|ترجمه عنوان مقاله||اجرای دستورالعمل های بالینی برای مصرف همزمان مواد و اختلالات روانی عمده در روانپزشکی قانونی سوئد: یک مطالعه مصاحبه اکتشافی و کیفی با کارکنان مراقبت های بهداشت روان|
|عنوان انگلیسی مقاله||Implementing clinical guidelines for co-occurring substance use and major mental disorders in Swedish forensic psychiatry: An exploratory, qualitative interview study with mental health care staff|
|انتشار||مقاله سال ۲۰۲۳|
|تعداد صفحات مقاله انگلیسی||۱۳ صفحه|
|هزینه||دانلود مقاله انگلیسی رایگان میباشد.|
|نوع نگارش مقاله
||مقاله پژوهشی (Research Article)|
|مقاله بیس||این مقاله بیس نمیباشد|
|نمایه (index)||JCR – Master Journal List – Scopus – Medline|
|فرمت مقاله انگلیسی|
||۳٫۵۰۲ در سال ۲۰۲۰|
|شاخص H_index||۱۰۹ در سال ۲۰۲۲|
|شاخص SJR||۱٫۲۲۸ در سال ۲۰۲۰|
|شاخص Quartile (چارک)||Q1 در سال ۲۰۲۰|
|رشته های مرتبط||روانشناسی – پزشکی|
|گرایش های مرتبط||روانشناسی بالینی – روانپزشکی|
|نوع ارائه مقاله
|مجله||مجله درمان سوء مصرف مواد – Journal of Substance Abuse Treatment|
|دانشگاه||Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden|
|کلمات کلیدی||اختلال مصرف مواد – تشخیص همزمان – پیاده سازی – دستورالعمل های بالینی – رویکرد تقویت جامعه – تحلیل موضوعی|
|کلمات کلیدی انگلیسی||Substance use disorder – Co-occurring diagnoses – Implementation – Clinical guidelines – Community reinforcement approach – Thematic analysis|
|شناسه دیجیتال – doi
|لینک سایت مرجع||https://www.journalofsubstanceabusetreatment.com/article/S0740-5472(22)00181-7/fulltext|
|وضعیت ترجمه مقاله||ترجمه آماده این مقاله موجود نمیباشد. میتوانید از طریق دکمه پایین سفارش دهید.|
|دانلود رایگان مقاله||دانلود رایگان مقاله انگلیسی|
|سفارش ترجمه این مقاله||سفارش ترجمه این مقاله|
|فهرست مطالب مقاله:|
۶ Conclusion and clinical implications
CRediT authorship contribution statement
Declaration of competing interest
|بخشی از متن مقاله:|
Patients with substance use disorders (SUD) and co-occurring mental disorders (COD) within forensic psychiatric care often suffer poor treatment outcomes and high rates of criminal recidivism, substance use, and psychiatric problems. This study aimed to describe the conditions for, and mental health care staff’s experiences with, implementing integrated SUD-focused clinical guidelines, including assessment and treatment for patients with COD at a high-security forensic mental health services (FMHS) facility in Sweden.
Study staff conducted nineteen semi-structured interviews with health care staff experienced in administering the new SUD assessment and treatment. The study conducted a thematic analysis to describe the health care staff’s experiences with these guidelines and suggestions for improvement.
Most participants reported appreciation for the implementation of clinical guidelines with an SUD focus, an area they considered to have previously been neglected, but also noted the need for more practical guidance in the administration of the assessments. Participants reported the dual roles of caregiver and warden as difficult to reconcile and a similar, hindering division was also present in the health care staff’s attitudes toward SUD. Participants’ reports also described an imbalance prior to the implementation, whereby SUD was rarely assessed but treatment was still initiated. One year after the implementation, an imbalance still existed, but in reverse: SUD was more frequently assessed, but treatment was difficult to initiate.
Despite indications of some ambivalence among staff regarding the necessity of the assessment and treatment guidelines, many participants considered it helpful to have a structured way to assess and treat SUD in this patient group. The imbalance between frequent assessment and infrequent treatment may have been due to difficulties transitioning patients across the “gap” between assessment and treatment. To bridge this gap, mental health services should make efforts to increase patients’ insight concerning their SUD, flexibility in the administration of treatment, and the motivational skills of the health care staff working with this patient group. Participants considered important for enhancing treatment quality a shared knowledge base regarding SUD, and increased collaboration between different professions and between in- and outpatient services.
Substance use disorders (SUD) significantly increase the risk that patients with psychiatric disorders will commit, and recidivate into, violent crimes (Baillargeon et al., 2009; Fazel et al., 2009; Lund et al., 2012). Treatment efficacy, retention, and outcome are worse for patients with SUD and one or more co-occurring mental disorders (henceforth COD; see Substance Abuse and Mental Health Services Administration (SAMHSA), 2020) (Choi et al., 2013). Forensic mental health services (FMHS) have an urgent need to integrate SUD treatment into clinical practice (Eagle et al., 2019; Jaffe et al., 2011; Kelly et al., 2011) Recently, clinical guidelines including SUD assessment and treatment for COD patients were implemented at a high-security FMHS facility in Sweden. The successful implementation of interventions in clinical settings requires sustained efforts from staff and continuous support from management. The purpose of the current study was to describe health care staff’s experiences with the implementation of the SUD-focused clinical guidelines, directly following its launch and one year later.
Conclusion and clinical implications
The results from this study highlight the value of unifying health care staff’s attitudes toward COD for the sustained implementation of interventions. One year after implementing the SUD-focused clinical guidelines, some of the initial resistance and skepticism regarding SUD had been overcome and the health care staff were starting to see its benefits. But successful implementation efforts take time, and many implementations in clinical settings fail due to low fidelity to sustained efforts (e.g., Drake & Bond, 2010). Without financial and organizational support, improvements following the implementation are likely to degrade. To improve implementation sustainability, the clinic must carefully plan and allocate long-term financial resources. FMHS should provide ongoing supervision and training, streamline documentation, and monitor changes to and the fidelity of the intervention implementation. Clinics should provide recurring education and workshops, where staff can deliberate on ambiguous results and discuss how to give patients feedback together with staff who have more assessment experience.