FEASIBILITY AND ACCEPTABILITY OF CRITICAL TIME INTERVENTION TO SUPPORT PEOPLE WITH SEVERE MENTAL ILLNESS FOLLOWING POST-ACUTE HOSPITAL DISCHARGE IN SOUTH AFRICA

为南非急性出院后严重精神疾病患者提供关键时间干预的可行性和可接受性

• 批准号: 10704627
• 负责人: Arvin Bhana
• 金额: $ 18.98万
• 依托单位: UNIVERSITY OF KWAZULU-NATAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10704627
• 关键词: Acute; Admission activity; Back; Caring; Cohort Studies; Collaborations; Communities; Community Developments; Community Health Aides; Community Healthcare; Complement; Consolidated Framework for Implementation Research; Continuity of Patient Care; Country; Data; Development; Effectiveness; Effectiveness of Interventions; Ethnography; Evidence based intervention; Evidence based practice; Evidence based program; Family; Family Relationship; Foundations; Frequencies; Guidelines; Health; Health system; Homelessness; Hospitalization; Hospitals; Income; Individual; Inpatients; Institution; International; Intervention; Local Government; Measures; Mental Health; Methods; Modeling; Municipalities; Nature; Outcome; Outcome Measure; Output; Pathway interactions; Personal Satisfaction; Persons; Prevention; Process Measure; Psyche structure; Psychiatric therapeutic procedure; Psychosocial Assessment and Care; Qualitative Research; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recurrence; Relapse; Research; Research Project Grants; Resource-limited setting; Resources; Services; Shapes; Social Workers; South Africa; South African; South America; Structure; Support Groups; Support System; System; Testing; Time; Training; Training Activity; Trauma; Vulnerable Populations; Work; acceptability and feasibility; base; community based care; community setting; effective intervention; effectiveness/implementation trial; evidence base; hospital readmission; implementation facilitators; implementation outcomes; implementation science; implementation strategy; improved; innovation; intervention effect; intervention program; low and middle-income countries; peer support; person centered; pilot test; prevent; primary outcome; psychosocial; recruit; secondary outcome; severe mental illness; social; social culture; stem; support network

PROJECT SUMMARY The development of appropriate and effective community-based care for people living with severe mental illness (SMIs) continues to be a global challenge, especially in low-and-middle income countries (LMICs). A particularly damaging cycle emerges when people with SMIs are admitted to hospital for acute psychiatric treatment, discharged back into community settings without appropriate support, only to be readmitted again due to psychiatric relapse. This “revolving door” phenomenon is a multilevel challenge to mental health systems, including in countries such as South Africa, with little to no formal community-based support systems for people living with SMIs. However, promising evidence has been produced that Critical Time Intervention (CTI), a time- limited psychosocial intervention with origins in the prevention of homelessness in the USA, could potentially improve individual and system outcomes by providing support to vulnerable service users during the difficult transition period from hospital to community settings. The proposed research project aims to build on a CTI version that draws from community health workers and peer support workers, adapted for low-resource settings in South America, to develop and pilot a locally appropriate intervention program for South Africa. Specifically, we will draw from partner project data, supplemented by additional qualitative research and collated to provide a contextual basis from which to adapt the CTI approach, its content and materials. In particular, we will seek out specific community resources that could be included in the development of support networks, including existing peer support groups, and, importantly, the involvement of traditional health practitioners. We will then conduct a pilot feasibility cohort study in the uMgungundlovu District Municipality in KwaZulu-Natal, South Africa. We will recruit and train five teams that each include an auxiliary social worker and a peer support worker to provide CTI support to 40 people with SMIs who are being discharged to community settings following acute psychiatric hospitalization. Quantitative and qualitative process measures in terms of the Consolidated Framework for Implementation Research (CFIR), and outcome measures in terms of Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) will be gathered at several intervals throughout the CTI piloting period. Our primary outcome will be the reduction in psychiatric readmission over a 16-month study period, relative to the previous 16-month period. Along with several secondary outcomes, these measures will provide the necessary data to establish feasibility, appropriateness, and limited effectiveness of the adapted CTI, and lay a foundation for further trial research.

项目摘要 开发适合患有严重精神疾病的人的适当有效的社区护理 （SMI）仍然是全球挑战，尤其是在中低收入收入国家（LMIC）。特别 当患有SMI的患者被送往医院接受急性精神病治疗时，会出现破坏性周期， 在没有适当支持的情况下回到社区环境中，只是由于 精神病继电器。这种“旋转门”现象是对心理卫生系统的多层次挑战， 包括南非等国家，几乎没有针对人们的社区支持系统 与SMI一起生活。但是，已经提出了证据表明关键时间干预（CTI），这是一个时间 - 有限的社会心理干预起源于预防美国无家可归的人，可能有可能 在困难期间为弱势服务用户提供支持，改善个人和系统成果 从医院到社区环境的过渡期。拟议的研究项目旨在以CTI为基础 从社区卫生工作者和同伴支持工人那里获取的版本，适用于低资源设置 在南美，为南非制定并试行了当地适当的干预计划。具体来说， 我们将从合作伙伴项目数据中获取，并补充其他定性研究，并合作提供 适应CTI方法，其内容和材料的上下文基础。特别是，我们将寻求 提供可能包括在支持网络的开发中的特定社区资源，包括 现有的同伴支持小组，重要的是，传统卫生从业人员的参与。然后我们会 在南非夸祖鲁 - 纳塔尔省的Umgungundlovu地区进行试验可行性队列研究。 我们将招募和培训五个团队，每个团队包括一名辅助社会工作者和一名同伴支持工作者 向40名有SMI的人提供CTI支持 精神病住院。根据合并的定量和定性过程度量 实施研究框架（CFIR）以及有关覆盖范围，有效性， 采用，实施和维护（RE-AIM）将在整个CTI中以几个间隔收集 试点期。我们的主要结果是在16个月的研究中减少精神病再入院 时期，相对于前16个月。除了几个次要结果，这些措施将 提供必要的数据以确定适当的CTI的可行性，适当性和有限的有效性， 并为进一步的试用研究奠定基础。