Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
BMC Psychiatry. 2022 May 21;22(1):350. doi: 10.1186/s12888-022-03992-2.
BACKGROUND: Components of crisis resolution teams' (CRTs) practices have been defined in recommendations and a fidelity scale, and surveys have reported how team leaders describe CRT practices. However, studies on CRTs have not measured and reported details of the crisis intervention provided to individual service users. The present study aimed to measure how various components of CRT practice were provided to individual service users and differences in practice between CRTs. METHODS: The study was exploratory and part of a prospective multicenter pre-post project on outcome of CRT treatment in Norway. Accessibility and intervention components of 25 CRTs were measured for 959 service users at the first contact after referral and in 3,244 sessions with service users. The data on CRT practice components were analyzed with descriptive statistics and factor analyses, and differences between teams were analyzed using ANOVA and calculating the proportion (intraclass correlation coefficient) of total variance that was due to differences between teams. RESULTS: One-third of the service users had their first session with the CRT the day of referral and another third the following day. Treatment intensity was mean 1.8 sessions the first week, gradually decreasing over subsequent weeks. Three of ten sessions were conducted in the service user's home and six of ten in the team's location. Eight of ten sessions took place during office hours and two of ten in the evening. The CRT provided assessment and psychological interventions to all service users. Family involvement, practical support, and medication were provided to two of ten service users. Between CRTs, significant differences were identified for a substantial proportion of practice components and especially for several aspects of accessibility. Cluster analysis identified two clusters of CRTs with significant differences in accessibility but no significant differences in the use of intervention components. CONCLUSIONS: Measurements of accessibility and interventions provided to individual service users gave a detailed description of CRT practices and differences between teams. Such measurements may be helpful as feedback on clinical practice, for studying and comparing crisis resolution team practices, and in future studies on the association between different outcomes and potential critical elements of crisis interventions.
背景：危机解决小组（CRT）实践的组成部分已在建议和保真度量表中定义，并且调查已经报告了团队负责人如何描述 CRT 实践。然而，关于 CRT 的研究并未测量和报告提供给个别服务用户的危机干预的详细信息。本研究旨在测量 CRT 实践的各个组成部分是如何提供给个别服务用户的，以及 CRT 之间的实践差异。
方法：该研究是探索性的，是挪威 CRT 治疗结果的前瞻性多中心前后项目的一部分。在转介后的第一次接触和与服务用户的 3244 次会议中，测量了 25 个 CRT 的可及性和干预性组成部分，共 959 名服务用户。使用描述性统计和因素分析分析 CRT 实践组成部分的数据，并使用 ANOVA 分析团队之间的差异，并计算总方差中因团队之间差异而导致的比例（组内相关系数）。
结果：三分之一的服务用户在转介当天和三分之一的服务用户在第二天与 CRT 进行了第一次会议。治疗强度在第一周平均为 1.8 次，随后几周逐渐减少。十个会议中有三个在服务用户的家中进行，十个会议中有六个在团队的地点进行。十个会议中有八个在办公时间进行，两个在晚上进行。CRT 为所有服务用户提供评估和心理干预。有两个服务用户获得了家庭参与、实际支持和药物治疗。CRT 之间在很大一部分实践组成部分，尤其是在可及性的几个方面，存在显著差异。聚类分析确定了 CRT 可及性方面存在显著差异的两个集群，但在干预组成部分的使用方面没有显著差异。
结论：对个别服务用户提供的可及性和干预措施的测量提供了 CRT 实践和团队之间差异的详细描述。这种测量可能有助于作为对临床实践的反馈，用于研究和比较危机解决小组的实践，以及在未来关于不同结果与潜在危机干预关键要素之间关联的研究中。
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