Adaptation and Implementation of Peer Support to Optimize Engagement and Outcomes for People with Serious Mental Illness in Campinas, Brazil

项目总结/摘要 精神障碍是世界范围内残疾和发病的主要原因之一， 由于巨大的治疗差距，估计70%需要精神卫生保健的人没有得到治疗， 或任何治疗。在巴西，尽管有一个全面的网络，公共资助，免费， 据估计，只有26%的精神病患者接受了以社区为基础的心理健康治疗， 成功地与基于社区的护理相结合。其余的人只在紧急或危机情况下寻求治疗 条件，造成急诊室过度拥挤，精神病病床等待时间长， 精神病寄宿，整体护理质量较差，以及过度依赖已经 负担过重（由于COVID-19，负担越来越重）。这一问题日益严重地 患有严重精神疾病（SMI）的穷人和非白人。恢复和重建目标 在社区中有意义的生活变得黯然失色那些稳定和症状管理。 造成这种心理健康治疗差距的因素很多（即，污名化和歧视，劳动力 短缺、经济差距、缺乏及时的后续行动和参与、不连续和分散 护理环境之间的联系），但解决办法很少。该项目采用参与式研究方法， 和适应设计，涉及利益攸关方，包括患有重度精神障碍的人，家庭成员，临床医生， 社区服务工作人员和行政人员在项目开发和实施的所有阶段都参与其中。 我们假设，成功的适应和实施基于证据的同伴支持模型 巴西文化，将有助于提高参与水平，改善护理的连续性， 改善巴西重度精神障碍患者的生活质量和福祉。为此，我们建议 （1）与巴西坎皮纳斯的当地利益攸关方合作， 以证据为基础的同伴干预，目标是与同伴建立联系，作为参与后危机的调解人。 急性精神和身体保健; 2）采用实验治疗方法来确定 通过试点临床试验，多水平靶点参与途径改善结局的程度; 3)评估适应性同行的可行性、可接受性、安全性、耐受性和传播潜力 多层次的干预。在本研究之后，我们将确定其可行性、可接受性、安全性和 耐受性，采用低成本，文化敏感，循证干预措施，以提高护理质量 重度精神障碍患者接受社区心理健康治疗的比例。此外，通过耶鲁大学的 坎皮纳斯伙伴关系，我们将促进国际合作，作为一项战略，以开发创新技术 这将为在拉丁美洲国家的贫困社区进行实施和有效性试验（R 01）做好准备。 最后，本提案中制定的适应战略可用于其他中低收入国家，以适应环境优先事项。

PROJECT SUMMARY/ABSTRACT Mental disorders are among the leading causes of disability and morbidity worldwide—conditions that are compounded by a vast treatment gap where an estimated 70% of people who need mental health care go without adequate or any treatment at all. In Brazil, despite having a comprehensive network of publicly-funded, free, community-based mental health treatment, it is estimated that only 26% of people with psychiatric conditions successfully connect to community-based care. The remaining seek treatment only under emergency or crisis conditions, contributing to overcrowding in emergency departments, long waiting periods for psychiatric beds, psychiatric boarding, poorer overall quality of care, and an overreliance on a hospital system that is already overburdened (and increasingly so due to COVID-19). This problem has increasingly and disproportionately affected people with a serious mental illness (SMI) who are poor and non-white. Goals of recovery and rebuilding a meaningful life in the community become overshadowed by those of stabilization and symptom management. Contributing factors to this mental health treatment gap are plenty (i.e., stigma and discrimination, workforce shortages, economic disparities, lack of timely follow-up and engagement, discontinuous and fragmented linkages between care settings), yet solutions are scarce. The proposed project uses a participatory research and adaptation design that involves stakeholders, including persons living with SMI, family members, clinicians, community services staff and administrators, throughout all stages of project development and implementation. We hypothesize that the successful adaptation and implementation of an evidence-based model of peer support to Brazilian culture, will contribute to enhanced levels of engagement, improved continuity of care, and improvements in quality of life and wellbeing among persons living with SMI in Brazil. To this end, we propose the following specific aims: 1) To work with local stakeholders in Campinas, Brazil on the cultural adaptation of an evidence-based peer intervention targeting connections with a peer as a mediator of engagement in post- acute mental and physical healthcare; 2) To employ an experimental therapeutics approach in determining the degree to which multi-level targets are engaged in the pathway improved outcomes through a pilot clinical trial; 3) To assess the feasibility, acceptability, safety, tolerability, and potential for dissemination of the adapted peer intervention at multiple levels. After this study, we will have established the feasibility, acceptability, safety and tolerability, of adapting a low-cost, culturally-responsive, evidence-based intervention to improve quality of care of people with SMI who access community mental health treatment. Moreover, through a Yale-University of Campinas partnership, we will foster international collaboration as a strategy to develop an innovative technology that would be ready for an implementation and effectiveness trial (R01) in poor communities in Latin countries. Finally, the adaptation strategy developed in this proposal can be used in other LMICs to adapt EBPs.