OnTrackChile for First Episode Psychosis

OnTrackChile 第一集精神病

• 批准号: 9755520
• 负责人: Ruben Vladimir Alvarado
• 金额: $ 59.49万
• 依托单位: UNIVERSIDAD DE O'HIGGINS
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-07 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9755520
• 关键词: Abbreviations; Address; Argentina; Blinded; Brazil; Caring; Charge; Chile; Chilean; Client; Clinic; Clinical; Collaborations; Communities; Community Mental Health Centers; Country; Data; Early Intervention; Effectiveness; Evaluation; Evidence based practice; Evidence based treatment; Family; Goals; Government; Health Care Reform; Health Personnel; Health Professional; Healthcare; Healthcare Systems; Hybrids; Income; Individual; Infrastructure; Intervention; Interview; Latin America; Leadership; Letters; Locales; Measures; Mediating; Mental Health; Mental disorders; Mentally Ill Persons; Methods; Modeling; Policies; Primary Health Care; Process; Provider; Psychotic Disorders; Public Health; Qualitative Evaluations; Randomized Controlled Trials; Research Personnel; Services; Site; Societies; South America; Symptoms; Testing; Training; base; care coordination; care delivery; compare effectiveness; cost; design; disability; evidence base; experience; first episode psychosis; implementation science; low and middle-income countries; medical specialties; programs; reduce symptoms; scale up; trial design; urban area

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.

大量数据支持对首次发作精神病患者进行早期干预 (FEP)减轻症状和减少残疾。FEP方案已广泛应用， 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） 获得FEP服务。智利在中低收入国家中是独一无二的，它为 实施家庭暴力受害者保护方案服务，包括1）强制要求确定家庭暴力受害者保护方案的家庭暴力受害者保护政策 在社区提供基于社区的FEP治疗 精神卫生中心（CMHC），以及2）公共卫生保健系统，其中这项任务 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， 该提案的目标是通过以下方式解决智利FEP循证实践的不足 首次采用OnTrackChile（OTCH）从OnTrackNY（OTNY），一个协调的专业护理 目前正在美国各地实施的FEP计划，然后在 一个大的规模。像大多数FEP项目一样，OTNY在临床上是有效的，但与大多数其他项目不同的是， 还拥有完善的培训和技术援助基础设施以及成熟的跟踪 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 动态自适应过程，首先通知OTCH的自适应和实现， 智利背景。然后，我们将使用混合试验设计来评估OTCH的实施 以及其在一个集群RCT（N = 300，来自20个CMHC）中的有效性和成本。这一簇- RCT将包括：与客户进行盲态访谈（基线、12个月、24个月）;详细信息 关于服务使用情况（每3个月一次，用于成本估算）; CMHC评估 提供者（6、12、18、24个月，需要进行忠诚度测量）;以及持续混合方法 评估执行过程。