Table_1_Engaging frontline workers in policy development to support the implementation of measurement-based care: Lessons learned from a field-based workgroup.DOCX

Measurement-Based Care (MBC) is the use of patient-reported outcome measures repeatedly over the course of treatment to track progress and empower both providers and patients to collaboratively set goals and plan treatment. The Measurement-Based Care in Mental Health Initiative within the Department of Veterans Affairs' Office of Mental Health and Suicide Prevention partnered with the Post Traumatic Stress Disorder (PTSD) Mentoring Program to create an interdisciplinary field-based workgroup. The workgroup included psychologists, clinical social workers, and mental health counselors from PTSD Clinical Teams. The task of the workgroup was to create guidelines for best practice in delivery of MBC in PTSD Clinical Teams given anticipated policy requiring MBC to be used in PTSD Clinical Teams. Framed in the Strategic Action Field Framework for Policy Implementation Research, the current paper evaluates this hybrid top-down and bottom-up process of policy development. Major barriers included difficulty with the workgroup as an authentic bottom-up process, inability to reach the entire field (e.g., focus groups not widely attended by providers), and limited diversity in the workgroup. Facilitators included using consensus to make decisions, support provided to workgroup members by national operations partners, and collaboration and mutual respect among workgroup members. Workgroup members noted an equal, respectful partnership between operations partners and the workgroup; they reported feeling empowered and believed the viewpoints of the field were included in the guidelines. Further, due to the COVID-19 pandemic, the workgroup included more guidelines specific to telehealth into the guidelines. This hybrid model provides a process through which frontline workers can inform policy development and implementation.

基于测量的护理（MBC）是指在治疗过程中反复使用患者报告的结局测量，以追踪进展并赋予医疗提供者和患者共同设定目标和规划治疗的权力。美国退伍军人事务部心理健康和预防自杀办公室内基于测量的护理计划与创伤后应激障碍（PTSD）辅导计划合作，组建了一个跨学科、基于现场的工作小组。该小组由来自PTSD临床团队的心理学家、临床社会工作者和心理健康咨询师组成。工作小组的任务是在预期政策要求PTSD临床团队使用基于测量的护理的背景下，制定MBC在PTSD临床团队中最佳实践的指南。在政策实施研究战略行动领域框架下，本文评估了这种混合自上而下和自下而上的政策制定过程。主要障碍包括工作小组作为真正自下而上过程的困难、无法触及整个领域（例如，焦点小组未得到提供者的广泛参与），以及工作小组中多样性的有限。促进因素包括通过达成共识来做出决策、国家运营合作伙伴为工作小组成员提供支持，以及工作小组成员之间的协作和相互尊重。工作小组成员指出，运营合作伙伴和工作小组之间存在着平等、尊重的伙伴关系；他们报告称感到赋权，并相信领域的观点已被纳入指南中。此外，由于COVID-19大流行，工作小组将更多针对远程医疗的具体指南纳入了指南中。这种混合模式提供了一个流程，使一线工作者能够参与政策制定和实施。