Griffiths Robert, Tai Sara, Ormrod Susan, Welsh Natalie, Jones Adam, Palmier-Claus Jasper, Dixon James, Dawber Alison, Lovell Karina
Mental Health Nursing Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
BMC Psychiatry. 2024 Dec 4;24(1):878. doi: 10.1186/s12888-024-06286-x.
Without effective and timely support, psychosis can lead to negative personal, economic, and societal outcomes. Care coordinators play a key role in the delivery of early intervention in psychosis services, which aim to improve outcomes and promote recovery for people experiencing first-episode psychosis. Enhancing the support offered by care coordinators could improve outcomes and reduce levels of service user disengagement. This study aimed to understand participants' views on the acceptability of a transdiagnostic talking therapy, called Method of Levels (MOL), delivered by care coordinators in early intervention in psychosis services. It also sought to understand participants' experiences of the MOL training and supervision programme, and to identify any barriers that might impact on the implementation of the approach in routine practice.
Semi-structured interviews and focus groups were conducted with service users (n = 14), care coordinators (n = 6), and team managers (n = 6) from early intervention in psychosis services. Interviews and focus groups were transcribed and reflexive thematic analysis was used to analyse the data.
Three themes were identified: 'Digging deeper to find my own solutions'; (2) 'Prepared for practice?'; and (3) 'Levels of implementation'. Participants described how the use of MOL enabled service users to explore problems in greater depth and generate their own solutions to these. Care coordinators generally reported feeling ready to deliver the intervention after attending MOL training and were able to integrate the approach into their practice in a flexible way. High workloads limited care coordinators' capacity to attend MOL supervision regularly, reducing their overall confidence in delivering the approach. This impacted on the degree to which care coordinators used MOL in their practice.
Findings suggest that MOL delivered by care coordinators could be a helpful approach for people experiencing first-episode psychosis. Care coordinators found it difficult to attend clinical supervision, however, which represents a barrier to implementation. This issue will need to be addressed before care coordinator delivered-MOL for first-episode psychosis can be evaluated in a larger study or implemented in practice.
若缺乏有效且及时的支持，精神病可能会导致负面的个人、经济和社会后果。护理协调员在精神病服务的早期干预中发挥着关键作用，早期干预服务旨在改善患有首发精神病患者的治疗效果并促进其康复。加强护理协调员提供的支持可以改善治疗效果并减少服务使用者的脱离率。本研究旨在了解参与者对护理协调员在精神病服务早期干预中提供的一种跨诊断谈话疗法——层次法（MOL）的可接受性的看法。研究还试图了解参与者对MOL培训和督导计划的体验，并识别可能影响该方法在常规实践中实施的任何障碍。
对来自精神病服务早期干预机构的服务使用者（n = 14）、护理协调员（n = 6）和团队经理（n = 6）进行了半结构化访谈和焦点小组讨论。对访谈和焦点小组讨论进行了转录，并采用反思性主题分析来分析数据。
确定了三个主题：“深入挖掘以找到自己的解决方案”；（2）“为实践做好准备了吗？”；以及（3）“实施水平”。参与者描述了使用MOL如何使服务使用者更深入地探讨问题并为这些问题找到自己的解决方案。护理协调员普遍报告称，参加MOL培训后他们已准备好实施干预，并能够以灵活的方式将该方法融入他们的实践中。高工作量限制了护理协调员定期参加MOL督导的能力，降低了他们实施该方法的总体信心。这影响了护理协调员在实践中使用MOL的程度。
研究结果表明，护理协调员提供的MOL可能是帮助患有首发精神病患者的一种有用方法。然而，护理协调员发现难以参加临床督导，这是实施过程中的一个障碍。在可以在更大规模的研究中评估或在实践中实施护理协调员为首发精神病患者提供的MOL之前，需要解决这个问题。
