OnTrackChile for First Episode Psychosis

大量数据支持对首发精神病患者进行早期干预 (FEP)以改善症状和最大限度地减少残疾。FEP计划得到了广泛的应用 在高收入国家成功实施。除了智利的部分例外， 然而，没有一个低收入和中等收入国家(LMIC)能够提供 获得FEP服务。智利在LMIC中是独一无二的，它为 实施FEP服务，包括1)强制识别FEP的FEP策略 接受初级保健的个人和社区提供以社区为基础的FEP治疗 精神卫生中心(CMHC)，以及2)公共卫生保健系统，在该系统内 都可以实现。尽管如此，我们已经记录了CMHC提供的FEP服务 不符合最近建立的循证方法。因此，最重要的是 这项提案的目标是解决智利FEP在循证实践方面的不足，办法是 首次从OnTrackNY(OTNY)改编OnTrack智利(OTCH)，这是一种协调的专业护理 FEP计划目前正在美国各地实施，然后在 规模很大。像大多数FEP计划一样，OTNY在临床上是有效的，但与大多数其他计划不同的是，它 还拥有完善的培训和技术援助基础设施，以及经过验证的轨道 在大城市地区扩大规模的记录。为了实现我们的主要目标，我们将使用 动态适应进程，首先告知OTCH的适应和在 智利的背景。然后，我们将使用混合试验设计来评估OTCH的实施 以及其在集群RCT中的有效性和成本(20个CMHC中的N=300个)。该集群- 随机对照试验将包括：与客户的盲谈(基线，12个月，24个月)；详细信息 关于服务使用情况(每3个月，成本估算所需)；CMHC评估 提供者(6个月、12个月、18个月、24个月，保真度测量所需)；以及正在进行的混合方法 对实施过程的评估。

Substantial data support early interventions for people experiencing First Episode Psychosis (FEP) to ameliorate symptoms and minimize disability. FEP programs have been widely and successfully implemented in high-income countries. With the partial exception of Chile, however, there is not a single low-and-middle income country (LMIC) that offers universal access to FEP services. Chile is unique among LMICs in having created a platform for the implementation of FEP services, including 1) a FEP policy that mandates identification of FEP individuals at primary care and delivery of community-based FEP treatments at Community Mental Health Centers (CMHCs), and 2) a public health care system within which this mandate can be fulfilled. Nonetheless, we have documented that FEP services provided at CMHCs do not conform to recently established evidence-based approaches. Therefore, the overarching goal of this proposal is to address the shortfall in evidence-based practices for FEP in Chile by first adapting OnTrackChile (OTCH) from OnTrackNY (OTNY), a coordinated specialty care program for FEP currently being implemented across the US, and then implementing OTCH on a wide scale. Like most FEP programs, OTNY is clinically effective, but unlike most others, it also has a well-established training and technical assistance infrastructure, and a proven track record of being scaled up in large urban areas. To achieve our main goal, we will use the Dynamic Adaptation Process to first inform the adaptation and implementation of OTCH in the Chilean context. We will then use a Hybrid Trial design to evaluate the implementation of OTCH as well as its effectiveness and cost in a cluster-RCT (N = 300 from 20 CMHCs). The cluster- RCT will include: blinded interviews with clients (baseline, 12, 24 months); detailed information about service use (every 3 months, needed for cost estimates); assessments of CMHC providers (6,12,18, 24 months, needed for fidelity measures); and ongoing mixed methods evaluation of the implementation process.