Changing practice to support self-management and recovery in mental illness: application of an implementation model

Health services introducing practice changes need effective implementation methods. Within the setting of a community mental health service offering recovery-oriented psychosocial support for people with mental illness, we aimed to: (i) identify a well-founded implementation model; and (ii) assess its practical usefulness in introducing a new programme for recovery-oriented self-management support. We reviewed the literature to identify implementation models applicable to community mental health organisations, and that also had corresponding measurement tools. We used one of these models to inform organisational change strategies. The literature review showed few models with corresponding tools. The Promoting Action on Research Implementation in Health Services (PARIHS) model and the related Organisational Readiness to Change Assessment (ORCA) tool were used. The PARIHS proposes prerequisites for health service change and the ORCA measures the extent to which these prerequisites are present. Application of the ORCA at two time points during implementation of the new programme showed strategy-related gains for some prerequisites but not for others, reflecting observed implementation progress. Additional strategies to address target prerequisites could be drawn from the PARIHS model. The PARIHS model and ORCA tool have potential in designing and monitoring practice change strategies in community mental health organisations. Further practical use and testing of implementation models appears justified in overcoming barriers to change.

Education for paediatric pain

This chapter focuses on educating children, parents, and health care professionals about pain management. The first half of the chapter examines issues related to children and parents while the second half concentrates on health care professionals. The current state of knowledge will be explored and strategies for educating each group discussed. The Promoting Action on Research Implementation in Health Services (PARiHS) model (see also Yamada and Hutchinson, Chapter 61, this volume) is used to help explain why healthcare professionals do not always use their knowledge in practice. Implications for practice, education and future research are also outlined.