Implementation of the PARTNERS model of care within two UK community mental health transformation systems: a qualitative realist evaluation.

چکیده اصلی

INTRODUCTION: PARTNERS is a model of care that was co-designed with service users and carers to address the needs of people with severe mental illness to receive better support in primary care. Taking learning from a randomised controlled trial and process evaluation of this complex person-centred goal and coaching-based approach to care, our aim was to understand better the challenges of implementing PARTNERS in complex dynamic service delivery systems. METHODS: We identified two Integrated Care Systems that were interested in adopting the PARTNERS model of care. We trained practitioners to adopt PARTNERS to their local settings and provided meta-supervision (supervision of supervisors). We examined the implementation period that covered site engagement, training of staff and initial delivery of the new PARTNERS model of care, undertaking a qualitative realist evaluation informed by the Consolidated Framework for Implementation Research (CFIR). Data collection involved semi-structured interviews with 10 System Change Leads, Supervisors, and trained intervention practitioners or 'Care Partners'; augmented by observations of supervision and practice within the systems and collation of documents. Analysis was qualitative informed by a realist approach and the CFIR. RESULTS: Analysis identified complex overlapping configurations of teams and roles within them, leadership, and individual characteristics influenced the systems' ability to implement the PARTNERS model of care. The presence or absence of leadership was instrumental in providing clarity regarding where the delivery of PARTNERS sat within newly emerging systems and was an important indicator of successful implementation. Collaborative leadership and supervision, alongside training tailored to the needs of individual practitioners, increased or decreased perceived self-efficacy amongst individual practitioners and their confidence in delivering the PARTNERS model of care. CONCLUSIONS: We identified that both internal and external supervision and system leadership are crucial to the implementation of PARTNERS, backed up by training delivered by a clinician and people with lived experience, to ensure that this new model of care is embedded in everyday practice. It is likely that the absence of any one of these mechanisms could make implementation and sustainability of the PARTNERS model challenging. CLINICAL TRIAL NUMBER: Not applicable.

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