for adults with complex health and social needs. These can inform future efforts to address the health and support needs of this vulnerable population.
背景
在许多司法管辖区，由于系统碎片化和现有服务严格的资格标准，患有复杂精神健康和社会需求的成年人在获得适当支持方面面临挑战。为了支持这个服务不足的人群，多伦多当地卫生当局在 2014 年推出了两种新的社区精神健康模式，这些模式是受灵活坚定社区团队原则的启发。本研究探讨了服务使用者和提供者对这些服务的可接受性的看法，以及在早期实施过程中吸取的经验教训。
方法
我们有目的地选取了 49 名利益相关者（工作人员、医生、服务使用者、卫生系统利益相关者），并于 2014 年 10 月 23 日至 2015 年 3 月 2 日进行了 17 次半结构化定性访谈和 5 次焦点小组，探讨了新推出的基于团队的模式的利益相关者观点，以及为支持早期实施而采取的活动和策略。访谈和焦点小组进行了录音、逐字转录，并使用主题分析进行了分析。
结果
研究结果广泛认可了这两种基于团队的模式在吸引有复杂服务需求的成年人这一目标人群方面的成功。实施的优势包括广泛认识到现有服务差距、使用跨学科团队和经验丰富的服务提供者、广泛的合作伙伴关系以及各服务部门之间的协作、培训和团队建设活动。新出现的挑战包括缺乏合适的住房等互补支持服务、组织环境不愿意接受变革和与复杂性相关的风险，以及服务提供者和组织提供循证干预措施的能力有限。
结论
研究结果确定了实践者、项目和系统层面的实施驱动因素，这些因素具体针对为有复杂健康和社会需求的成年人提供社区精神健康干预措施的实施。这些可以为未来满足这个弱势群体的健康和支持需求的努力提供信息。
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