Effect of a needs-based model of care on the characteristics of healthcare services in England: the i-THRIVE National Implementation Programme.

IF 5.9 2区 医学 Q1 PSYCHIATRY
R Sippy, L Efstathopoulou, E Simes, M Davis, S Howell, B Morris, O Owrid, N Stoll, P Fonagy, A Moore
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Abstract

Aims: Developing integrated mental health services focused on the needs of children and young people is a key policy goal in England. The THRIVE Framework and its implementation programme, i-THRIVE, are widely used in England. This study examines experiences of staff using i-THRIVE, estimates its effectiveness, and assesses how local system working relationships influence programme success.

Methods: This evaluation uses a quasi-experimental design (10 implementation and 10 comparison sites.) Measurements included staff surveys and assessment of 'THRIVE-like' features of each site. Additional site-level characteristics were collected from health system reports. The effect of i-THRIVE was evaluated using a four-group propensity-score-weighted difference-in-differences model; the moderating effect of system working relationships was evaluated with a difference-in-difference-in-differences model.

Results: Implementation site staff were more likely to report using THRIVE and more knowledgeable of THRIVE principles than comparison site staff. The mean improvement of fidelity scores among i-THRIVE sites was 16.7, and 8.8 among comparison sites; the weighted model did not find a statistically significant difference. However, results show that strong working relationships in the local system significantly enhance the effectiveness of i-THRIVE. Sites with highly effective working relationships showed a notable improvement in 'THRIVE-like' features, with an average increase of 16.41 points (95% confidence interval: 1.69-31.13, P-value: 0.031) over comparison sites. Sites with ineffective working relationships did not benefit from i-THRIVE (-2.76, 95% confidence interval: - 18.25-12.73, P-value: 0.708).

Conclusions: The findings underscore the importance of working relationship effectiveness in the successful adoption and implementation of multi-agency health policies like i-THRIVE.

基于需求的护理模式对英格兰医疗保健服务特点的影响:i-THRIVE国家实施方案。
目标:发展以儿童和青少年需求为重点的综合心理健康服务是英格兰的一项关键政策目标。THRIVE框架及其实施方案i-THRIVE在英国得到广泛应用。本研究考察了工作人员使用i-THRIVE的经验,估计了其有效性,并评估了地方系统工作关系如何影响项目的成功。方法:本评价采用准实验设计(10个实施点和10个比较点)。测量包括员工调查和评估每个站点的“蓬勃发展”特征。从卫生系统报告中收集了其他站点级别的特征。i-THRIVE的效果采用四组倾向评分加权差中差模型进行评估;采用差中差中差模型评价系统工作关系的调节作用。结果:实施站点的工作人员比比较站点的工作人员更有可能报告使用THRIVE,并且更了解THRIVE原则。i-THRIVE网站的保真度平均提高了16.7分,比较网站的保真度平均提高了8.8分;加权模型没有发现统计学上的显著差异。然而,结果表明,当地系统中强大的工作关系显著提高了i-THRIVE的有效性。具有高效工作关系的网站在“类似繁荣”特征方面表现出显著改善,比比较网站平均增加16.41点(95%置信区间:1.69-31.13,p值:0.031)。工作关系无效的站点没有从i-THRIVE中获益(-2.76,95%置信区间:- 18.25-12.73,p值:0.708)。结论:调查结果强调了工作关系有效性对成功通过和实施i-THRIVE等多机构卫生政策的重要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.80
自引率
1.20%
发文量
121
审稿时长
>12 weeks
期刊介绍: Epidemiology and Psychiatric Sciences is a prestigious international, peer-reviewed journal that has been publishing in Open Access format since 2020. Formerly known as Epidemiologia e Psichiatria Sociale and established in 1992 by Michele Tansella, the journal prioritizes highly relevant and innovative research articles and systematic reviews in the areas of public mental health and policy, mental health services and system research, as well as epidemiological and social psychiatry. Join us in advancing knowledge and understanding in these critical fields.
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