Table 5 Implementation outcomes by CFIR (Consolidated Framework for Implementation Research) domain
Domain | Synthesised data | Reference |
|---|---|---|
Innovation The ‘thing’ being implemented, e.g. a new clinical treatment, educational programme, or city service | - High acceptability and feasibility of PSW-led support. - Engaging the community in a co-production approach should be adopted in the design of the peer provision service. | |
Outer Setting The setting in which the Inner Setting exists, e.g. hospital system, school district, state. There may be multiple Outer Settings and/or multiple levels within the Outer Setting (e.g. community, system, state) | - Integration of intervention implementation within existing healthcare systems. - National policy initiatives and funding provisions for employing and retaining PSWs. - PSWs having access to a wider peer network. - Interference of work with social security benefits. - Power hierarchies in certain broader cultural contexts. - Difficulties incorporating PSWs in a medical model of mental health care. - A lack of recognised certification for peer workers. | |
Inner Setting The setting in which the innovation is implemented, e.g. hospital, school, city. There may be multiple Inner Settings and/or multiple levels within the Inner Setting, e.g. unit, classroom, team | - Strong leadership and support from leadership at the highest level. - Importance of a workplace culture emphasising recovery-orientated practice. - Employers being flexible and understanding of needs of PSWs. - A supportive, accepting and trusting workplace culture where PSWs occupy a central position within service network and fit in well with other staff members. - Trusting culture allows management of risk in a psychologically safe space. - Access to necessary resources, e.g. desk space, computer, administrative data and medical records. - Time pressure and high caseloads leading to not enough time with patients. - Not enough funding for PSW role and no or limited renumeration for PSWs. - Effective communication and collaboration between PSWs and other workers. - Organisational openness and readiness to employ PSWs. - Organisations encouraging a ‘keeping well at workplan’ to support their PSWs, especially in times of crisis. | |
Individuals The roles and characteristics of individuals | - Professionalisation and legitimisation of PSW role with performance standards/code of ethics. - The use of rigorous recruitment practices to hire PSWs. - High levels of competency among peer-counsellors when delivering interventions and having relevant skills and knowledge, e.g. mental health conditions. - Conflicted sense of identity when constructing either ‘professional identity’ or ‘peer worker identity’. - Required recovery status for peer supporters. - PSWs ability to use coping skills and be resilient to avoid potential negative impacts on their wellbeing. - Staff willingness and ability to work with PSWs and accepting them as part of the service. - The use of champions and implementation leaders to drive the set up and maintenance of PSW interventions. - The use of appropriate confidentiality considerations (e.g. removing PSWs details from the service if they had previously been a patient there). | |
Implementation Process The activities and strategies used to implement the innovation | - Comprehensive training for PSWs delivered prior to starting work and on an ongoing basis. - Training should include practical skills for the PSW role, knowledge and awareness of mental health conditions. - Training other members of staff to effectively work with PSWs. - Regular clinical supervision for PSWs. - Clear role definition for PSW with appropriate boundaries. - Safeguarding precautions, e.g. removal of triggering content; psychiatric assessment and monitoring for PSWs. - Establishing sustainable systems of implementation (e.g. models of cost and supervision) from the outset of the implementation process to sustain PSW engagement over time. - Taking service user and PSW preferences into account when matching based on certain characteristics (e.g. demographics/diagnosis). |