Places for People.
Department of Psychiatry and Behavioral Sciences.
Psychiatr Rehabil J. 2020 Jun;43(2):121-131. doi: 10.1037/prj0000387. Epub 2019 Sep 2.
The study purpose was to assess the feasibility, advantages/disadvantages, and factors that hinder or facilitate the implementation of illness management and recovery (IMR) within assertive community treatment (ACT) teams.
A qualitative study was conducted with 11 ACT teams that implemented IMR. We conducted semistructured individual interviews with 17 persons enrolled in services and 55 ACT staff in individual and focus groups. Questions were designed to assess perceptions of IMR implementation, effects of IMR, staff training considerations, and recommendations. Data were analyzed using an inductive, consensus-building, thematic analysis, which included multiple research staff reviewing interview transcripts and field notes, developing and refining a codebook, constructing data summaries, and thematic synthesis.
The analysis revealed six major themes: (a) a generally positive fit exists between the two models and population served, (b) both people with serious mental illness and staff benefited from ACT + IMR, (c) ACT teams encountered significant implementation barriers, (d) relationships and engagement with participants facilitated implementation, (e) taking a flexible approach to IMR and ACT improved implementation, and (f) programs should focus on greater integration of IMR within ACT teams.
While there can be barriers to implementing IMR within ACT teams, there is generally a positive fit, it is feasible to implement, and it offers meaningful benefits. ACT teams should improve their recovery orientation by more widespread implementation of IMR. Future research on ACT + IMR should include mixed-methods approaches, implementation methodologies to identify barriers and facilitators, and idiographic measures that capture the individualized recovery goals of people with serious mental illness. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
本研究旨在评估在积极社区治疗（ACT）团队中实施疾病管理和康复（IMR）的可行性、优缺点，以及阻碍或促进其实施的因素。
采用定性研究方法，对 11 个实施 IMR 的 ACT 团队进行研究。我们对 17 名接受服务的人员和 55 名 ACT 工作人员进行了半结构化的个人访谈，访谈形式包括个人访谈和焦点小组。问题设计旨在评估 IMR 实施的看法、IMR 的效果、员工培训的考虑因素和建议。使用归纳法、共识建立、主题分析对数据进行分析，包括多名研究人员对访谈记录和实地笔记进行审查、开发和完善代码本、构建数据摘要和主题综合。
分析揭示了六个主要主题：（a）两种模式和服务人群之间存在着大致上的契合；（b）严重精神疾病患者和工作人员都从 ACT+IMR 中受益；（c）ACT 团队遇到了重大的实施障碍；（d）与参与者的关系和参与促进了实施；（e）采取灵活的方法来实施 IMR 和 ACT 提高了实施效果；（f）项目应注重在 ACT 团队内更大程度地整合 IMR。
虽然在 ACT 团队中实施 IMR 可能存在障碍，但总体上有很好的契合，是可行的，并且具有有意义的益处。ACT 团队应通过更广泛地实施 IMR 来提高其康复方向。未来关于 ACT+IMR 的研究应包括混合方法方法、实施方法来识别障碍和促进因素，以及个体化测量方法，以捕捉严重精神疾病患者的个体化康复目标。
