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

• Published in: Cadernos de saúde pública Vol. 35; no. 4; p. e00108018
• Main Authors: Mascayano, Franco, Alvarado, Ruben, Andrews, Howard F, Jorquera, Maria Jose, Lovisi, Giovanni Marcos, Souza, Flavia Mitkiewicz de, Pratt, Charissa, Rojas, Graciela, Restrepo-Toro, Maria E, Fader, Kim, Gorroochurn, Prakash, Galea, Sandro, Dahl, Catarina Magalhães, Cintra, Jacqueline, Conover, Sarah, Burrone, Maria Soledad, Baumgartner, Joy Noel, Rosenheck, Robert, Schilling, Sara, Sarução, Keli Rodrigues, Stastny, Peter, Tapia, Eric, Cavalcanti, Maria Tavares, Valencia, Eliecer, Yang, Lawrence H, Susser, Ezra
• Format: Journal Article
• Language: English
• Published: Brazil Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz 01.01.2019; Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz
• Subjects: Adult; Aged; Brazil; Chile; Clinical Protocols; Community Mental Health Services; Global Health; Humans; Middle Aged; Pilot Projects; Psychotic Disorders; Psychotic Disorders - rehabilitation; PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH; Quality of Life; Randomized Controlled Trial; Young Adult; Brazil; Chile; Ensayo Clínico Controlado Aleatorio; Ensaio Clínico Controlado Aleatório; Serviços Comunitários de Saúde Mental; Global Health; Transtornos Psicóticos; Saúde Global; Community Mental Health Services; Trastornos Psicóticos; Psychotic Disorders; Servicios Comunitarios de Salud Mental; Salud Global; Randomized Controlled Trial
• ISSN: 0102-311X; 1678-4464; 1678-4464
• DOI: 10.1590/0102-311X00108018

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.