Implementing the protocol of a pilot randomized controlled trial for the recovery-oriented intervention to people with psychoses in two Latin American cities

Mascayano, Franco; Alvarado, Rubén; Andrews, Howard; Jorquera, María José; Lovisi, Giovanni Marcos; Souza, Flávia Mitkiewicz de; Pratt, Charissa; Rojas, Graciela; Restrepo-Toro, Maria; Fader, Kim; Gorroochurn, Prakash; Galea, Sandro; Dahl, Catarina Magalhães; Cintra, Jacqueline; Conover, Sarah; Burrone, María Soledad; Baumgartner, Joy Noel; Rosenheck, Robert A.; Schilling, Sara; Sarução, Keli Rodrigues; Šťastný, Peter; Tapia, Eric; Cavalcanti, Maria Tavares; Valencia, Eliecer; Yang, Lawrence H.; Süsser, Ezra

doi:10.1590/0102-311x00108018

Cited by 30 publications

(7 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One exception is a study we conducted in Santiago, Chile, which incorporated peer workers into a community mental health intervention, called Critical Time Intervention—Task Shifting (CTI-TS), to support users with schizophrenia ( 65 ). A qualitative study that evaluated the users' experience with CTI-TS found that the users felt a special connection and reciprocity with the peer workers, who had also experienced psychosis ( 66 ).…”

Section: Discussionmentioning

confidence: 99%

Experts by Experience: Qualitative Evaluation of Adolescent Participation in the Development of a Technological Intervention to Prevent Youth Suicide in Chile

et al. 2021

Self Cite

View full text Add to dashboard Cite

Adolescent suicide is a pressing problem in Chile that has not yet been sufficiently addressed, as suicide rates have stagnated in recent years. One possible explanation could be linked to the adult-centered paradigm that continues to prevail in relation to adolescent health initiatives. In light of this, programs that seek to promote youth mental health should consider incorporating adolescents in the design process using participatory methodologies, to ensure that these initiatives are well-suited for the population. In line with this recommendation, a group of seven adolescents, 13 to 20 years of age, were incorporated into a research team to actively guide the design, development, and validation of a technology-based intervention, known as Project Clan, which was piloted to reduce adolescent suicide in schools in Chile. This group was known as the “Group of Experts,” in acknowledgment of their role as experts by experience on adolescence. A qualitative case study was conducted to explore their lived experiences, through semistructured individual in-depth interviews with six members of the group. Results showed that the adolescents had a high level of interest in mental health and had experienced problems of their own or accompanied friends who were struggling, which motivated their participation in the study. They had a critical view of the previous interventions they had received through educational institutions and valued their role in the promotion of their peers' mental health through the Group of Experts. They also highlighted the importance of creating tools that complement their daily lives and provide an alternative to existing social networks, by respecting their anonymity, providing a secure place for divulgation and self-expression, and facilitating access to professional support. We conclude that programs that address issues that affect adolescents should incorporate adolescents in the decision-making and design processes to ensure the acceptability and effectivity of their interventions.

show abstract

Section: Discussionmentioning

confidence: 99%

Experts by Experience: Qualitative Evaluation of Adolescent Participation in the Development of a Technological Intervention to Prevent Youth Suicide in Chile

et al. 2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…Centro de Atenção Psicossocial -CAPS), while in Santiago it was conducted within users' homes and surrounding neighborhoods. These adaptations were drafted collaboratively by researchers at Columbia University, Universidade Federal do Rio de Janeiro, and Universidad de Chile, and informed by their experience developing and piloting CTI in Brazil (Mascayano et al ., 2019 ).…”

Section: Adapting Cti For the La Settingmentioning

confidence: 99%

“…the task-shifting/task-sharing strategy and the community-based aspect – remained the same due to the dearth of mental health professionals as well as the cultural profile of both the settings. Other elements of the intervention were also similar across sites; for example, the structure and contents of the worker-pair trainings were standardized and manualized (Mascayano et al ., 2019 ).…”

Section: Adapting To the Community Conditions Through Modifying The Intervention Settingmentioning

confidence: 99%

Implementation of a pilot community-based psychosocial intervention for patients with psychoses in Chile and Brazil: a comparative analysis of users' perspectives

