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Implementing a continuum of evidence-based psychosocial interventions for people with severe mental illness: part 2-review of critical implementation issues.

ABSTRACT: OBJECTIVE:In North America and internationally, efforts have been made to reduce the gaps between knowledge of psychosocial evidence-based practices (EBPs) and the delivery of such services in routine mental health practice. Part 2 of this review identifies key issues for stakeholders to consider when implementing comprehensive psychosocial EBPs for people with severe mental illness (SMI). METHOD:A rapid review of the literature was conducted. Searches were carried out in MEDLINE and PsycINFO for reports published between 1990 and 2012 using key words related to SMI, and psychosocial practices and implementation. The Consolidated Framework for Implementation Research (CFIR) was used to structure findings according to key domains and constructs known to influence the implementation process. RESULTS:The CFIR allowed us to identify 17 issues reflecting more than 30 constructs of the framework that were viewed as influential to the process of implementing evidence-based psychosocial interventions for people with SMI. Issues arising at different levels of influence (intervention, individual, organizational, and system) and at all phases of the implementation process (planning, engagement, execution, and evaluation) were found to play important roles in implementation. CONCLUSION:The issues identified in this review should be taken into consideration by stakeholders when engaging in efforts to promote uptake of new psychosocial EBPs and to widen the range of effective psychosocial services available in routine mental health care.

SUBMITTER: Briand C

PROVIDER: S-EPMC4079132 | biostudies-literature | 2014 Apr

REPOSITORIES: biostudies-literature

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Implementing a continuum of evidence-based psychosocial interventions for people with severe mental illness: part 2-review of critical implementation issues.

Briand Catherine C Menear Matthew M

Canadian journal of psychiatry. Revue canadienne de psychiatrie 20140401 4

<h4>Objective</h4>In North America and internationally, efforts have been made to reduce the gaps between knowledge of psychosocial evidence-based practices (EBPs) and the delivery of such services in routine mental health practice. Part 2 of this review identifies key issues for stakeholders to consider when implementing comprehensive psychosocial EBPs for people with severe mental illness (SMI).<h4>Method</h4>A rapid review of the literature was conducted. Searches were carried out in MEDLINE ...[more]

PMID: 25007111

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Project description:BackgroundPeople often prefer evidence-based psychosocial interventions (EBPIs) for mental health care; however, these interventions frequently remain unavailable to people in nonspecialty or integrated settings, such as primary care and schools. Previous research has suggested that usability, a concept from human-centered design, could support an understanding of the barriers to and facilitators of the successful adoption of EBPIs and support the redesign of EBPIs and implementation strategies.ObjectiveThis study aimed to identify and categorize usability issues in EBPIs and their implementation strategies.MethodsWe adapted a usability issue analysis and reporting format from a human-centered design. A total of 13 projects supported by the National Institute of Mental Health-funded Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness Center at the University of Washington used this format to describe usability issues for EBPIs and implementation strategies with which they were working. Center researchers used iterative affinity diagramming and coding processes to identify usability issue categories. On the basis of these categories and the underlying issues, we propose heuristics for the design or redesign of EBPIs and implementation strategies.ResultsThe 13 projects reported a total of 90 usability issues, which we categorized into 12 categories, including complex and/or cognitively overwhelming, required time exceeding available time, incompatibility with interventionist preference or practice, incompatibility with existing workflow, insufficient customization to clients/recipients, intervention buy-in (value), interventionist buy-in (trust), overreliance on technology, requires unavailable infrastructure, inadequate scaffolding for client/recipient, inadequate training and scaffolding for interventionists, and lack of support for necessary communication. These issues range from minor inconveniences that affect a few interventionists or recipients to severe issues that prevent all interventionists or recipients in a setting from completing part or all of the intervention. We propose 12 corresponding heuristics to guide EBPIs and implementation strategy designers in preventing and addressing these usability issues.ConclusionsUsability issues were prevalent in the studied EBPIs and implementation strategies. We recommend using the lens of usability evaluation to understand and address barriers to the effective use and reach of EBPIs and implementation strategies.International registered report identifier (irrid)RR2-10.2196/14990.

