Individual Placement and Support (IPS) for serious mental illness in Jalisco, Mexico

项目摘要 大量数据表明，个人安置和支持（IPS）模式，一个众所周知的，证据的做法， 可以帮助精神疾病（PSMI）在竞争性就业中取得成功（即，平均55%，但在 可信的研究）。然而，拉丁美洲没有一个国家提供IPS服务。此外，服务 其他支助就业和教育活动往往是临时性、强度低和没有得到很好评估，因为大多数 临床医生没有接受过循证方法的培训，也没有提供高保真服务。的 该项目的总体目标是在长期住院综合护理中心试点IPS用于PSMI 心理健康（西班牙语：CAISAME-EB）是墨西哥哈利斯科最大的心理健康诊所。CAISAME-EB 整合初级保健，并为大量人口提供药物和心理社会康复服务 PSMI（n= 5,000）。该团队为边缘化社区提供服务，类似于其他城市地区的低- 拉丁美洲和其他地区的中等收入国家（LMIC）。我们将使用动态适应过程 模型首先通知适应IPS在墨西哥，利用我们以前的经验，适应IPS和深 对本地环境的理解（例如，墨西哥就业市场的性质），以便为调整提供信息。我们 然后将在试点RCT（N = 200）中评估适应性IPS的实施和影响。该试点RCT将 包括在基线、6个月和12个月时与客户进行定量和定性评估， 供应商和其他主要利益相关者。我们的目标是完善实施过程，了解结果， 工具，并估计未来在拉丁美洲进行区域试验的功率。

Project Summary Substantial data indicate that the Individual Placement and Support (IPS) model, a well-know, evidence-practice, can help mental illness (PSMI) to succeed in competitive employment (i.e., average 55%, but over 60% in credible studies). However, not a single country offers IPS services in Latin America. Moreover, services to support employment and education other tend to be ad hoc, low intensity, and not well assessed, because most clinicians are not trained in evidence-based approaches and do not provide high-fidelity services. The overarching goal of this project is to pilot IPS for PSMI in the Center for Comprehensive Care in Long-Stay Mental Health (CAISAME-EB, in Spanish), the largest mental health clinic in Jalisco, Mexico. CAISAME-EB integrates primary care and provides medication and psychosocial rehabilitation services to a large population of PSMI (n=~5,000). This team serves marginalized communities resembling other urban areas of low-and- middle-income countries (LMICs) in Latin America and elsewhere. We will use the Dynamic Adaptation Process model to first inform the adaptation of IPS in Mexico, using our prior experiences adapting IPS and deep understanding of the local context (e.g., the nature of the job market in Mexico) to inform the adaptations. We will then evaluate the implementation and impact of the adapted IPS in a pilot RCT (N = 200). This pilot RCT will include quantitative and qualitative assessments at baseline, 6, and 12 months, conducted with clients, providers, and other key stakeholders. We aim to refine implementation processes, understand outcomes and instruments, and estimate power for a future, regional trial in Latin America.