et al. 2021

Self Cite

View full text Add to dashboard Cite

Background Few studies provide clear rationale for and the reception of adaptations of evidence-based interventions. To address this gap, we describe the context-dependent adaptations in critical time intervention-task shifting (CTI-TS), a manualized recovery program for individuals with psychosis in Rio de Janeiro, Brazil and Santiago, Chile. Implications of the adaptations – incorporating a task-shifting approach and modifying the mode of community-based service delivery – are examined from users' perspectives. Methods A secondary analysis of in-depth interviews with CTI-TS users (n = 9 in Brazil; n = 15 in Chile) was conducted. Using the framework method, we thematically compared how participants from each site perceived the main adapted components of CTI-TS. Results Users of both sites appreciated the task-shifting worker pair to provide personalized, flexible, and relatable support. They wanted CTI-TS to be longer and experienced difficulty maintaining intervention benefits in the long-term. In Chile, stigma and a perceived professional hierarchy toward the task-shifting providers were more profound than in Brazil. Engagement with community-based services delivery in homes and neighborhoods (Chile), and at community mental health centers (Brazil) were influenced by various personal, familial, financial, and social factors. Uniquely, community violence was a significant barrier to engagement in Brazil. Conclusion CTI-TS’ major adaptations were informed by the distinct mental health systems and social context of Santiago and Rio. Evaluation of user experiences with these adaptations provides insights into implementing and scaling-up task-shifting and community-oriented interventions in the region through the creation of specialized roles for the worker pair, targeting sustained intervention effects, and addressing socio-cultural barriers.

show abstract

“…For example, although over 80% of people treated for FEP in Chile receive medications, only 40% receive other important services such as support for education and employment, family counseling, and peer support [ 8 , 9 ]. Moreover, when these other services are offered, they tend to be ad-hoc because most mental health providers are not appropriately trained in evidence-based approaches (i.e., psychosocial interventions) for psychosis [ 9 , 10 ]. This is the gap that is being addressed by the current study by first adapting OnTrackChile (OTCH) from OnTrackNY (OTNY), a coordinated specialty care (CSC) program for FEP currently being implemented across the US, and then examining its effectiveness and implementation across five different regions in Chile.…”

Section: Introductionmentioning

confidence: 99%

OnTrack Chile for people with early psychosis: a study protocol for a Hybrid Type 1 trial

Mascayano

Bello

Andrews

et al. 2022

Trials

Self Cite

View full text Add to dashboard Cite

Background Substantial data from high-income countries support early interventions in the form of evidence-based Coordinated Specialty Care (CSC) for people experiencing First Episode Psychosis (FEP) to ameliorate symptoms and minimize disability. Chile is unique among Latin American countries in providing universal access to FEP services through a national FEP policy that mandates the identification of FEP individuals in primary care and guarantees delivery of community-based FEP treatments within a public health care system. Nonetheless, previous research has documented that FEP services currently provided at mental health clinics do not provide evidence-based approaches. This proposal aims to address this shortfall by first adapting OnTrackNY (OTNY), a CSC program currently being implemented across the USA, into OnTrackChile (OTCH), and then examine its effectiveness and implementation in Chile. Methods The Dynamic Adaptation Process will be used first to inform the adaptation and implementation of OTCH to the Chilean context. Then, a Hybrid Type 1 trial design will test its effectiveness and cost and evaluate its implementation using a cluster-randomized controlled trial (RCT) (N = 300 from 21 outpatient clinics). The OTCH program will be offered in half of these outpatient clinics to individuals ages 15-35. Usual care services will continue to be offered at the other clinics. Given the current COVID-19 pandemic, most research and intervention procedures will be conducted remotely. The study will engage participants over the course of 2 years, with assessments administered at enrollment, 12 months, and 24 months. Primary outcomes include implementation (fidelity, acceptability, and uptake) and service outcomes (person-centeredness, adherence, and retention). Secondary outcomes comprise participant-level outcomes such as symptoms, functioning, and recovery orientation. Over the course of the study, interviews and focus groups with stakeholders will be conducted to better understand the implementation of OTCH. Discussion Findings from this study will help determine the feasibility, effectiveness, and cost for delivering CSC services in Chile. Lessons learned about facilitators and barriers related to the implementation of the model could help inform the approach needed for these services to be further expanded throughout Latin America. Trial registration www.ClinicalTrials.govNCT04247711. Registered 30 January 2020. Trial status The OTCH trial is currently recruiting participants. Recruitment started on March 1, 2021, and is expected to be completed by December 1, 2022. This is the first version of this protocol (5/12/2021).

show abstract

Implementing the protocol of a pilot randomized controlled trial for the recovery-oriented intervention to people with psychoses in two Latin American cities

Cited by 30 publications

References 33 publications

Experts by Experience: Qualitative Evaluation of Adolescent Participation in the Development of a Technological Intervention to Prevent Youth Suicide in Chile

Experts by Experience: Qualitative Evaluation of Adolescent Participation in the Development of a Technological Intervention to Prevent Youth Suicide in Chile

Implementation of a pilot community-based psychosocial intervention for patients with psychoses in Chile and Brazil: a comparative analysis of users' perspectives

OnTrack Chile for people with early psychosis: a study protocol for a Hybrid Type 1 trial

Contact Info

Product

Resources

About