Division of Mental and Physical Health, Department of Health Promotion, Norwegian Institute of Public Health, Zander Kaaes gate 7, 5015, Bergen, Norway.
Faculty of Psychology, Department of Clinical Psychology, University of Bergen, Bergen, Norway.
BMC Health Serv Res. 2020 May 19;20(1):437. doi: 10.1186/s12913-020-05311-5.
Prompt Mental Health Care (PMHC) is the Norwegian adaptation of Improving Access to Psychological Therapies (IAPT). Thus far, evaluations of PMHC have mostly focused on the effectiveness, rather than on contextual and implementation processes. Therefore, the objective of this study was to do a process evaluation and examine: 1) To what extent do the services follow guidelines provided by the Norwegian Directorate of Health (NDH), 2) what the therapists experienced as important barriers and facilitators in implementing the service, and 3) client treatment satisfaction and its associations with baseline variables.
The present study uses data from 526 clients who received PMHC treatment in the municipalities of Sandnes and Kristiansand. The therapists completed questionnaires about each client's course of treatment. We conducted semi-structured interviews with the therapists and analysed them using thematic analysis. Data from client questionnaires were used to report descriptive sample statistics including symptom severity and treatment satisfaction. Linear regression was adopted to examine the associations between client treatment satisfaction and baseline characteristics.
Several aspects of PMHC were implemented in line with the guidelines provided by NDH. Importantly, both services reached out to the intended target group, and could further be characterized as low-threshold with relatively short waiting times (median waiting time between initial contact and treatment start was 27 days, IQR 18-39), no waiting lists, and frequent use of self-referral (33.3%). From the client perspective, results indicated a high degree of treatment satisfaction (Mean = 3.93 (SD = .71, range 1-5)), and this was true across demographic characteristics and symptom severity at baseline (all p > .05). Most notable challenges that came forward were; the low provision of guided self-help (received by only 1.0% of clients), the lack of focus on work participation (low to some degree of focus in 70.8% among sick-listed clients), the collaboration with other services (no collaboration in 85.3% of the clients), and some aspects regarding future development of the service.
Both sites managed to implement key aspects of PMHC in line with the guidelines, but further development of the program is warranted. Discussion of challenges and future recommendations are presented.
及时心理保健（PMHC）是挪威对改善心理治疗机会（IAPT）的改编。到目前为止，对 PMHC 的评估大多集中在有效性上，而不是在背景和实施过程上。因此，本研究的目的是进行过程评估，并检查：1）服务在多大程度上遵循挪威卫生署（NDH）提供的指南，2）治疗师在实施服务时遇到的重要障碍和促进因素，以及 3）客户治疗满意度及其与基线变量的关联。
本研究使用了 526 名在桑讷和克里斯蒂安桑德市接受 PMHC 治疗的客户的数据。治疗师完成了关于每位客户治疗过程的问卷。我们对治疗师进行了半结构化访谈，并使用主题分析对其进行了分析。客户问卷中的数据用于报告描述性样本统计数据，包括症状严重程度和治疗满意度。采用线性回归检验客户治疗满意度与基线特征之间的关联。
PMHC 的几个方面都符合 NDH 提供的指南。重要的是，两项服务都针对目标人群，并且可以进一步描述为低门槛，等待时间相对较短（从首次接触到治疗开始的中位数等待时间为 27 天，IQR 为 18-39），没有等待名单，并且经常使用自我推荐（33.3%）。从客户的角度来看，结果表明治疗满意度很高（平均值=3.93（SD=0.71，范围 1-5）），这在人口统计学特征和基线症状严重程度方面都是如此（所有 p>.05）。最值得注意的挑战是：指导自助的提供不足（仅 1.0%的客户接受），对工作参与的关注不足（在一定程度上关注 70.8%的请病假客户），与其他服务的合作（85.3%的客户没有合作），以及服务未来发展的某些方面。
两个地点都设法按照指南实施了 PMHC 的关键方面，但需要进一步发展该计划。提出了对挑战和未来建议的讨论。
