Implementing a community-based task-shifting psychosocial intervention… (International Journal of Psychiatry – February 2019)

21 June, 2024

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

Martin Agrest(1), PhuongThao D Le(2), Lawrence H Yang(3,4(, Franco Mascayano(4,5), Silvia
Alves-Nishioka(6), Saloni Dev(6,7), Tanvi Kankan(6), Thamara Tapia-Muñoz(8), Samantha Sawyer(8),Josefina Toso-Salman(6), Gabriella A Dishy(6), Maria Jose Jorquera(9), Sara Schilling(10),Charissa Pratt(4), LeShawndra Price(11,12), Eliecer Valencia(4,13), Sarah Conover(14), Ruben Alvarado(13), and Ezra S Susser(15)

(1)Proyecto Suma, Buenos Aires, Argentina

(2)Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,
USA

(3)Department of Social and Behavioral Sciences, College of Global Public Health, New York
University, NY, USA

(4)Department of Epidemiology, Mailman School of Public Health, Columbia University, New York,
NY, USA

(5)Division of Behavioral Health Services and Policy Research, New York State Psychiatric
Institute, New York, NY, USA

(6)Teachers College, Columbia University, New York, NY, USA

(7)Bouve College of Health Sciences, Northeastern University, Boston MA, USA

(8)Mailman School of Public Health, Columbia University, New York, NY, USA

(9)Primary Care and Family Health Department, University of Chile, Santiago, Chile

(10)Schools of Public Health and Medicine, University of Chile, Santiago, Chile

(11)National Institute of Mental Health (NIMH) and National Institutes of Health, Washington, DC,
USA

(12)National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA

(13)Institute of Health Sciences, University of O’Higgins, Rancagua, Chile

(14)Center for the Advancement of Critical Time Intervention, Silberman School of Social Work,
Hunter College, City University of New York, New York, NY, USA

(15)Mailman School of Public Health and New York State Psychiatric Institute, Columbia University,
New York, NY, USA

Corresponding author: Martin Agrest, Proyecto Suma, Güemes 4l30, l425 Buenos Aires, Argentina., magrest66@gmail.com.

Abstract

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 20l5, 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 communitybased 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.

Keywords: Community mental health; Critical Time Intervention; Latin America; task shifting; user perspective…

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