Douglas Susan, Page Andrew C, Moltu Christian, Kyron Michael, Satterthwaite Tim
Department of Leadership, Policy and Organizations, Vanderbilt University, Peabody College, 230 Appleton Place PMB #414, Nashville, TN, 37203-5721, USA.
School of Psychological Science and WA Mental Health Research Centre, University of Western Australia, Perth, Australia.
Adm Policy Ment Health. 2024 May;51(3):318-335. doi: 10.1007/s10488-023-01304-8. Epub 2023 Sep 28.
Intended for researchers and clinical leaders, this article suggests that embedded program evaluation is a good fit with the desired features of practice-oriented research. The systematic nature of evaluation that is built into the operational workflow of a practice setting may increase the diversity of methods available to explore processes and outcomes of interest. We propose a novel conceptual framework that uses a human-centered systems lens to foster such embedded evaluation in clinical routine. This approach emphasizes the evaluator-practitioner partnership to build confidence in the bi-directional learning of practice-based evidence with evidence-based practice. The iterative cycles inherent to design thinking are aimed at developing better evaluation questions. The attention to structure and context inherent to systems thinking is intended to support meaningful perspectives in the naturally complex world of health care. Importantly, the combined human-centered systems lens can create greater awareness of the influence of individual and systemic biases that exist in any endeavor or institution that involves people. Recommended tools and strategies include systems mapping, program theory development, and visual facilitation using a logic model to represent the complexity of mental health treatment for communication, shared understanding, and connection to the broader evidence base. To illustrate elements of the proposed conceptual framework, two case examples are drawn from routine outcome monitoring (ROM) and progress feedback. We conclude with questions for future collaboration and research that may strengthen the partnership of evaluators and practitioners as a community of learners in service of local and system-level improvement.
本文面向研究人员和临床领导者，提出嵌入式项目评估与实践导向型研究的理想特征相契合。融入实践环境操作流程的评估系统性，可能会增加可用于探索感兴趣的过程和结果的方法的多样性。我们提出了一个新颖的概念框架，该框架使用以人为主的系统视角，在临床常规中促进这种嵌入式评估。这种方法强调评估者与从业者的伙伴关系，以建立对基于实践的证据与循证实践双向学习的信心。设计思维固有的迭代循环旨在提出更好的评估问题。系统思维中对结构和背景的关注旨在支持在自然复杂的医疗保健世界中形成有意义的观点。重要的是，以人为主的系统视角相结合，可以提高人们对任何涉及人的努力或机构中存在的个人和系统偏见影响的认识。推荐的工具和策略包括系统映射、项目理论发展以及使用逻辑模型进行可视化促进，以呈现心理健康治疗的复杂性，用于沟通、达成共同理解以及与更广泛的证据基础建立联系。为了说明所提出概念框架的要素，从常规结果监测（ROM）和进展反馈中选取了两个案例。我们最后提出了一些关于未来合作和研究的问题，这些问题可能会加强评估者和从业者作为学习者群体的伙伴关系，以服务于地方和系统层面的改进。
