Implementing the protocol of a pilot randomized controlled trial for the recovery-oriented intervention to people with psychoses in two Latin American cities

Implementação de um protocolo para um estudo piloto randomizado e controlado sobre uma intervenção voltada para a recuperação em pessoas com psicoses em duas cidades latino-americanas

Implementando un protocolo para una prueba piloto controlada aleatorizada en una intervención orientada a la recuperación de personas con psicosis en dos ciudades latinoamericanas

Franco Mascayano Ruben Alvarado Howard F. Andrews Maria Jose Jorquera Giovanni Marcos Lovisi Flavia Mitkiewicz de Souza Charissa Pratt Graciela Rojas Maria E. Restrepo-Toro Kim Fader Prakash Gorroochurn Sandro Galea Catarina Magalhães Dahl Jacqueline Cintra Sarah Conover Maria Soledad Burrone Joy Noel Baumgartner Robert Rosenheck Sara Schilling Keli Rodrigues Sarução Peter Stastny Eric Tapia Maria Tavares Cavalcanti Eliecer Valencia Lawrence H. Yang Ezra Susser About the authors

Several Latin American countries have made remarkable strides towards offering community mental health care for people with psychoses. Nonetheless, mental health clinics generally have a very limited outreach in the community, tending to have weaker links to primary health care; rarely engaging patients in providing care; and usually not providing recovery-oriented services. This paper describes a pilot randomized controlled trial (RCT) of Critical Time Intervention-Task Shifting (CTI-TS) aimed at addressing such limitations. The pilot RCT was conducted in Santiago (Chile) and Rio de Janeiro (Brazil). We included 110 people with psychosis in the study, who were recruited at the time of entry into community mental health clinics. Trial participants were randomly divided into CTI-TS intervention and usual care. Those allocated to the intervention group received usual care and, in addition, CTI-TS services over a 9-month period. Primary outcomes include quality of life (WHO Quality of Life Scale - Brief Version) and unmet needs (Camberwell Assessment of Needs) at the 18-month follow-up. Primary outcomes at 18 months will be analyzed by Generalized Estimating Equations (GEE), with observations clustered within sites. We will use three-level multilevel models to examine time trends on the primary outcomes. Similar procedures will be used for analyzing secondary outcomes. Our hope is that this trial provides a foundation for planning a large-scale multi-site RCT to establish the efficacy of recovery-oriented interventions such as CTI-TS in Latin America.

Community Mental Health Services; Psychotic Disorders; Randomized Controlled Trial; Global Health

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