Bitter Neis, Roeg Diana, Van Nieuwenhuizen Chijs, Van Weeghel Jaap
Department of Social and Behavioural Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands.
GGzE Institute for Mental Health Care, Eindhoven, The Netherlands.
Scand J Caring Sci. 2019 Jun;33(2):457-466. doi: 10.1111/scs.12644. Epub 2019 Jan 17.
Several studies have reported difficulties concerning the implementation of recovery-oriented interventions. In this study, the effect of training in the Comprehensive Approach to Rehabilitation (CARe) on daily practice was evaluated. Additionally, we aimed to acquire insight into the experiences with the implementation process involving professionals, management and trainers.
Fourteen teams for sheltered and supported housing in the Netherlands participated in this study. As part of a cluster-randomised controlled trial (RCT) design, eight teams received training in the CARe methodology. Model fidelity (using the CARe fidelity audit) and professionals' knowledge of recovery (using the Recovery Knowledge Inventory) were measured for all teams until 20 months after the start. Afterwards, an evaluation meeting with participating stakeholders was organised in which barriers and facilitators of the implementation of the CARe methodology were inventoried.
Ten months after the training, the intervention teams scored higher than the control teams on the fidelity subscales: 'recovery', 'strengths orientation' and 'amount of training and coaching'. Twenty months after the training, only the effect of 'amount of coaching and training' remained. Additionally, 'methodological working' clearly differed between the groups after 20 months in favour of the intervention teams. In all teams, model fidelity was moderate at both measurements. The knowledge of recovery of the trained teams was slightly and significantly higher at 10 and 20 months after training. Although professionals were positive about recovery and strength-oriented working, they experienced several organisational and societal barriers.
Training in the CARe methodology improved the fidelity and knowledge of recovery among professionals. However, the differences were small, and fidelity decreased over time. More in-depth knowledge is needed on which barriers professionals experience in practice so that tailored training and implementation strategies can be developed. Furthermore, more attention is needed for professional development and the translation of theory into practice.
多项研究报告了以康复为导向的干预措施在实施过程中存在的困难。在本研究中，评估了综合康复方法（CARe）培训对日常实践的影响。此外，我们旨在深入了解专业人员、管理人员和培训师在实施过程中的经验。
荷兰的14个庇护性和支持性住房团队参与了本研究。作为整群随机对照试验（RCT）设计的一部分，8个团队接受了CARe方法的培训。在开始后的20个月内，对所有团队进行模型保真度（使用CARe保真度审计）和专业人员的康复知识（使用康复知识量表）测量。之后，组织了一次与参与的利益相关者的评估会议，列出了CARe方法实施的障碍和促进因素。
培训10个月后，干预组在保真度分量表“康复”“优势导向”和“培训与指导量”上的得分高于对照组。培训20个月后，仅“指导与培训量”的效果仍然存在。此外，20个月后，两组在“方法性工作”方面明显不同，干预组更具优势。在两次测量中，所有团队的模型保真度均为中等。接受培训的团队在培训后10个月和20个月时的康复知识略有提高且具有显著差异。尽管专业人员对康复和以优势为导向的工作持积极态度，但他们也经历了一些组织和社会方面的障碍。
CARe方法培训提高了专业人员的保真度和康复知识。然而，差异较小，且保真度随时间下降。需要更深入地了解专业人员在实践中遇到的障碍，以便制定针对性的培训和实施策略。此外，需要更多地关注专业发展以及将理论转化为实践。
