Factors impacting the implementation of a psychoeducation intervention within the Mental Health System: a multisite study using the Consolidation Framework for Implementation Research

Abstract Background Despite a strong evidence base and policy recommendation supporting the implementation of psychoeducation interventions within the mental health system, equitable access for many service users and family members has not been achieved. To enhance translation, developing an evidence-base around the factors that influence implementation of interventions is critical. Methods The aim of the study was to explore the factors influencing implementation of a group cofacilitated recovery focused psychoeducation intervention. The study design was explorative qualitative descriptive, involving the collection of data through individual and focus group interviews with key stakeholders (n=75) involved with the implementation within 14 mental health sites in the Republic of Ireland. The Consolidation Framework for Implementation Research (CFIR) was used as a conceptual framework to guide data collection and analysis. Results Key enablers and barriers were identified across all CFIR domains of the framework with some factors (depending on context) being both an enabler and a barrier. National policy; structural stability with national systems; leadership at all levels; peer payment system; local champions and support from multidisciplinary team members; evidence strength and quality of the programme design; availability of resources; referral pathways; knowledge, beliefs and self-efficacy of facilitators, as well as local culture influenced implementation. While some were specific to the programme, many barriers reflected systemic and structural challenges within health services more generally. Conclusion: Findings from this study provide an enhanced understanding of the different layers of determinants to implementation of an intervention. Overcoming challenges will involve positive and ongoing engagement and collaboration across the full range of stakeholders that are active within each domain, including policy and operational levels. The quality of leadership at each domain level is of crucial importance to successful implementation.

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Factors Impacting the Implementation of a Psychoeducation Intervention Within the Mental Health System: a Multisite Study Using the Consolidation Framework for Implementation Research

10.21203/rs.3.rs-45002/v1 ◽

2020 ◽

Author(s):

Agnes Higgins ◽

Rebecca Murphy ◽

Carmel Downes ◽

Jennifer Barry ◽

Mark Monahan ◽

...

Keyword(s):

Mental Health ◽

Health System ◽

Implementation Research ◽

Mental Health System ◽

Full Range ◽

National Policy ◽

Evidence Base ◽

Successful Implementation ◽

The Republic

Abstract Background Despite a strong evidence base and policy recommendation supporting the implementation of psychoeducation interventions within the mental health system, equitable access for many service users and family members has not been achieved. To enhance translation, developing an evidence-base around the factors that influence implementation of interventions is critical.Methods The aim of the study was to explore the factors influencing implementation of a group cofacilitated recovery focused psychoeducation intervention. The study design was explorative qualitative descriptive, involving the collection of data through individual and focus group interviews with key stakeholders (n=75) involved with the implementation within 14 mental health sites in the Republic of Ireland. The Consolidation Framework for Implementation Research (CFIR) was used as a conceptual framework to guide data collection and analysis. Results Key enablers and barriers were identified across all CFIR domains of the framework with some factors (depending on context) being both an enabler and a barrier. National policy; structural stability with national systems; leadership at all levels; peer payment system; local champions and support from multidisciplinary team members; evidence strength and quality of the programme design; availability of resources; referral pathways; knowledge, beliefs and self-efficacy of facilitators, as well as local culture influenced implementation. While some were specific to the programme, many barriers reflected systemic and structural challenges within health services more generally. Conclusion: Findings from this study provide an enhanced understanding of the different layers of determinants to implementation of an intervention. Overcoming challenges will involve positive and ongoing engagement and collaboration across the full range of stakeholders that are active within each domain, including policy and operational levels. The quality of leadership at each domain level is of crucial importance to successful implementation.

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Factors impacting the implementation of a psychoeducation intervention within the mental health system: a multisite study using the consolidation framework for implementation research

BMC Health Services Research ◽

10.1186/s12913-020-05852-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Agnes Higgins ◽

Rebecca Murphy ◽

Carmel Downes ◽

Jennifer Barry ◽

Mark Monahan ◽

...

Keyword(s):

