预期之外：一项关于儿童心理健康服务实施工作连锁反应的定性研究
Expect the Unexpected: A Qualitative Study of the Ripple Effects of Children's Mental Health Services Implementation Efforts.
作者信息
Pullmann Michael D, Dorsey Shannon, Duong Mylien T, Lyon Aaron R, Muse Ian, Corbin Cathy M, Davis Chayna J, Thorp Kristin, Sweeney Millie, Lewis Cara C, Powell Byron J
机构信息
University of Washington School of Medicine; Department of Psychiatry and Behavioral Sciences; School Mental Health Assessment, Research, and Training Center; 6200 NE 74 Street, Suite 110, Seattle, WA 98115-6560.
University of Washington Department of Psychology; 335 Guthrie Hall, Box 351525, Seattle, WA 98195.
出版信息
Implement Res Pract. 2022;3. doi: 10.1177/26334895221120797. Epub 2022 Aug 28.
BACKGROUND
Strategies to implement evidence-based interventions (EBIs) in children's mental health services have complex direct and indirect causal impacts on multiple outcomes. Ripple effects are outcomes caused by EBI implementation efforts that are unplanned, unanticipated, and/or more salient to stakeholders other than researchers and implementers. The purpose of the current paper is to provide a compilation of possible ripple effects associated with EBI implementation strategies in children's mental health services, to be used for implementation planning, research, and quality improvement.
METHODS
Participants were identified via expert nomination and snowball sampling. Online surveys were completed by 81 participants, each representing one of five roles: providers of mental health services to children or youth, researchers, policy makers, caregivers, and youth. A partially directed conventional content analysis with consensus decision making was used to code ripple effects.
RESULTS
Four hundred and four unique responses were coded into 66 ripple effects and 14 categories. Categories include general knowledge, skills, attitudes, and confidence about using EBIs; general job-related ripple effects; EBI treatment adherence, fidelity, and alignment; gaming the system; equity and stigma; shifting roles, role clarity, and task shifting; economic costs and benefits; EBI treatment availability, access, participation, attendance, barriers, and facilitators; clinical process and treatment quality; client engagement, therapeutic alliance, and client satisfaction; clinical organization structure, relationships in the organization, process, and functioning; youth client and caregiver outcomes; and use of EBI strategies and insights in one's own life.
CONCLUSIONS
This research advances the field by providing children's mental health implementers, researchers, funders, policy makers, and consumers with a menu of potential ripple effects. It can be a practical tool to ensure compliance with guidance from Quality Improvement/Quality Assurance, Complexity Science, and Diffusion of Innovation Theory. Future phases will match potential ripple effects with salient children's mental health implementation strategies for each participant role.
背景
在儿童心理健康服务中实施循证干预措施（EBI）的策略，会对多种结果产生复杂的直接和间接因果影响。涟漪效应是指EBI实施工作所导致的结果，这些结果是计划外的、未预料到的，和/或对研究人员和实施者以外的利益相关者更为显著。本文的目的是汇编与儿童心理健康服务中EBI实施策略相关的可能涟漪效应，用于实施规划、研究和质量改进。
方法
通过专家提名和滚雪球抽样确定参与者。81名参与者完成了在线调查，他们分别代表五个角色之一：儿童或青少年心理健康服务提供者、研究人员、政策制定者、照顾者和青少年。采用带有共识决策的部分定向常规内容分析法对涟漪效应进行编码。
结果
404条独特的回复被编码为66种涟漪效应和14个类别。类别包括对使用EBI的一般知识、技能、态度和信心；与工作相关的一般涟漪效应；EBI治疗的依从性、保真度和一致性；钻制度空子；公平与污名；角色转变、角色清晰度和任务转移；经济成本和效益；EBI治疗的可获得性、可及性、参与度、出勤率、障碍和促进因素；临床过程和治疗质量；客户参与度、治疗联盟和客户满意度；临床组织结构、组织内关系、过程和功能；青少年客户和照顾者的结果；以及在个人生活中使用EBI策略和见解。
结论
本研究为儿童心理健康实施者、研究人员、资助者、政策制定者和消费者提供了一系列潜在的涟漪效应，推动了该领域的发展。它可以作为一种实用工具，以确保符合质量改进/质量保证、复杂性科学和创新扩散理论的指导。未来阶段将把潜在的涟漪效应与每个参与者角色的显著儿童心理健康实施策略相匹配。
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