L’implantation au Québec de l’Integrated Psychological Treatment (IPT) auprès des personnes atteintes de schizophrénie : cinq ans après

Abstract

Cet article s’intéresse à l’adoption au Québec d’une pratique basée sur l’évidence scientifique, l’Integrated Psychological Treatment (IPT) auprès des personnes atteintes de schizophrénie, et à la pérennité de cette pratique dans neuf milieux cliniques en contexte de transformation des services. Une équipe de recherche du Centre de recherche Fernand Seguin de l’Hôpital Louis-H. Lafontaine a observé l’implantation et le maintien de l’IPT dans neuf milieux cliniques. L’article présente les facteurs qui ont contribué, sur une période de cinq ans, au maintien (ou non) de l’IPT dans ces milieux. Il soulève une question importante sur la pérennité des approches spécialisées et spécifiques à une clientèle dans des contextes de transformation des services.This article examines the adoption in Québec of the evidence-based practice, Integrated Psychological Treatment (IPT) of people with schizophrenia and the longevity of this practice within nine clinical milieus in a context of transformation of services. A team of researchers of the Centre de recherche Fernand Seguin has closely followed the implementation and the maintenance of the IPT in nine clinical milieus. More specifically, this article presents the factors that have contributed, on a five year period, to the maintenance (or not) of the IPT in these settings. It raises the important question of longevity of an approach that is specialized and specific to a clientele in contexts of transformation of services.Este artículo se interesa por la adopción en Quebec de una práctica basada en la evidencia científica, el Tratamiento Psicológico Integrado (IPT) para las personas que sufren de esquizofrenia, y la perennidad de esta práctica en nueve medios clínicos en un contexto de transformación de los servicios. Un equipo de investigadores del Centro de Investigaciones Fernand Seguin del Hospital Louis-H. Lafontaine observó la implantación y mantenimiento del IPT en nueve medios clínicos. El artículo presenta los factores que contribuyeron, en un período de cinco años, a mantener (o no) el IPT en estos medios. Resalta una cuestión importante acerca de la perennidad de los enfoques especializados y específicos a una clientela en los contextos de transformación de los servicios.Este artigo se interessa pela adoção no Quebec de uma prática baseada na experiência clínica, a Terapia Psicológica Integrada (Integrated Psychological Treatment — IPT) junto às pessoas que sofrem de esquizofrenia, e pela continuidade desta prática em nove meios clínicos em contexto de transformação dos serviços. Uma equipe de pesquisa do Centro de pesquisa Fernand Séguin do Hospital Louis-H. Lafontaine observou a implantação e a manutenção da IPT em nove meios clínicos. O artigo apresenta os fatores que contribuíram, em um período de cinco anos, para a manutenção ou não da IPT nestes meios. Ele levanta uma questão importante sobre a continuidade das abordagens especializadas e específicas a uma clientela, em contexto de transformação dos serviços

The Integrated Psychological Treatment for Individuals With Schizophrenia in Correctional and Forensic Psychiatric Settings: An Implementation Study

“…Some of the aforementioned issues echo those already identified in our implementation study of IPT in general psychiatry (Briand et al, 2010; that is, exigency of IPT, lack of resources, and commitment of leaders). However, other issues were more specific to correctional and forensic psychiatric settings (i.e., the legal and clinical picture of the clientele, tensions between rehabilitation and security requirements, interdisciplinary collaboration, and the recognition of the approach in a national correctional programming).…”

“…In this study, one of the two cases (INPL) has continued to deliver IPT following the implementation project. As highlighted by our prior multiple case studies on IPT (Briand et al, 2010) as well as the broader literature on psychosocial interventions (Briand & Menear, 2014), several factors need to be considered to ensure the sustainability of EBP in mental health services. Engagement and commitment of leaders in the implementation is one of those key factors (Bond, 2009; Briand et al, 2010; Drake et al, 2009).…”

“…These cases represented two different but typical Canadian care settings for individuals with schizophrenia having legal involvement (involuntary hospitalization and detention). They added to the nine cases already studied by our research team in general psychiatry (Briand et al, 2010). Ethical approval of the study was obtained in each setting.…”

“…It consists of six modules of increasing complexity: cognitive differentiation, social perception, verbal communication, social skills, emotional management, and problem-solving (Pomini et al, 1998). In Québec (Canada), where it has been implemented in several general psychiatric settings (Briand et al, 2010), IPT is delivered to groups of eight to 12 participants over 9 to 12 months (2-hr sessions twice a week). It is usually facilitated by two rehabilitation professionals.…”

Les interventions basées sur les résultats probants en réadaptation psychiatrique: Auxquelles accorder la priorité et pourquoi?

“…'écueil principal auquel se butent les intervenants qui souhaitent offrir la TRC est d'avoir à choisir parmi le vaste nombre de modalités. Il existe actuellement des modalités papier-crayon et par ordinateur32 ainsi que des modalités de groupe plus exhaustives, comme l'Integrated Psychological Treatment33 , traduites en français. La plupart des interventions de TRC nécessitent peu de formation et peuvent avoir un effet significatif sur le fonctionnement de la personne, particulièrement en contexte de travail ou de retour aux études.…”