Developing and Testing an Evaluation Framework for Collaborative Mental Health Services in Primary Care Systems in Latin America.

To develop and pilot-test a feasible and meaningful evaluation framework to support the ongoing improvement and performance measurement of services and systems in Latin America regarding Collaborative Mental health Care (CMHC). This mixed methods study, guided by a developmental evaluation approach, included: (1) a critical review of the literature; (2) an environmental scan at three selected health networks in Mexico, Nicaragua and Chile; (3) a Delphi group with experts; (4) a final consultation in the three sites; and (5) a pilot-test of the framework. A comprehensive evaluation framework was developed and successfully piloted. It considers five levels, 28 dimensions and 40 domains, as well as examples of indicators and an implementation plan. This evaluation framework represents an important effort to foster accountability and quality regarding CMHC in Latin America. Recommendations to build upon current capacity and to effectively address the existing implementation challenges are further discussed.

Evaluation of collaborative mental health services in Latin America: Theoretical and methodological basis.

OBJECTIVES: Approaches to collaborative mental health care (CMHC) have been implemented in many countries to strengthen the accessibility and delivery of mental health services in primary care. However, there are not well-defined frameworks to evaluate CMHC models. The purpose of this article is to identify, contextualize and discuss relevant health services research approaches, theory, and evaluation models for the development of an appropriate evaluation framework in order to foster effective CMHC in Latin America. METHODS: A comprehensive literature review informed a critical analysis of relevant theories and alternative methods to be considered in the development of the framework. RESULTS: Specific health services research frameworks are discussed in the context of evaluating CMHC. Two theoretical perspectives - collaboration theory and systems theory - and three evaluation models- realistic, developmental and collaborative - are analyzed in terms of their relevance. Methodological implications are identified. CONCLUSION: An appropriate evaluation framework for CMHC in Latin America needs to reflect theoretical and contextual considerations and relevant evaluation approaches and methods, including key dimensions and attributes/variables, core indicators, and recommendations for implementation.

Therapeutic Effects of Ceremonial Ayahuasca Use for Methamphetamine Use Disorders and Other Mental Health Challenges: Case Studies in an Indigenous Community in Sonora, Mexico.

This paper describes three case studies from an outpatient intercultural therapeutic program founded and run by Yaqui health professionals and traditional healers to serve members of the Yaqui tribe residing in Sonora, Mexico. This pilot therapeutic program has been designed specifically for Indigenous individuals, incorporating the ceremonial use of naturally derived psychedelics in addressing substance use disorders and other mental health issues. The program employs a community-based approach, integrating various traditional Indigenous healing practices like the sweatlodge (temazcal), medicinal plant preparations, and the ritualistic use of selected psychedelics from natural sources (such as ayahuasca, peyote, and secretions from Incilius alvarius). These approaches are complemented by culturally attuned group and individual psychotherapy sessions, as well as group sports, community meals, collaborative construction efforts for a permanent clinical infrastructure, and cultural engagements such as art, crafts, and collective music. To evaluate the program's efficacy, safety, and cultural implications, an ongoing observational study is being conducted by an international team of researchers. The preliminary results demonstrate therapeutic progress and improved psychometric outcomes observed in the three case studies presented, indicating promise for this intercultural therapeutic intervention.

[Association of COVID-19 dissemination with symptoms of anxiety and depression among university students]. / Asociación de la diseminación del COVID-19 con síntomas de ansiedad y depresión en estudiantes universitarios.

BACKGROUND: Evidence about the impact of the COVID-19 pandemic on the mental health of specific subpopulations- such as university students-is needed as communities prepare for future waves. AIMS: To study the association of proximity of COVID-19 with symptoms of anxiety and depression in university students. METHODS: This trend study analyzed weekly cross-sectional surveys of probabilistic samples of students from the University of British Columbia for 13 weeks through the first wave of COVID-19. The main variable assessed was propinquity of COVID-19, defined as "knowing someone who tested positive for COVID-19", which was specified at different levels: knowing someone anywhere globally, in Canada, in Vancouver, in their course, or at home. Proximity was included in multivariable linear regressions to assess its association with primary outcomes, including 30-day symptoms of anxiety and/or depression. RESULTS: Of 1,388 respondents (adjusted response rate=50%), 5.6% knew someone with COVID-19 in Vancouver, 0.8% in their course, and 0.3% at home. Ten percent were overwhelmed and unable to access help. Knowing someone in Vancouver was associated with an 11 percentage-point increase in the probability of 30-day anxiety symptoms (SE=0,05; p≤0,05), moderated by gender, with a significant interaction of the exposure and being female (coefficient= 20(SE=0,09), p≤0,05). No association was found with depressive symptoms. CONCLUSION: Propinquity of COVID-19 cases may increase the likelihood of anxiety symptoms in students, particularly amongst men. Most students report coping well, but additional supports are needed for an emotionally overwhelmed minority who report being unable to access help.

