RESUMO
BACKGROUND: Recovery-oriented practice promotes the strengths and recovery potential of individuals. We aimed to establish whether individuals who access mental health services where staff have received the REFOCUS-PULSAR intervention, an adaptation of the UK's REFOCUS recovery-oriented staff intervention for use in Australia, show increased recovery compared with people using non-intervention services. METHODS: We did a pragmatic, two-step, stepped-wedge, randomised controlled trial at 18 sites grouped into 14 clusters across public mental health services and mental health community support services in Victoria, Australia. Eligible staff were working part-time or full-time in a direct service role at one of the 18 sites and had consumers being recruited for this study. Eligible consumers were receiving care from a participating cluster, with contact in the 3 months before data collection; aged 18-75 years; and not imprisoned. Clusters were randomly assigned with a web-based randomisation tool to receive the REFOCUS-PULSAR intervention in either the first year (step one) or second year (step two). Consumers, but not staff, were masked to treatment assignment. The primary outcome was the Questionnaire about the Process of Recovery (QPR), for which cross-sectional data were collected across three timepoints (baseline [T0], year 1 [T1], and year 2 [T2]). The primary analysis was done by intention to treat. This trial is registered with ANZCTR, number ACTRN12614000957695. FINDINGS: 190 staff (111 from public mental health services and 79 from mental health community support services) received the REFOCUS-PULSAR recovery-oriented training intervention. Between Sept 18, 2014, and May 19, 2017, 942 consumers were recruited across the three timepoints (T0: n=301; T1: n=334; T2: n=307). The mean QPR score was 53·6 (SD 16·3) in the control group and 54·4 (16·2) in the intervention group (adjusted difference 3·7, 95% CI 0·5-6·8; p=0·023). The Cohen's d value for the intervention effect was small (d=0·23). INTERPRETATION: The REFOCUS-PULSAR intervention had a small but significant effect on the QPRs of individuals using community mental health services and might be effective in promotion of recovery-oriented practice across sectors. FUNDING: Victorian Government Mental Illness Research Fund.
Assuntos
Pessoal de Saúde/educação , Transtornos Mentais/terapia , Recuperação da Saúde Mental , Serviços de Saúde Mental , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Vitória , Adulto JovemRESUMO
While the practice and the science of employee engagement continue to run on largely separate paths, the science of engagement continues to evolve with ongoing incremental refinements to existing models and measures. This qualitative study sought to map the extent of the science-practice divide and to further inform the content of the science and the practice of employee engagement. Interview data obtained from 51 senior operational and human resource managers of a large multi-national mining company revealed that whereas a considerable overlap is apparent in the way that scientists and practitioners view the nature and the drivers of employee engagement, there are also key differences and differences of emphasis. Consistent with recent research, the importance of a reciprocal or two-way partnership between management and employees was highlighted by interviewees as being very important to engagement. The interview data also suggested that focused energy and alignment with organizational goals should further be recognized as key attributes of engagement within the academic literature. Importantly, a number of opportunities to elaborate the Job Demands-Resources model were identified. First, the differential influence of organizational level resources (e.g. senior leadership; organizational climate) versus job level resources emerged. Second, the potential differential influence that challenge versus stressor demands can exert at the organizational level (e.g. large scale organizational change; organizational politics) and at the job level (e.g. role ambiguity; role conflict) emerged. Third, the direct effects of both challenge demands and hindrance demands on work engagement could be usefully and more explicitly acknowledged in the JD-R model. Finally, taking into account the study limitations, we propose future opportunities to extend the integration of the science and the practice of employee engagement.
Mientras que la práctica y la ciencia del engagement laboral continúan recorriendo caminos separados, la ciencia del engagement sigue evolucionando a través de constantes refinamientos aplicados a modelos y medidas existentes. Este estudio cualitativo busca poder mapear el alcance de la separación de la ciencia y la práctica; además de informar el contenido de la ciencia y la práctica del engagement laboral. Los datos obtenidos a partir de un universo de 51 operadores experimentados y gerentes de recursos humanos, pertenecientes a una compañía minera multinacional, revelaron que mientras una considerable sobreposición es aparente en la forma en que los científicos y practicantes ven la naturaleza y las conducciones del engagement laboral, también existen diferencias clave y de énfasis. De manera consistente con investigaciones recientes, la importancia recíproca, o la sociedad igualitaria entre gerentes y empleados, se destacó como algo esencial por parte de los entrevistados en función del engagement. Los datos obtenidos también sugieren que la energía enfocada y la alineación de objetivos organizacionales, deberían ser reconocidos como atributos fundamentales del engagement dentro de la literatura académica. Es de esta forma, se identificaron un número de oportunidades para elaborar un modelo de Demandas y Recursos Laborales (Job Demands-Resources model, en inglés). Lo primero en surgir fue la influencia diferencial de los recursos de nivel organizacional (liderazgo experimentado; clima organizacional) versus los recursos de nivel laboral. Lo segundo en presentase fue la influencia potencial diferencial que desafía versus las demandas estresantes que se ejercen a nivel organizacional (cambio organizacional a gran escala, políticas organizacionales) y al nivel laboral (ambigüedad de rol, conflictos de rol). Tercero, los efectos directos de las ordenes complicadas y las demandas obstaculizadoras sobre el engagement laboral...