Mental Health ◽

Health System ◽

Implementation Research ◽

Mental Health System ◽

Full Range ◽

Evidence Base ◽

Influential Factors ◽

Successful Implementation ◽

The Republic ◽

Inner Setting

Abstract Background Despite a strong evidence base and policy recommendation supporting the implementation of psychoeducation interventions within the mental health system, equitable access for many service users and family members has not been achieved. To enhance translation, developing an evidence-base around the factors that influence implementation of interventions is critical. Methods The aim of the study was to explore the factors influencing implementation of a group cofacilitated recovery focused psychoeducation intervention. The study design was explorative qualitative descriptive, involving the collection of data through individual and focus group interviews with key stakeholders (n = 75) involved with the implementation within 14 mental health sites in the Republic of Ireland. The Consolidation Framework for Implementation Research (CFIR) was used as a conceptual framework to guide data collection and analysis. Results Key enablers and barriers were identified across all CFIR domains of the framework with some factors (depending on context) being both an enabler and a barrier. Important factors in the outer setting domain included structural stability within national systems and the peer payment system, while the extent of a recovery-oriented culture, leadership, implementation readiness, and buy-in were influential factors in the inner setting. The characteristics of the intervention in terms of design, evidence-base and adaptability also shaped the intervention’s implementation as did the knowledge, beliefs and self-efficacy of facilitators. In terms of processes, implementation was influenced by the degree of engagement of key individuals who championed and supported the programme. The results highlight that while some of the barriers were specific to the programme, many reflected systemic and structural challenges within health services more generally. Conclusion Findings from this study provide an enhanced understanding of the different layers of determinants to implementation of an intervention. Overcoming challenges will involve positive and ongoing engagement and collaboration across the full range of stakeholders that are active within each domain, including policy and operational levels. The quality of leadership at each domain level is of crucial importance to successful implementation.

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‘Gentlemen, we have no money therefore we must think’ – mental health services in hard times

The Psychiatrist ◽

10.1192/pb.bp.110.030627 ◽

2011 ◽

Vol 35 (3) ◽

pp. 81-83 ◽

Cited By ~ 4

Author(s):

Frank Holloway

Keyword(s):

Mental Health ◽

Health Services ◽

Health System ◽

Mental Health System ◽

Mental Healthcare ◽

Evidence Base ◽

Evidence Based ◽

Demographic Trends ◽

Hard Times ◽

Uncertain Future

SummaryIn common with all elements of public services, mental healthcare in England faces a troubling and uncertain future. Two things, however, are certain: demographic trends ensure that demand will rise and harsh economic realities dictate that resources will in real terms shrink. In order to cope with these challenges, commissioners and providers will have to review very critically all aspects of the mental health system, including those that are currently fashionable. There is a need to identify and promote activities that are evidence-based and effective and to jettison practices and services that lack an evidence base.

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Evaluating the quality of correctional mental health services: an approach to surveying a correctional mental health system

Behavioral Sciences & the Law ◽

10.1002/(sici)1099-0798(199723/09)15:4<427::aid-bsl286>3.0.co;2-s ◽

1997 ◽

Vol 15 (4) ◽

pp. 427-438 ◽

Cited By ~ 9

Author(s):

Richard L. Elliott

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Health System ◽

Mental Health System ◽

Correctional Mental Health

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Investment in Australian mental health carer services: how much and does it reflect evidence of effectiveness?

Australian Health Review ◽

10.1071/ah18065 ◽

2020 ◽

Vol 44 (1) ◽

pp. 104 ◽

Cited By ~ 1

Author(s):

Jaclyn Schess ◽

Sandra Diminic ◽

Emily Hielscher ◽

Meredith G. Harris ◽

Yong Yi Lee ◽

...

Keyword(s):

Mental Health ◽

Health System ◽

Mental Health System ◽

Financial Burden ◽

Critical Role ◽

Government Expenditure ◽

Evidence Base ◽

Fiscal Year ◽

Published Data ◽

Service Outcomes

Objective The aims of this study were to quantify Australian federal and state government expenditure on mental health carer services for 2014–15, map the types of services being provided and explore how funded service types compare with the evidence base for the outcomes of these carer services. Methods Web searches were conducted to identify in-scope mental health carer services in Australia funded by federal and state and territory governments. Funding estimates were confirmed where possible with available government and carer organisation contacts. A literature search was conducted for reviews of studies investigating mental health carer service outcomes. Results In 2014–15, the estimated Australian national, state and territory government expenditure on mental health carer services was approximately A$90.6million. This comprised A$65.6million in federal expenditure and A$25.0million in state and territory expenditure. Most funding streams provided respite and psychoeducation. The literature showed positive carer outcomes for psychoeducation and intensive family interventions. Evidence was lacking for the effectiveness of respite services. Conclusions These findings suggest a mismatch between what is known about the extent to which different service types deliver positive carer outcomes and the current allocation of funds across Australia’s mental health system. This study also highlights the fragmentation of the mental health carer services system, supporting the need to streamline access. What is known about this topic? Informal carers of people with mental disorders provide a critical role to the significant number of individuals with mental illness in Australia, and provide an unpaid workforce to the Australian mental health system. This role comes with significant physical, emotional and financial burden, which government-funded services can assist with to allow mental health carers to continue to serve in their caring role while improving their quality of life. What does this paper add? Using both published data and communication with health and non-government officials, we have estimated federal and state expenditure on mental health carer services at A$90.6million in 2014–15 fiscal year and have provided a mapping of the services this expenditure funds. In addition, through analysis of the literature on outcomes of carer services provided, we have seen a mismatch of expenditure and the evidence base. What are the implications for practitioners? There is a necessity for both more research into service outcomes aimed particularly at mental health carers and thinking critically about whether the current prioritisation of funds can be increased and/or reallocated to create better outcomes for mental health carers.

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