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标题：The Evergreen Programme Revisited- Making a Therapeutic Programme for Older Adults Fit for Purpose
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作者：Declan Lyons ; Roisin McCafferty
期刊名称：International Journal of Integrated Care
电子版ISSN：1568-4156
出版年度：2017
卷号：17
期号：5
DOI：10.5334/ijic.3876
出版社：Utrecht University, Maastricht University, Groningen University
摘要：Introduction : The Evergreen programme is a group based psychoeducational therapeutic programme for older adults in an inpatient psychiatric facility (St Patrick's Mental Health Services Dublin). The programme assists in the rehabilitation of older adults experiencing acute mental illness by emphasising independence and restoration of function. Education about strategies to enhance wellness and recovery is also prioritised. Five weekly groups were facilitated by all the members of an Old Age Psychiatric Multidisciplinary Team. The programme had been in operation since 2003 and although anecdotally well regarded, the programme lacked cohesion and organisation and was seen as diversional rather than therapetic. Aims and Objectives : In conjunction with other members of the multidisciplinary team, the author reviewed the content, scope and operation of the programme with the aim of streamlining the operation of the programme and enhancing the quality and diversity of groups available to participants. The team wished to reduce reliance on medication as the sole form of therapy on the acute ward and to obtain more resources for the programme. Methods : Through a series of focussed discussions, a survey of team members and participant feedback obtained over a six month period, a number of priorities emerged for changes, as well as an immedicate commitment to 'relaunch' a new and improved timetable with additional groups. The author and the team chose Kotter's model(1) (with awareness of organisational developemnt approaches) to facilitate the change. Results : A series of 5 meetings took place and 6 key priorities for change were agreed upon and some progress was made towards their implementation. Change implementers were identified and supported through the process and immedicate changes/ 'quick wins' (such as additional therapy groups being added to the timetable) sustained team interest. The change process mapped onto an appropriate quality framework and initial participant feedback regarding the redesigned programme was positive. Organisational impact : 55 % of thoese who participated in the groups regarded the new programme as 'excellent', as opposed to 33% for the old programme, thus validating the change efforts. Change agents were identified within the team to drive the improvements and although the initial changes were cost-neutral to the organisation, discussion and the team survey did reveal the need for extra resources for the programme. The team has successfully engaged with a change process using Kotter's model. Whilst initial improvements will enhance patient care, the challenge is to culturally embed and renew the change within the organisation. A well-structured and well functioning psychoeducational programme, with input from different disciplines, is a useful template for high quality interdisciplinary clinical/therapeutic activity in acute psychiatric settings generally. References : 1- Kotter J. 'Leading Change: Why Transformation Efforts Fail' Harvard Business Review, March-April 1995:59-67.
关键词：psycho-education ; programme ; group ; rehabilitation ; change process