Research and organizational issues for the implementation of family work in community psychiatric services.
BACKGROUND
The need for evidence-based practice (EBP) to guide and develop mental health services remains fundamental for modern services. Aim. To discuss issues that impact upon implementation of EBP and practice development using family work (FW) as an example.


METHODS
A selection of the FW literature was reviewed drawing on sources including the Cochrane Library, Cinahl and Medline. Keywords used were FW, community mental health team and research design.


RESULTS
Centralized policy initiatives and guidelines that are themselves guided by evidence of randomized controlled trials predominantly risk alienating practitioners and clients/carers. Family work has some demonstrable clinical benefits although models differ and the active therapeutic agent remains unclear. Its adoption into routine care is also hindered by a productivity management outlook that seeks to maximize stretched resources and whose values are likely to be internalized by practitioners. The dichotomous position of previous research and practice development make implementation of EBP difficult and highlights the need for strategic planning that embraces both factors.


CONCLUSIONS
The current drive to increase EBP requires a bi-directional process of influence that allows individual practitioners and clients/carers to become producers of evidence and not simply recipients. The authors support wider adoption of case study research designs to reflect the unpredictable nature of mental health care. Adoption of assertive community treatment models within community services is most likely to promote the excellence management model and accommodate EBP such as FW.
Jones
Adrian
A
Mental Health Directorate, North East Wales NHS Trust, Wrexham Maelor Hospital, Wrexham, UK. adrian.jones@new-tr.wales.nbs.uk
Scannell
Tony
T
D003152:Community Health Nursing / Q000458:organization & administration*; D003156:Community Mental Health Services / Q000458:organization & administration*; D004526:Efficiency; D019317:Evidence-Based Medicine / Q000458:organization & administration; D022143:Family Nursing / Q000458:organization & administration*; D006801:Humans; D007587:Job Description; D016294:Models, Nursing; D017146:Models, Organizational; D020380:Needs Assessment; D009720:Nurse Clinicians / Q000458:organization & administration; D024802:Nurse's Role; D015403:Nursing Evaluation Research; D019982:Organizational Case Studies; D015279:Organizational Culture; D009938:Organizations; D018802:Patient-Centered Care / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D016730:Program Development; D011568:Psychiatric Nursing / Q000458:organization & administration*; D012107:Research Design