A Recovery-Oriented Intervention for People With Psychosis: A Pilot Randomized Controlled Trial.

OBJECTIVE: This pilot randomized controlled trial evaluated the effectiveness of critical time intervention-task shifting (CTI-TS) for people with psychosis in Santiago, Chile, and Rio de Janeiro. CTI-TS is a 9-month intervention involving peer support workers and is designed to maintain treatment effects up to 18 months. METHODS: A total of 110 people with psychosis were recruited when they enrolled in community mental health clinics (Santiago, N=60; Rio de Janeiro, N=50). Participants within each city were randomly assigned to either CTI-TS or usual care for 9 months. Primary outcomes were quality of life, measured with the World Health Organization Quality of Life Assessment-Brief Version (WHOQOL-BREF), and unmet needs, measured with the Camberwell Assessment of Need (CAN), at 18-month follow-up. Results were analyzed according to intention-to-treat guidelines. Generalized estimating equations, with observations clustered within cities, and multiple imputation for missing data were used. RESULTS: At 18 months, both groups showed improved primary outcomes. In both unadjusted and fully adjusted analyses, no significant differences between CTI-TS and usual care (WHOQOL-BREF question on quality of life and CAN mean number of unmet needs) were found. CONCLUSIONS: Three factors might explain the lack of difference between CTI-TS and usual care: first-contact enrollment precluded rapport prior to randomization, a minority of patients were uncomfortable with peers being on the treatment team, and primary outcome measures may not have been sensitive enough to capture the effects of a recovery-oriented intervention. The results have implications for the design of transitional services for people with psychosis, especially in Latin America.

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

Several Latin American countries have made remarkable strides towards offering community mental health care for people with psychoses. Nonetheless, mental health clinics generally have a very limited outreach in the community, tending to have weaker links to primary health care; rarely engaging patients in providing care; and usually not providing recovery-oriented services. This paper describes a pilot randomized controlled trial (RCT) of Critical Time Intervention-Task Shifting (CTI-TS) aimed at addressing such limitations. The pilot RCT was conducted in Santiago (Chile) and Rio de Janeiro (Brazil). We included 110 people with psychosis in the study, who were recruited at the time of entry into community mental health clinics. Trial participants were randomly divided into CTI-TS intervention and usual care. Those allocated to the intervention group received usual care and, in addition, CTI-TS services over a 9-month period. Primary outcomes include quality of life (WHO Quality of Life Scale - Brief Version) and unmet needs (Camberwell Assessment of Needs) at the 18-month follow-up. Primary outcomes at 18 months will be analyzed by Generalized Estimating Equations (GEE), with observations clustered within sites. We will use three-level multilevel models to examine time trends on the primary outcomes. Similar procedures will be used for analyzing secondary outcomes. Our hope is that this trial provides a foundation for planning a large-scale multi-site RCT to establish the efficacy of recovery-oriented interventions such as CTI-TS in Latin America.

Implementing the protocol of a pilot randomized controlled trial for the recovery-oriented intervention to people with psychoses in two Latin American cities / Implementação de um protocolo para um estudo piloto randomizado e controlado sobre uma intervenção voltada para a recuperação em pessoas com psicoses em duas cidades latino-americanas / Implementando un protocolo para una prueba piloto controlada aleatorizada en una intervención orientada a la recuperación de personas con psicosis en dos ciudades latinoamericanas

Several Latin American countries have made remarkable strides towards offering community mental health care for people with psychoses. Nonetheless, mental health clinics generally have a very limited outreach in the community, tending to have weaker links to primary health care; rarely engaging patients in providing care; and usually not providing recovery-oriented services. This paper describes a pilot randomized controlled trial (RCT) of Critical Time Intervention-Task Shifting (CTI-TS) aimed at addressing such limitations. The pilot RCT was conducted in Santiago (Chile) and Rio de Janeiro (Brazil). We included 110 people with psychosis in the study, who were recruited at the time of entry into community mental health clinics. Trial participants were randomly divided into CTI-TS intervention and usual care. Those allocated to the intervention group received usual care and, in addition, CTI-TS services over a 9-month period. Primary outcomes include quality of life (WHO Quality of Life Scale - Brief Version) and unmet needs (Camberwell Assessment of Needs) at the 18-month follow-up. Primary outcomes at 18 months will be analyzed by Generalized Estimating Equations (GEE), with observations clustered within sites. We will use three-level multilevel models to examine time trends on the primary outcomes. Similar procedures will be used for analyzing secondary outcomes. Our hope is that this trial provides a foundation for planning a large-scale multi-site RCT to establish the efficacy of recovery-oriented interventions such as CTI-TS in Latin America.

