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)模式是一种众所周知的证据实践， 可以帮助精神疾病(PSMI)在竞争性就业中取得成功(例如，平均55%，但在 可信的研究)。然而，没有一个国家在拉丁美洲提供IPS服务。此外，服务于 支持就业和教育其他往往是临时的、低强度的，而且没有得到很好的评估，因为大多数 临床医生没有接受循证方法的培训，也不提供高保真服务。这个 该项目的总体目标是在长期综合护理中心试行针对PSMI的IPS 心理健康(西班牙语，CAISAME-EB)，墨西哥哈利斯科最大的心理健康诊所。蔡萨梅-EB 整合初级保健并向大量人口提供药物和心理社会康复服务 PSMI(n=~5,000)。该团队服务于边缘社区，类似于其他低收入和低收入的城市地区 拉丁美洲和其他地区的中等收入国家。我们将使用动态适应过程 模型首先告知墨西哥适应IPS的情况，利用我们之前适应IPS和Depth的经验 了解当地情况(例如，墨西哥就业市场的性质)，以便为适应提供信息。我们 然后将在试点RCT(N=200)中评估调整后的IPS的实施和影响。这项试点RCT将 包括与客户一起进行的基线、6个月和12个月的定量和定性评估， 供应商和其他关键利益攸关方。我们的目标是完善实施过程，了解结果和 工具，并估计未来在拉丁美洲进行区域审判的力量。

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.