Adaptation and Implementation of Peer Support to Optimize Engagement and Outcomes for People with Serious Mental Illness in Campinas, Brazil

调整和实施同伴支持，以优化巴西坎皮纳斯严重精神疾病患者的参与和结果

• 批准号: 10539079
• 负责人: Chyrell Denise Bellamy
• 金额: $ 31.92万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10539079
• 关键词: Accident and Emergency department; Acute; Administrator; Affect; Beds; Brazil; COVID-19; Caring; Clinical Trials; Collaborations; Communitarianism; Communities; Community Mental Health Services; Community Services; Continuity of Patient Care; Country; Development; Discrimination; Emergency Situation; Environment; Evidence based intervention; Family member; Fostering; Funding; Goals; Health Services; Healthcare; Hospitals; Income; International; Intervention; Investigational Therapies; Life; Mediator of activation protein; Mental Health; Mental Health Services; Mental disorders; Methods; Modeling; Morbidity - disease rate; National Institute of Mental Health; Outcome; Pathway interactions; Personal Satisfaction; Persons; Population; Psyche structure; Public Health; Quality of Care; Quality of life; Recovery; Research; Research Priority; Research Support; Resource-limited setting; Safety; Service delivery model; Services; Societies; Source; Structure; System; Time; Translating; Translations; Universities; Work; base; behavioral health; community based care; cost; design; disability; economic disparity; effectiveness trial; evidence base; experience; follow-up; healing; implementation science; implementation trial; improved; improved outcome; innovation; innovative technologies; low and middle-income countries; peer; peer support; poor communities; psychosocial; scale up; severe mental illness; social; social stigma; symptom management

PROJECT SUMMARY/ABSTRACT Mental disorders are among the leading causes of disability and morbidity worldwide—conditions that are compounded by a vast treatment gap where an estimated 70% of people who need mental health care go without adequate or any treatment at all. In Brazil, despite having a comprehensive network of publicly-funded, free, community-based mental health treatment, it is estimated that only 26% of people with psychiatric conditions successfully connect to community-based care. The remaining seek treatment only under emergency or crisis conditions, contributing to overcrowding in emergency departments, long waiting periods for psychiatric beds, psychiatric boarding, poorer overall quality of care, and an overreliance on a hospital system that is already overburdened (and increasingly so due to COVID-19). This problem has increasingly and disproportionately affected people with a serious mental illness (SMI) who are poor and non-white. Goals of recovery and rebuilding a meaningful life in the community become overshadowed by those of stabilization and symptom management. Contributing factors to this mental health treatment gap are plenty (i.e., stigma and discrimination, workforce shortages, economic disparities, lack of timely follow-up and engagement, discontinuous and fragmented linkages between care settings), yet solutions are scarce. The proposed project uses a participatory research and adaptation design that involves stakeholders, including persons living with SMI, family members, clinicians, community services staff and administrators, throughout all stages of project development and implementation. We hypothesize that the successful adaptation and implementation of an evidence-based model of peer support to Brazilian culture, will contribute to enhanced levels of engagement, improved continuity of care, and improvements in quality of life and wellbeing among persons living with SMI in Brazil. To this end, we propose the following specific aims: 1) To work with local stakeholders in Campinas, Brazil on the cultural adaptation of an evidence-based peer intervention targeting connections with a peer as a mediator of engagement in post- acute mental and physical healthcare; 2) To employ an experimental therapeutics approach in determining the degree to which multi-level targets are engaged in the pathway improved outcomes through a pilot clinical trial; 3) To assess the feasibility, acceptability, safety, tolerability, and potential for dissemination of the adapted peer intervention at multiple levels. After this study, we will have established the feasibility, acceptability, safety and tolerability, of adapting a low-cost, culturally-responsive, evidence-based intervention to improve quality of care of people with SMI who access community mental health treatment. Moreover, through a Yale-University of Campinas partnership, we will foster international collaboration as a strategy to develop an innovative technology that would be ready for an implementation and effectiveness trial (R01) in poor communities in Latin countries. Finally, the adaptation strategy developed in this proposal can be used in other LMICs to adapt EBPs.

项目摘要/摘要 精神障碍是全球残疾和发病率的主要原因之一 据一个巨大的治疗差距加重了，估计需要精神保健的人中有70％的人没有 完全或任何治疗。在巴西，多皮有一个全面的公共资助，免费，免费的网络 基于社区的心理健康治疗，据估计，只有26％的精神病患者 成功连接到基于社区的护理。其余的仅在紧急或危机下寻求治疗 条件，导致紧急部门人满为患，精神科床的长期等待期， 精神科登机，整体护理质量较差，并且对已经已经存在的医院系统过度依赖 负担过重（越来越多，由于Covid-19）。这个问题越来越不成比例 贫穷和非白人患有严重精神疾病（SMI）的人。恢复和重建目标 社区中有意义的生活被稳定和症状管理的生活所掩盖。 为这种心理健康治疗差距的贡献因素很大（即污名和歧视，劳动力 短缺，经济差异，缺乏及时的随访和参与，不连续和分散 护理环境之间的联系），但解决方案却很少。拟议的项目使用参与研究 以及涉及利益相关者的适应设计，包括与SMI，家庭成员，临床医生一起生活的人， 社区服务人员和管理员在项目开发和实施的所有阶段。 我们假设成功适应和实施了基于证据的同伴支持模型 对于巴西文化，将有助于提高参与水平，改善护理的连续性以及 在巴西有SMI的人们的生活质量和福祉的改善。为此，我们提出 以下具体目的：1）与巴西坎皮纳斯的当地利益相关者合作，以进行文化适应 基于证据的同伴干预针对与同伴的联系作为参与后的调解人 急性身心医疗保健； 2）雇用一种实验疗法来确定 通过试点临床试验，多级目标参与途径改善结果的程度； 3）评估可行性，可接受性，安全性，耐受性和传播适应性同行的潜力 干预多个层次。在这项研究之后，我们将确定可行性，可接受性，安全性和 耐受性，适应低成本，文化响应，基于证据的干预措施以提高护理质量 患有社区心理健康治疗的SMI的人。而且，通过耶鲁大学 Campinas Partnership，我们将培养国际合作，作为开发创新技术的战略 这将准备好在拉丁国家的贫困社区进行实施和有效性试验（R01）。 最后，该提案中制定的适应策略可以在其他LMIC中用于适应EBP。