Project description:BackgroundThe German guideline on psychosocial interventions for people with severe mental disorders recommends a broad spectrum of evidence-based treatments. Structured implementation of the associated patient version of the guideline is missing to date. The study aims to assess whether structured implementation of a patient guideline improves the empowerment of patients with severe mental disorders, as well as knowledge, attitudes and experiences regarding psychosocial interventions, service use, treatment satisfaction, treatment needs, quality of life and burden of care.MethodsThe study is a multicentre, cluster-randomised, controlled study with two parallel groups. Inpatients and day hospital patients (all sexes; 18-65?years) with severe mental disorders will be included. Additionally, relatives of patients with mental disorders (all sexes; ? 18?years) will be included. In the experimental group, the patient guideline will be implemented using a multimodal strategy. Participants in the control group will receive treatment as usual but will be made aware of the patient guideline. The primary outcome is the change of empowerment, assessed by using the 'empowerment in the process of psychiatric treatment of patients with affective and schizophrenia disorders' (EPAS) scale. In addition, knowledge, attitudes and experiences regarding psychosocial interventions will be assessed as secondary outcomes, as well as service use, satisfaction with care, patient need and quality of life and participation and social inclusion. For relatives, the perceived burden of care also will be recorded. Results will be analysed using hierarchical linear models. For the health economic evaluation, the incremental cost-utility ratios will be computed using the differences in total costs of illness and the differences in quality-adjusted life years (QALY) between study groups.DiscussionThe study will be the first to assess the effects of a structured implementation of the patient version of a psychiatric treatment guideline. The study has some limitations regarding the transferability of the results to other patients and other regions. Furthermore, problems with the recruitment of patients and relatives and with the implementation of intervention could occur during the study.Trial registrationThe study is registered in the German Clinical Trials Register (DRKS) and the WHO International Clinical Trials Registry Platform (ICTRP) under registration number DRKS00017577 (Date of registration: 23 October 2019.

Project description:The full range of biopsychosocial complexity is mind-boggling, spanning a vast range of spatiotemporal scales with complicated vertical, horizontal, and diagonal feedback interactions between contributing systems. It is unlikely that such complexity can be dealt with by a single model. One approach is to focus on a narrower range of phenomena which involve fewer systems but still cover the range of spatiotemporal scales. The suggestion is to focus on the relationship between temperament in healthy individuals and mental illness, which have been conjectured to lie along a continuum of neurobehavioral regulation involving neurochemical regulatory systems (e.g., monoamine and acetylcholine, opiate receptors, neuropeptides, oxytocin), and cortical regulatory systems (e.g., prefrontal, limbic). Temperament and mental illness are quintessentially dynamical phenomena, and need to be addressed in dynamical terms. A meteorological metaphor suggests similarities between temperament and chronic mental illness and climate, between individual behaviors and weather, and acute mental illness and frontal weather events. The transition from normative temperament to chronic mental illness is analogous to climate change. This leads to the conjecture that temperament and chronic mental illness describe distinct, high level, dynamical phases. This suggests approaching biopsychosocial complexity through the study of dynamical phases, their order and control parameters, and their phase transitions. Unlike transitions in physical systems, these biopsychosocial phase transitions involve information and semiotics. The application of complex adaptive dynamical systems theory has led to a host of markers including geometrical markers (periodicity, intermittency, recurrence, chaos) and analytical markers such as fluctuation spectroscopy, scaling, entropy, recurrence time. Clinically accessible biomarkers, in particular heart rate variability and activity markers have been suggested to distinguish these dynamical phases and to signal the presence of transitional states. A particular formal model of these dynamical phases will be presented based upon the process algebra, which has been used to model information flow in complex systems. In particular it describes the dual influences of energy and information on the dynamics of complex systems. The process algebra model is well-suited for dealing with the particular dynamical features of the continuum, which include transience, contextuality, and emergence. These dynamical phases will be described using the process algebra model and implications for clinical practice will be discussed.

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Implementing a continuum of evidence-based psychosocial interventions for people with severe mental illness: part 2-review of critical implementation issues.

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Implementing a continuum of evidence-based psychosocial interventions for people with severe mental illness: part 2-review of critical implementation issues.

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