Keeler-Villa Natalie R, Beaulieu Danie, Harris-Lane Laura M, Bérubé Stéphane, Burke Katie, Churchill AnnMarie, Cornish Peter, Goguen Bernard, Jaouich Alexia, Michaud Mylène, Losier Anne, Snow Nicole, Rash Joshua A
Department of Psychology, Memorial University of Newfoundland, 230 Elizabeth Ave, St. Johns, NL, A1B 3X9, Canada.
Department of Psychology, University of New Brunswick, Fredericton, Canada.
Adm Policy Ment Health. 2024 Nov 23. doi: 10.1007/s10488-024-01423-w.
Government of New Brunswick implemented One-at-a-Time (OAAT) therapy, a single-session approach to care, within Addiction and Mental Health (A&MH) services. We conducted interviews to understand determinants of implementation from program champions. Champions of the OAAT therapy implementation (N = 19; Child/Youth n = 8, Adult n = 11) working within A&MH services and school districts were recruited through the provincial implementation team. Transcripts were synthesized using thematic analysis. Determinants were organized as facilitators and barriers in accordance with the Consolidated Framework for Implementation Research (CFIR). Thematic analysis resulted in 18 themes and 5 recommendations. Facilitators within the inner setting included: (1) need for change and perceived benefits of OAAT therapy; (2) compatibility of OAAT therapy with previous practice and service processes; and (3) support received from champions and colleagues. Insufficient resources (e.g., staff and physical infrastructure), and a culture that favored long-term therapy were barriers. Navigating age of consent, and implementation around COVID-19 were barriers within the outer setting. Facilitators within the implementation process domain included: (1) interconnected teams across sites, regions and the province; (2) collaborative implementation planning; (3) flexibility to tailor implementation at sites; and (4) mentorship provided by champions. Insufficient standardization of the implementation and limited representation among affected parties (e.g., community partners) were barriers within the implementation process. This study elucidated determinants that influenced implementation of a new service delivery within an Eastern Canadian provincial health care system. Findings can serve as a heuristic for organizations looking to enact similar implementation initiatives.
新不伦瑞克省政府在成瘾与心理健康（A&MH）服务中实施了“一次治疗”（OAAT）疗法，这是一种单次治疗的护理方法。我们进行了访谈，以了解项目倡导者对实施该疗法的决定因素。通过省级实施团队招募了在A&MH服务和学区工作的OAAT疗法实施倡导者（N = 19；儿童/青少年n = 8，成人n = 11）。使用主题分析法对访谈记录进行了综合分析。根据实施研究综合框架（CFIR），将决定因素分为促进因素和障碍因素。主题分析得出了18个主题和5条建议。内部环境中的促进因素包括：（1）变革的必要性以及OAAT疗法的预期益处；（2）OAAT疗法与先前实践和服务流程的兼容性；（3）从倡导者和同事那里获得的支持。资源不足（如人员和物理基础设施）以及倾向于长期治疗的文化是障碍因素。在外部环境中，应对同意年龄问题以及围绕新冠疫情进行实施是障碍因素。实施过程领域中的促进因素包括：（1）跨地点、地区和省份的相互关联的团队；（2）协作实施计划；（3）在各地点灵活调整实施方式；（4）倡导者提供的指导。实施缺乏足够的标准化以及受影响方（如社区合作伙伴）的代表性有限是实施过程中的障碍因素。本研究阐明了影响加拿大东部省级医疗系统内一项新服务提供方式实施的决定因素。研究结果可为希望开展类似实施举措的组织提供启发。