Diversos países latino-americanos já alcançaram avanços notáveis na oferta de assistência em saúde mental para pessoas com psicoses. No entanto, as clínicas de saúde mental geralmente realizam atividades de extensão muito limitadas dentro das comunidades, tendem a ter vínculos fracos com a assistência primária, raramente envolvem os próprios pacientes nos cuidados e poucas vezes prestam serviços orientados para a recuperação. O artigo descreve um estudo piloto randomizado e controlado sobre a Critical Time Intervention-Task Shifting (CTI-TS), que teve como objetivo analisar essas limitações. O estudo piloto foi realizado em Santiago (Chile) e no Rio de Janeiro (Brasil). Teve como meta a inclusão de 110 pessoas com psicose, recrutadas no momento da entrada em clínicas comunitárias de saúde mental. Os participantes foram randomizados para o CTI-TS ou para os cuidados usuais. Aqueles alocados ao grupo da intervenção receberam os cuidados usuais e os serviços de CTI-TS ao longo de 9 meses. Os desfechos primários incluíram a qualidade de vida (WHO Quality of Life Scale - Brief Version) e as necessidades não atendidas (Camberwell Assessment of Needs) no acompanhamento aos 18 meses. Os desfechos primários aos 18 meses serão analisados com a técnica de Equações de Estimação Generalizadas (GEE), com as observações agrupadas dentro dos locais do estudo. Serão utilizados modelos em três níveis para examinar as tendências temporais nos desfechos primários. Procedimentos semelhantes serão utilizados para analisar os resultados secundários. Espera-se que o estudo forneça uma base para planejar um estudo randomizado e controlado em grande escala e em múltiplos locais para estabelecer a eficácia da intervenção orientada para a recuperação, a exemplo da CTI-TS, na América Latina.

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[Peers as fellow workers: understanding and respecting their roles]. / Pares como compañeros de trabajo: entendiendo y respetando sus funciones.

The literature reveals that peer support in mental health services is growing around the world. In the context of peer support, a "peer" is a person with lived experienced of mental illness and choose to share his or her recovery experience in an effective manner. However, tensions between traditional mental health professionals and peer supporters have arisen in the U.S. as what are the roles of peers within mental health systems. This article aims to review the integration of peers in the existing mental health systems, the values of peer support and to discuss training implications.

Pares como compañeros de trabajo: entendiendo y respetando sus funciones. / [Peers as fellow workers: understanding and respecting their roles].

The literature reveals that peer support in mental health services is growing around the world. In the context of peer support, a "peer" is a person with lived experienced of mental illness and choose to share his or her recovery experience in an effective manner. However, tensions between traditional mental health professionals and peer supporters have arisen in the U.S. as what are the roles of peers within mental health systems. This article aims to review the integration of peers in the existing mental health systems, the values of peer support and to discuss training implications.

Pares como compañeros de trabajo: entendiendo y respetando sus funciones / [Peers as fellow workers: understanding and respecting their roles].

The literature reveals that peer support in mental health services is growing around the world. In the context of peer support, a "peer" is a person with lived experienced of mental illness and choose to share his or her recovery experience in an effective manner. However, tensions between traditional mental health professionals and peer supporters have arisen in the U.S. as what are the roles of peers within mental health systems. This article aims to review the integration of peers in the existing mental health systems, the values of peer support and to discuss training implications.

Recovery narratives: 'see how far i've come' / Narrativas de recuperação: 'veja onde cheguei'

As the paradigm shift towards a recovery-oriented mental health system becomes more prominent, individuals with lived experience of mental illness will continue to write and speak their narratives of mental illness and recovery. This article discusses the social reality of people with mental illness: how they are stigmatized by the media and how competing narratives within the mental health system afflict people with this disability. It also discusses the empowering process of constructing a narrative that enables the narrator/speaker to find meaning in her/his experience while putting a realistic 'face' on mental illness and recovery for the general public. It further describes how telling a narrative to diverse audiences, including a college class of 'people in recovery' enhances the author's personal recovery by giving his life new meaning and purpose.

Na medida em que a mudança de paradigma para um sistema de saúde mental orientado à recuperação se torna mais proeminente, indivíduos com experiências de vivência de doença mental continuarão a escrever e contar suas historias de doença mental e recuperação. Este artigo discute a realidade social das pessoas com doenças mentais: como elas são estigmatizadas pela imprensa e como outras linhas discursivas dentro do sistema de saúde mental as afetam. O artigo também discute o processo de capacitação que a construção da narrativa oferece ao narrador/palestrante, possibilitando-o a encontrar um significado para sua experiência ao mesmo tempo em que fornece uma 'face' realista à doença mental e recuperação para o público em geral. O artigo também descreve como o processo de contar a narrativa a audiências variadas, inclusive uma turma de faculdade de 'pessoas em recuperação', acentua a recuperação pessoal do autor na medida em que dá à sua vida um novo sentido e propósito.