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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Psychiatry 1/2018

Building flexibility and managing complexity in community mental health: lessons learned in a large urban centre

Zeitschrift:
BMC Psychiatry > Ausgabe 1/2018
Autoren:
Vicky Stergiopoulos, Dima Saab, Kate Francombe Pridham, Anjana Aery, Arash Nakhost
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12888-018-1597-y) contains supplementary material, which is available to authorized users.

Abstract

Background

Across many jurisdictions, adults with complex mental health and social needs face challenges accessing appropriate supports due to system fragmentation and strict eligibility criteria of existing services. To support this underserviced population, Toronto’s local health authority launched two novel community mental health models in 2014, inspired by Flexible Assertive Community Team principles. This study explores service user and provider perspectives on the acceptability of these services, and lessons learned during early implementation.

Methods

We purposively sampled 49 stakeholders (staff, physicians, service users, health systems stakeholders) and conducted 17 semi-structured qualitative interviews and 5 focus groups between October 23, 2014 and March 2, 2015, exploring stakeholder perspectives on the newly launched team based models, as well as activities and strategies employed to support early implementation. Interviews and focus groups were audio recorded, transcribed verbatim and analyzed using thematic analysis.

Results

Findings revealed wide-ranging endorsement for the two team-based models’ success in engaging the target population of adults with complex service needs. Implementation strengths included the broad recognition of existing service gaps, the use of interdisciplinary teams and experienced service providers, broad partnerships and collaboration among various service sectors, training and team building activities. Emerging challenges included lack of complementary support services such as suitable housing, organizational contexts reluctant to embrace change and risk associated with complexity, as well as limited service provider and organizational capacity to deliver evidence-based interventions.

Conclusions

Findings identified implementation drivers at the practitioner, program, and system levels, specific to the implementation of community mental health interventions for adults with complex health and social needs. These can inform future efforts to address the health and support needs of this vulnerable population.
Zusatzmaterial
Additional file 1: Appendix X_Guide_Staff Focus Group Discussion Guide. (DOC 48 kb)
12888_2018_1597_MOESM1_ESM.doc
Additional file 2: Appendix Y_Guide_Client Focus Group Discussion Guide. (DOC 49 kb)
12888_2018_1597_MOESM2_ESM.doc
Additional file 3: Appendix W_Guide_Key Informant Interview Guide. (DOC 47 kb)
12888_2018_1597_MOESM3_ESM.doc
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