Issues in Mental Health Nursing, 31:716–722, 2010 Copyright © Informa Healthcare USA, Inc. ISSN: 0161-2840 print / 1096-4673 online DOI: 10.3109/01612840.2010.503008 Contemporary Mental Health Program Implementation and Evaluation Timothy Wand, MHN, RN, NP DAS (Nurs), Grad. Dip. (MHN), MN (Hons) Royal Prince Alfred Hospital, Camperdown, Australia, and University of Sydney, Sydney Nursing School, Camperdown, Australia Kathryn White, RN, MNurs., PhD University of Sydney, Sydney Nursing School, Camperdown, Australia Joanna Patching, RN, PhD University of Sydney, Sydney Nursing School, Camperdown, Australia Evaluation is a burgeoning field of health care program re- search. Experimental designs and meta-analyses have tradition- ally been considered the most suitable means of assessing program effectiveness. Qualitative methods also have been widely adopted. Mixed-methods designs have now emerged as a promising alterna- tive. This paper highlights the key features of contemporary mental health program implementation and evaluation. Realistic Evalu- ation is identified as a relatively new methodology that is more concerned with a deeper process-oriented inquiry and appreciates that any program must be understood within the given context. Two projects applying Realistic Evaluation are cited to illustrate the value of this methodology to mental health program research. In health care there is presently a strong emphasis on “ser- vice re-design” and “models of care” as a means of improving quality, practice, and cost effectiveness. It is also posited that developing new services will often involve more collaborative and patient- centred care, which requires the development of new systems, new roles, and new methods of evaluation (Byng, Norman, Redfern, & Jones, 2008). Evaluating the efficacy of any change in health care practice or service delivery is critical, yet often neglected. As health care changes, procedures for ex- amining the impact and efficacy of new practices and services are also changing. The intent of this paper is to explore evolv- ing perspectives and newer approaches to health care program evaluation and how this can be applied to research in mental health. There are challenges for clinical researchers seeking to bring the rigour that is often associated with traditional experimen- tal designs to the messy world of health service evaluation. Address correspondence to Timothy Wand, Royal Prince Alfred Hospital, Emergency Department, Missenden Rd., Camperdown, 2050 Australia. E-mail: timothy.wand@sswahs.nsw.gov.au Consequently, evaluation frameworks that are flexible and re- sponsive while maintaining research rigor are required. In order to meet these diverse needs, mixed-method studies that utilise both qualitative and quantitative methods in a complementary manner have emerged as a promising and pragmatic (albeit con- troversial) alternative for capturing the breadth and depth of outcomes emanating from a given program in order to enhance description and understanding (Giddings, & Grant, 2007; John- son, Onwuegbuzie, & Turner, 2007). Moreover, contemporary evaluation research is increasingly less focused simply on data collection and measurement. In- terest is now directed toward illuminating the process of suc- cessful program implementation, the inquiry into how complex programs work, and distilling what it is about a given context that explains the effectiveness of a particular program. Realistic Evaluation (Pawson & Tilley 1997) is identified as a method- ology that supports a range of methods and provides a flexible framework for understanding how individuals respond to an in- tervention or program in the light of local conditions, including community, social, and political factors. Finally, reference is made to two recent projects that have applied Realistic Evalua- tion and a summary of their key findings is presented. THE QUEST FOR ENHANCED EXPLANATION AND UNDERSTANDING IN EVALUATION RESEARCH The popularity of randomized controlled trials (RCTs) as a means for determining the effectiveness of medicines and medical treatments has resulted in health services research be- ing dominated by a preference for studies that concentrate on whether or not the outcome was achieved (Byng, Norman, & Redfern, 2005). However the World Health Organisation (WHO, 2004), for example, asserts that controlled laboratory-style ex- periments are an inappropriate means of generating evidence of 716 Issues Ment Health Nurs Downloaded from informahealthcare.com by 152.76.1.242 on 10/11/10 For personal use only.