Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 10 Park Place SE, Suite 620, Atlanta, GA, 30303, USA.
NaviPsych, LLC, Atlanta, GA, USA.
Community Ment Health J. 2023 Oct;59(7):1428-1435. doi: 10.1007/s10597-023-01120-2. Epub 2023 Mar 20.
The objective was to determine the feasibility of an Open Dialogue-inspired approach in a metropolitan, public hospital setting with predominately African American participants. Participants were ages 18-35, experienced psychosis within the past month, and involved at least one support person in their care. We evaluated domains of feasibility including implementation, adaptation, practicality, acceptability, and limited-efficacy. An organizational change model (Addressing Problems Through Organizational Change) facilitated implementation. Clinicians received three trainings and ongoing supervision. Network meetings were successfully implemented with good self-reported fidelity to principles of dialogic practice. Some adaptations (less frequent meetings and no home visits) were necessary. A subset of individuals completed research assessments over 12 months. Qualitative interviews with participants suggested the intervention was acceptable. Symptom and functional outcomes were preliminary but trended toward improvement. Implementation was feasible with relatively brief training, organizational change processes, and context-specific adaptations. Lessons learned can assist in planning a larger research study.
目的是在一个以非洲裔美国人为主的大都市公立医院环境中，确定受“开放对话”启发的方法的可行性。参与者年龄在 18-35 岁之间，在过去一个月内经历过精神病，并且在他们的护理中至少有一个支持人员。我们评估了可行性的领域，包括实施、适应、实用性、可接受性和有限效果。一个组织变革模型（通过组织变革解决问题）促进了实施。临床医生接受了三次培训和持续监督。网络会议成功实施，原则上遵循对话实践的自我报告的一致性很好。一些适应措施（会议次数减少，没有家访）是必要的。一组参与者完成了 12 个月的研究评估。对参与者的定性访谈表明，干预是可以接受的。症状和功能结果是初步的，但呈改善趋势。相对简短的培训、组织变革过程和特定于上下文的适应措施使得实施是可行的。所吸取的经验教训可以帮助计划更大的研究。
