The Centre for Family-Based Mental Health Care, St. Vincent's Private Hospital, Darlinghurst, New South Wales, Australia.
School of Medicine, University of Notre Dame Australia, Darlinghurst, New South Wales, Australia.
Int J Ment Health Nurs. 2021 Jun;30(3):811-816. doi: 10.1111/inm.12866. Epub 2021 Apr 13.
Open Dialogue is a need-adapted approach to mental health care that was originally developed in Finland. Like other need-adapted approaches, Open Dialogue aims to meet consumer's needs and promote collaborative person-centred dialogue to support recovery. Need-adapted mental health care is distinguished by flexibility and responsiveness. Fidelity, defined from an implementation science perspective as the delivery of distinctive interventions in a high quality and effective fashion is a key consideration in health care. However, flexibility presents challenges for evaluating fidelity, which is much easier to evaluate when manualization and reproducible processes are possible. Hence, it remains unclear whether Open Dialogue and other need-adapted mental health interventions can be meaningfully evaluated for fidelity. The aim of this paper was to critically appraise and advance the evaluation of fidelity in need-adapted mental health care, using Open Dialogue as a case study. The paper opens a discussion about how fidelity should be evaluated in flexible, complex interventions, and identifies key questions that need to be asked by practitioners working in need-adapted mental health care to ensure they deliver these interventions as intended and in an evidence-based fashion.
开放对话是一种适应需求的心理健康护理方法，最初在芬兰开发。像其他适应需求的方法一样，开放对话旨在满足消费者的需求，并促进以合作为基础的以人为本的对话，以支持康复。适应需求的心理健康护理的特点是灵活性和响应性。从实施科学的角度来看，保真度被定义为以高质量和有效的方式提供独特的干预措施，这是医疗保健的一个关键考虑因素。然而，灵活性给保真度的评估带来了挑战，当手工和可重复的过程成为可能时，评估保真度就容易得多。因此，目前尚不清楚开放对话和其他适应需求的心理健康干预措施是否可以对其保真度进行有意义的评估。本文旨在以开放对话为例，批判性地评估和推进适应需求的心理健康护理中保真度的评估。本文讨论了如何在灵活、复杂的干预措施中评估保真度，并确定了在适应需求的心理健康护理中工作的从业者需要提出的关键问题，以确保他们按照预期并以循证的方式提供这些干预措施。
