Integrating an evidence‐based intervention into clinical practice: ‘transitional relationship model’

Abstract

Accessible summary The transitional relationship model (TRM) facilitates the discharge of psychiatric clients from hospital to community by providing hospital staff involvement until a therapeutic relationship has been established with a community care provider as well as peer support. Psychiatric wards at six hospital sites implemented the TRM in three waves. Monthly summaries, progress reports, meeting minutes and focus group discussions were reviewed in order to uncover facilitators and barriers to TRM implementation. Factors that facilitated TRM implementation included: educational modules for staff and peer training, the presence of on‐site champions, and supportive documentation systems. Barriers included: feeling swamped/overwhelmed, death by process, team dynamics and changes in champions. Implementation strategies suggested by the initial hospital wards were used to enhance implementation on subsequent wards, leading to positive outcomes. This study highlights the need to address work environment issues when implementing healthcare interventions, particularly for interprofessional teams. Abstract The transitional relationship model (TRM) facilitates the discharge process by providing peer support and hospital staff involvement until a therapeutic relationship has been established with a community care provider. A quasi‐experimental, action‐oriented research design was employed in which psychiatric wards at six hospital sites implemented the model in three waves. Helpful strategies were identified by each wave of wards for consideration by subsequent wards. Using an ethnographic approach, qualitative data were examined to uncover experiences and perceptions of TRM implementation and to help identify key issues that were supporting or hampering implementation. Specific strategies that facilitate the implementation of TRM include: (1) the use of educational modules for on‐ward hospital staff training and peer training; (2) presence of on‐site champions; and (3) supportive documentation systems. Issues identified as barriers to implementation included: (1) feeling drowned, swamped and overwhelmed; (2) death by process; (3) team dynamics; and (4) changes in champions. Staged large‐scale implementation of the TRM allowed for iterative improvements to the model leading to positive outcomes. This study highlights the need to address work environment issues, particularly interprofessional teams.

Evaluation of the transitional discharge model on use of psychiatric health services: An interrupted time series analysis

“…It is possible that TDM was effectively implemented within the duration of the study time when survey data were being collected, but fidelity to the model waned over time. A previous TDM study found that the level of TDM implementation could change significantly if the champion for TDM implementation changed or if staff felt overworked with other tasks (Forchuk et al., ). As mentioned previously, the effect of TDM on outcomes in tertiary care units may also be affected by the inability to uniquely identify units using provincial health administrative data.…”

“…Due to the overlap in care during the transition period until relationships between patient and community partners are developed, TDM increases the work of care providers and appears more costly. Although studies have been conducted on the use of TDM, these have mostly occurred in tertiary care units with small sample sizes and limited follow‐up time (Forchuk et al., , , , ). More important, these studies have always looked at readmission and emergency department visits to the same hospital from which patients were discharged.…”

Interprofessional Collaboration in the Mental Health Services in Norway

“…Smooth pathways included ensuring patient support from the hospital until relationships with community care had been established (cf. [12]). Open communication with patients and families as well as collaboration among healthcare providers can ensure a seamless transition to the next care level and facilitate best patient outcomes [4].…”

“…Reynolds et al [11] tested an intervention called transitional discharge, which included an overlap between in-patient and community staff, where the former continued to care for the discharged patient until a working relationship was established with a community care professional. Forchuk et al [12] developed a transitional model that facilitated the discharge process by ensuring support from the hospital until a therapeutic relationship with a community care provider had been established.…”

Transitioning into the Community: Outcomes of a Pilot Housing Program for Forensic Patients

“…The Transitional Relationship Model (formerly called the Transitional Discharge Model; Forchuk et al, 2013) described by Forchuk, Martin, Chan, and Jensen (2005) involves: (1) overlapping contact with inpatient and community support providers until the client develops a working relationship with community support providers and (2) peer support. Psychiatric (including forensic) patients who received this overlapping contact with support providers and peer support were discharged after a shorter time in hospital and, a year post-discharge, reported improved quality of life in terms of social relations compared to patients receiving treatment as usual, although there was no group difference in global quality of life (Forchuk et al, 2005).…”