Estimating Service Needs for Alcohol and Other Drug Users According to a Tiered Framework: The Case of the São Paulo, Brazil, Metropolitan Area.

OBJECTIVE: The purpose of this study was to estimate the need for population-level services for alcohol and other drug abuse in support of local planning. METHOD: Data were drawn from a subsample of 2,942 interviewees from the São Paulo Megacity Study, which evaluated mental health in the general population (18 years and older) of residents in the São Paulo metropolitan area. This population was classified into five hierarchical categories of severity, making it possible to obtain estimates of need for services, combining evaluation criteria regarding drug and alcohol use and general and mental health comorbidities over the last 12 months. For the at-risk groups in this population, estimates from the Potential Demand for the Use of Services survey interviews over the last year were generated. RESULTS: Concerning the need for services, 86.5% of the population (Tier 1) had no problems related to drug and alcohol use, 8.9% (Tier 2) used heavily, 3.5% (Tiers 3, 4, and 5) met criteria for substance abuse disorders, among whom 1.3% (Tiers 4 and 5) require more specialized and intensive treatment and support. The following estimates for the Potential Demand for the Use of Services were found: 25.5% (Tier 3) and 51.1% (Tier 4), indicating that a significant number of individuals met criteria for substance abuse disorders but did not perceive any need for professional help or neglected the help available. CONCLUSIONS: In São Paulo there exists a large sector of the population that requires prevention strategies regarding the risks and harm resulting from alcohol and drug use, followed by a group requiring more specialized care. But a large number of substance users requiring specialized support did not use services and did not believe that they needed professional help.

Evaluation dimensions for collaborative mental health services in primary care systems in latin america: results of a Delphi group.

This article presents the results of a Delphi group to identify the dimensions of an evaluation framework for collaborative mental health care (CMHC) in Latin America. A three-round Delphi process was implemented with 26 experts from Latin America and Canada to identify main areas of consensus, as well as disagreements, about the importance and feasibility of potential evaluation dimensions previously identified in Mexico, Nicaragua and Chile. Participants validated 40 evaluation dimensions. They strongly endorsed a comprehensive evaluation framework for CMHC in Latin America. This study represents a solid foundation for developing an evaluation framework for CMHC.

Client characteristics within the Chilean National Youth Addiction Treatment Demonstration System.

In the context of an evaluation of a national demonstration program for youth addiction treatment in Chile, a sociodemographic and substance use profile of children and adolescents accessing services through this new program was developed. Information regarding sociodemographic factors, substance use, and problem severity; services used; and unmet needs was retrospectively gathered for all clients (685) admitted between January 1 and June 30, 2006. Thirty-two treatment centers (91.4%) provided data. The client population profile reflected severe psychosocial circumstances (e.g., 61.4% early exit from school). Of the population, 64.9% were classified in the highest substance risk level. The primary drug reported was cocaine-paste-base (52.7%). Comparisons to similar data in other countries illustrate the more severe profile of this Chilean treatment sample. The results suggest the need for increased outreach and comprehensive intersectoral approaches. Monitoring and evaluation should become part of the culture of the national drug treatment system in Chile and other countries.

The evaluation of treatment services and systems for substance use disorders

A pesquisa científica e a avaliação de programas não têm merecido um papel de destaque no desenvolvimento de serviços e sistemas de tratamento na maioria dos países. Essa lacuna conduziu à disparidades no desenvolvimento, gerenciamento e monitoramento dos sistemas de tratamento em nível nacional. Na avaliação do tratamento para o uso de substâncias, o clínico avaliador estará, geralmente, trabalhando em um dos seguintes níveis: um caso individual, a atividade de tratamento, o serviço de tratamento, o órgão de tratamento ou o sistema de tratamento. Um dos maiores obstáculos para levar a cabo programas internos de avaliação é a crença de que se trata de um complicado processo de pesquisa, que deve ser deixado àqueles que possuam treinamento específico em pesquisa. Os gerentes de programas e as equipes estão aptos a planejar e iniciar um processo de avaliação para seus programas, bastando que tenham acesso a especialistas em pesquisa quando isso se mostrar necessário em partes específicas do processo. Existem sete componentes principais de um processo de avaliação, que podem ser planejados e implementados: avaliação da necessidade, planejamento da avaliação, avaliação do processo, análise de custo, avaliação da satisfação do cliente, avaliação do resultado e avaliação econômica. Entretanto, a avaliação representa mais do que as técnicas e a tecnologia exigidas para a implementação dessas atividades. Ela também envolve o questionamento rotineiro da prática utilizada, mesmo quando o feedback possa ser menos positivo que o esperado. Uma cultura saudável de avaliação é aquela na qual os laços de feedback estão entremeados no tecido do serviço ou sistema de tratamento. Existem diversos obstáculos à avaliação em serviços para abuso de substâncias, mas eles podem ser superados através de um criterioso planejamento e do comprometimento com a criação de serviços baseados em evidências.