Division of Psychiatry, University College London, London, UK.
Acute and Rehabilitation Directorate, North East London NHS Foundation Trust, Goodmayes Hospital, Ilford, UK.
Clin Psychol Psychother. 2024 Jul-Aug;31(4):e3032. doi: 10.1002/cpp.3032.
Mental health crisis rates in the United Kingdom are on the rise. The emergence of community mental health models, such as Crisis Resolution Home Treatment Teams (CRHTTs), offers a vital pathway to provide intensive assessment and treatment to individuals in their homes, including psychological interventions. Previous qualitative literature has identified facilitators and barriers to the implementation of psychological interventions within CRHTT settings; however, a synthesis of this literature has not yet been conducted. To address this gap, a systematic review was undertaken with the aim of identifying the reported facilitators and barriers of implementing evidence-based psychological interventions in CRHTTs.
A systematic review and narrative synthesis were conducted. Studies were included if they examined the implementation of evidence-based psychological interventions in a CRHTT setting. The study population had to be 18 and over and could include healthcare professionals working in CRHTTs, service users of CRHTTs, or family and carers of CRHTT service users. Studies of any formal research methodology were included. Four databases were searched (MEDLINE, CINAHL Plus, Embase and PsycINFO), along with Google Scholar, to identify eligible studies.
Six studies were identified, using mixed qualitative and quantitative methodologies, with the predominant focus being the exploration of stakeholder perspectives on care implementation within CRHTTs, encompassing aspects including but not restricted to psychological care implementation. The literature was deemed to be of moderate to high quality. Facilitators included adapting psychological therapies, prioritizing the therapeutic relationship, increasing psychological skills and training of CRHTT staff and psychologically informed CRHTT models. The barriers identified included a medical model bias within teams, resource constraints and elements pertaining to CRHTT services.
Further robust research in this area is imperative. We recommend that future research be implemented in the form of service evaluations and randomized controlled trials (RCTs) and that the principles of implementation science be used to assess and develop the evidence base for psychological intervention delivery in CRHTTs.
英国的心理健康危机发生率正在上升。社区心理健康模式的出现，如危机解决家庭治疗小组 (CRHTT)，为在家庭中为个人提供密集评估和治疗提供了重要途径，包括心理干预。以前的定性文献已经确定了在 CRHTT 环境中实施心理干预的促进因素和障碍；然而，尚未对该文献进行综合分析。为了解决这一差距，进行了系统评价，旨在确定报告的在 CRHTT 中实施基于证据的心理干预的促进因素和障碍。
进行了系统评价和叙述性综合。如果研究检查了在 CRHTT 环境中实施基于证据的心理干预，则包括研究在内。研究人群必须年满 18 岁，可以包括在 CRHTT 工作的医疗保健专业人员、CRHTT 的服务使用者或 CRHTT 服务使用者的家人和照顾者。包括任何正规研究方法的研究。共搜索了四个数据库（MEDLINE、CINAHL Plus、Embase 和 PsycINFO）和 Google Scholar，以确定符合条件的研究。
使用混合定性和定量方法确定了六项研究，主要重点是探索利益相关者对 CRHTT 内护理实施的看法，包括但不限于心理护理实施的各个方面。该文献被认为质量中等偏上。促进因素包括调整心理疗法、优先考虑治疗关系、提高 CRHTT 工作人员的心理技能和培训以及心理知情的 CRHTT 模式。确定的障碍包括团队中的医学模式偏见、资源限制以及与 CRHTT 服务相关的因素。
该领域需要进一步进行强有力的研究。我们建议未来的研究采用服务评估和随机对照试验 (RCT) 的形式，并使用实施科学的原则来评估和发展 CRHTT 中心理干预提供的证据基础。
