Evaluation of new flexible and integrative psychiatric treatment models in Germany- assessment and preliminary validation of specific program components

BackgroundFlexible and integrative treatment (FIT) models are rather novel in German mental health care. This study aimed at identifying and evaluating empirically based, practicable, and quantifiable program components that describe the specific treatment structures and processes of German FIT models.MethodsA multi-step, iterative research process, based on Grounded Theory Methodology (GTM), was used to identify and operationalise components. A complex algorithm and expert-interviews were applied to quantify the relative weight of each component and to develop a sum score. Face and content validity were examined and internal consistency was tested by Cronbach’s α coefficient.ResultsTen of eleven FIT components could be operationalised, quantified and united in the total score. All operationalised components showed sufficient face and content validity and eight components had a good reliability.ConclusionsThe components are a first step in the process of operationally defining German FIT models. They considerably overlap with various critical ingredients of international FIT models and may serve as a theoretical basis for constructing fidelity tools and research guides to enable process and outcome evaluation of German FIT models.

[1]  J. P. Winter,et al.  The Dartmouth Assertive Community Treatment Scale (DACTS) , 2000, Evaluation review.

[2]  T. Steinert,et al.  Systematische Literaturübersicht zur Implementierung der sektorübergreifenden Versorgung (Regionalbudget, integrierte Versorgung) in Deutschland , 2013, Psychiatrische Praxis.

[3]  Janet Mancini Billson,et al.  Focus Groups: A Practical Guide for Applied Research , 1989 .

[4]  H. Hoffmann,et al.  Versorgungsmodelle in Psychiatrie und Psychotherapie , 2008 .

[5]  Linda M. Cabral,et al.  Overview Of Publicly Funded Managed Behavioral Health Care , 2005, Administration and Policy in Mental Health and Mental Health Services Research.

[6]  M. Petticrew,et al.  Developing and evaluating complex interventions: the new Medical Research Council guidance , 2008, BMJ : British Medical Journal.

[7]  C. H. Lawshe A QUANTITATIVE APPROACH TO CONTENT VALIDITY , 1975 .

[8]  S. Ziguras,et al.  A meta-analysis of the effectiveness of mental health case management over 20 years. , 2000, Psychiatric services.

[9]  A. Bramesfeld Wie gemeindenah ist die psychiatrische Versorgung in der Bundesrepublik Deutschland? , 2003 .

[10]  R. Kilian,et al.  Does one size really fit all? The effectiveness of a non-diagnosis-specific integrated mental health care program in Germany in a prospective, parallel-group controlled multi-centre trial , 2017, BMC Psychiatry.

[11]  David Hindle,et al.  Development of a measure of model fidelity for mental health Crisis Resolution Teams , 2016, BMC Psychiatry.

[12]  U. Malm,et al.  Case management and assertive community treatment in Europe. , 2001, Psychiatric services.

[13]  H. S. Kim,et al.  From good intentions to real life: introducing crisis resolution teams in Norway. , 2008, Nursing inquiry.

[14]  J. Coid,et al.  Community mental health teams (CMHTs) for people with severe mental illnesses and disordered personality. , 2007, The Cochrane database of systematic reviews.

[15]  L. Stein,et al.  Alternative to mental hospital treatment. I. Conceptual model, treatment program, and clinical evaluation. , 1980, Archives of general psychiatry.

[16]  G. Teague,et al.  The TMACT: A New Tool for Measuring Fidelity to Assertive Community Treatment , 2011, Journal of the American Psychiatric Nurses Association.

[17]  R. Merton Social Theory and Social Structure , 1958 .

[18]  J. Schwarz,et al.  Spezifische Merkmale zur Einstufung der Modellversorgung nach § 64b SGB V , 2018, Der Nervenarzt.

[19]  M. Greenblatt,et al.  Deinstitutionalization: health consequences for the mentally ill. , 1983, Annual Review of Public Health.

[20]  K. R. Priya Grounded Theory Methodology , 2013 .

[21]  David Hindle,et al.  Crisis resolution and home treatment: stakeholders’ views on critical ingredients and implementation in England , 2017, BMC Psychiatry.

[22]  Interprofessional education in Erlangen: A needs analysis and the conceptual work of a student working group , 2016, GMS journal for medical education.

[23]  John W. Creswell,et al.  Designing and Conducting Mixed Methods Research , 2006 .

[24]  N. Brimblecombe Acute mental health care in the community : intensive home treatment , 2001 .

[25]  Brynmor Lloyd-Evans,et al.  National implementation of a mental health service model: A survey of Crisis Resolution Teams in England , 2018, International journal of mental health nursing.

[26]  M. Salyers,et al.  Processes underlying treatment success and failure in assertive community treatment , 2012, Journal of mental health.

[27]  Michelle P. Salyers,et al.  Measuring the fidelity of implementation of a mental health program model. , 1994, Journal of consulting and clinical psychology.

[28]  G. Bond,et al.  Critical ingredients of assertive community treatment: Judgments of the experts , 2006, The journal of mental health administration.

[29]  M. Tansella,et al.  Components of a modern mental health service: a pragmatic balance of community and hospital care , 2004, British Journal of Psychiatry.

[30]  Fidelity outcomes in the National Implementing Evidence-Based Practices Project. , 2007, Psychiatric services.

[31]  Alison E. Peterson,et al.  Validation of the Revised Individual Placement and Support Fidelity Scale (IPS-25). , 2012, Psychiatric services.

[32]  Michelle P. Salyers,et al.  Measurement of Fidelity in Psychiatric Rehabilitation , 2000, Mental health services research.

[33]  CMHC Adherence to National Mental Health Plan Standards in Italy: A Survey 30 Years After National Reform Law , 2011 .

[34]  C. Coleborne Psychiatric Cultures Compared: Psychiatry and Mental Health Care in the Twentieth Century: Comparisons and Approaches , 2006 .

[35]  G. Bond,et al.  Client perspectives on helpful ingredients of assertive community treatment. , 1996 .

[36]  P. Fayers,et al.  Quality of Life: The assessment, analysis and interpretation of patient-reported outcomes , 2007 .

[37]  M. Angermeyer,et al.  [The regional psychiatry budget (RPB): a model for a new payment system of hospital based mental health care services]. , 2010, Psychiatrische Praxis.

[38]  L. Cronbach Coefficient alpha and the internal structure of tests , 1951 .

[39]  Thomas Becker,et al.  Mental health care in Germany: current state and trends. , 2007, European archives of psychiatry and clinical neuroscience.

[40]  Pat Bazeley,et al.  Editorial: Integrating Data Analyses in Mixed Methods Research , 2009 .