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: 10675099
• 负责人: Chyrell Denise Bellamy
• 金额: $ 26.23万
• 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/10675099
• 关键词: Accident and Emergency department; Acute; Administrator; Affect; Beds; Brazil; COVID-19; Caring; Clinical Trials; Collaborations; Communities; Community Mental Health Services; Community Services; Continuity of Patient Care; Country; Crowding; Development; Discrimination; Emergency Situation; Environment; Evidence based intervention; Family member; Fostering; Funding; Goals; Health Services; Healthcare; Hospitals; Implementation readiness; Income; International; Intervention; Investigational Therapies; Life; Mediator; Mental Health; Mental Health Services; Mental disorders; Methods; Modeling; Morbidity - disease rate; National Institute of Mental Health; Natural Source; Outcome; Pathway interactions; Personal Satisfaction; Persons; Political Factor; Population; Public Health; Quality of Care; Quality of life; Recommendation; Recovery; Research; Research Priority; Research Support; Resource-limited setting; Safety; Service delivery model; Services; Societies; Structure; System; Translating; Translations; Universities; Work; 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; physical conditioning; 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.

项目概要/摘要 精神障碍是全世界残疾和发病的主要原因之一 巨大的治疗差距使得情况更加复杂，估计 70% 需要精神卫生保健的人却得不到治疗 在巴西，尽管有一个全面的公共资助、免费、 基于社区的心理健康治疗，估计只有 26% 的人患有精神疾病 其余的人仅在紧急情况或危机下寻求治疗。 条件，导致急诊科过度拥挤，精神科床位等待时间较长， 精神科寄宿、整体护理质量较差以及对已经存在的医院系统的过度依赖 负担过重（由于 COVID-19，这个问题变得越来越严重）。 患有严重精神疾病 (SMI) 的穷人和非白人患者 康复和重建的目标。 社区中有意义的生活被稳定和症状管理的生活所掩盖。 造成这种心理健康治疗差距的因素有很多（即耻辱和歧视、劳动力 短缺、经济差异、缺乏及时的后续行动和参与、不连续和分散 护理机构之间的联系），但拟议的项目采用了参与式研究。 涉及利益相关者的适应设计，包括 SMI 患者、家庭成员、赞助人、 社区服务人员和管理人员，贯穿项目开发和实施的所有阶段。 我们追求成功地适应和实施基于证据的同伴支持模型 巴西文化，将有助于提高参与水平，改善护理的连续性，以及 改善巴西 SMI 患者的生活质量和福祉 为此，我们建议。 具体目标如下： 1) 与巴西坎皮纳斯当地利益相关者合作，进行文化适应 一种基于证据的同伴干预，旨在与同伴建立联系，作为参与后的调解人 急性精神和身体保健；2) 采用实验治疗方法来确定 通过试点临床试验改善结果的途径中多层次目标的参与程度； 3) 评估适应同行的可行性、可接受性、安全性、耐受性和传播潜力 经过这项研究，我们将确定可行性、可接受性、安全性和有效性。 耐受性，采用低成本、文化敏感、循证干预措施来提高护理质量 此外，通过耶鲁大学获得社区心理健康治疗的 SMI 患者。 坎皮纳斯合作伙伴关系，我们将促进国际合作作为开发创新技术的战略 将为在拉丁国家的贫困社区进行实施和有效性试验（R01）做好准备。 最后，本提案中制定的适应策略可用于其他中低收入国家以适应 EBP。