Understanding Users' Perspectives of Psychosocial Mechanisms Underpinning Peer Support Work in Chile.

This study explores the beliefs and attitudes about the psychosocial mechanisms of peer support work among users who participated in Critical Time Intervention-Task Shifting (CTI-TS), which tested the acceptability and feasibility of a peer support work model to improve community-based mental health care for individuals with psychosis in Latin America. We conducted a secondary analysis of 15 in-depth interviews with CTI-TS participants in Chile, using the framework method and defined the framework domains based on five major mechanisms of peer support work identified by a recent literature review. The analysis revealed that users' perceptions of peer support work mechanisms were strongly shaped by personal motivations, beliefs about professional hierarchies, familial support, and the Chilean mental health system's incipient recovery orientation. The findings underscore the importance of adopting culturally tailored strategies to promote peer support work, such as involving mental health professionals and fostering equal-powered relationships between PSWs and users.

Critical Time Intervention - Task-Shifting for Individuals with Psychosis in Latin America: A Multi-stakeholder Qualitative Analysis of Implementation Barriers and Facilitators.

This article presents the results of a qualitative study conducted to understand the barriers and facilitators in implementing a pilot trial of Critical Time Intervention-Task-Shifting-a time-limited, community-based, recovery-oriented intervention for individuals with psychosis-in Rio de Janeiro, Brazil, and Santiago, Chile. Data included 40 semi-structured interviews with service users, task-shifting providers, and administrators. Analysis proceeded in three iterative phases and combined inductive and deductive approaches. Coding frameworks for implementation factors, and whether or not they acted as barriers and facilitators, were developed and refined using many domains and constructs from the Consolidated Framework for Implementation Research. Barriers and facilitators were ultimately grouped into five domains: 1-Personal; 2-Interpersonal; 3-Intervention; 4-Mental Health System; and 5-Contextual. A rating system was also developed and applied, which enabled comparisons across stakeholders and study sites. Major facilitators included intervention characteristics such as the roles of the task-shifting providers and community-based care. Top barriers included mental health stigma and community conditions (violence). Nevertheless, the findings suggest that Critical Time Intervention-Task-Shifting is largely acceptable and feasible, and could contribute to efforts to strengthen community mental health systems of care for individuals with psychosis in Latin America, especially in advancing the task-shifting strategy and the recovery-oriented approach.

"About Navigating Chaos": Latin American and Caribbean Mental Health Workers' Personal Impact Due to SARS-CoV-2 in the First Hundred Days.

Objectives: The personal impact of COVID-19 on mental health care workers (MHWs) has received scarce attention despite their work addressing the emotional wellbeing of those affected by the pandemic. This study aims to analyze Latin American and Caribbean's MHWs' subjective impact in connection to working during the initial times of the pandemic. Methods: One hundred and fifty-five persons (n = 155) from seventeen countries were contacted in May-June 2020 through a snowball approach. Complementary methodological strategies of analysis used for data triangulation included content analysis, thematic analysis, and interpretative phenomenological analysis. Results: Participants reported feelings of fear, anxiety, anguish, and fatigue. Milder negative impacts (e.g., uncertainty, concern), and complex feelings (e.g., ambivalence) were also frequent. One third of participants acknowledged their capacity to learn from this situation and/or experience satisfaction. Conclusion: Mental health of MHWs in Latin America and the Caribbean were under severe strain and the ongoing mental health reforms at risk during the pandemic's beginning. More research and additional care may be needed to offer support to those involved in caring for the wellbeing of others.

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

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.

Implementing a community-based task-shifting psychosocial intervention for individuals with psychosis in Chile: Perspectives from users.

BACKGROUND: Latin America, and Chile in particular, has a rich tradition of community mental health services and programs. However, in vivo community-based psychosocial interventions, especially those with a recovery-oriented approach, remain scarce in the region. Between 2014 and 2015, a Critical Time Intervention-Task Shifting project (CTI-TS) was implemented in Santiago, Chile, as part of a larger pilot randomized control trial. CTI is a time-limited intervention delivered at a critical-time to users, is organized by phases, focuses on specific objectives and decreases in intensity over time. CTI-TS, which combines both the task-shifting strategy and the use of peers, introduces a novel approach to community mental health care that has not yet been tried in Chile. AIMS: We aim to evaluate the feasibility, acceptability and applicability of such a community-based psychosocial intervention in urban settings in Latin America - specifically, in Santiago (Chile) from a user perspective. METHOD: We analyzed 15 in-depth interviews ( n = 15) with service users who participated in the intervention about their perceptions and experiences with CTI-TS through thematic analysis. RESULTS: Three themes were revealed. The first was related to the structural characteristics of CTI-TS, especially regarding the timing, duration and phasic nature of the intervention. The second pertained to the acceptability of the in vivo community-based approach. The third theme dealt with the task-shifting aspect, that is, users' perceptions of the peer support workers and the community mental health workers. CONCLUSIONS: CTI-TS was generally acceptable in this Latin American context. Users' perspectives pointed to the need to make adjustments to some of the structural characteristics of the CTI model and to combine this type of intervention with others that can address stigma. Thus, future adaptations of CTI-TS or similar psychosocial interventions in Latin American contexts are feasible and can enhance community mental health in the region.