Changing practice to support self-management and recovery in mental illness: application of an implementation model
Battersby, Malcolm Wayne
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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 (a) identify a well-founded implementation model and (b) assess its practical usefulness in introducing a new program for recovery-oriented self-management support. We reviewed the literature to identify implementation models applicable to community mental health, and having 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 Organizational Readiness to Change Assessment (ORCA) tool were used. 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 program 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. Further practical use and testing of implementation models appears justified in overcoming barriers to change.