Evidence-based practice for young people who self harm: can it be sustained and does it improve outcomes?

In 1998-1999, two Area Health Services in NSW conducted a project to implement evidence-based service enhancements for the clinical management of young people who present with Deliberate Self Harm (DSH) behaviour. The present study examined what structures and procedures were required to implement and sustain evidence-based practice in different health care settings for patients with DSH behaviour. Service provision was assessed at three points during the initial project to assess the degree of change that occurred, and 9 months after the completion of the project to allow an assessment of sustainability of the service provision. We examined staff perceptions of the importance of education, management directives, policy and procedure changes, and cultural/attitudinal changes, in implementing clinical best practice. Results indicated that support from both service management and clinical staff is necessary for successful implementation of service enhancements. High levels of staff education and policy development were also associated with high levels of service performance. The best sustained enhancements were those that were developed by the services themselves.

1998年至1999年，新南威尔士州的两个地区卫生服务机构开展了一个项目，针对有蓄意自伤（DSH）行为的年轻人的临床管理实施基于证据的服务改进。本研究探讨了在不同的医疗环境中，针对有DSH行为的患者实施和维持基于证据的实践需要哪些结构和程序。在初始项目的三个时间点对服务提供情况进行了评估，以评估所发生的变化程度，并在项目完成9个月后进行评估，以了解服务提供的可持续性。我们研究了工作人员对教育、管理指令、政策和程序变更以及文化/态度转变在实施临床最佳实践中的重要性的看法。结果表明，服务管理部门和临床工作人员的支持对于成功实施服务改进是必要的。高水平的工作人员教育和政策制定也与高水平的服务绩效相关。持续效果最好的改进是由服务机构自身开展的那些改进。