FEASIBILITY AND ACCEPTABILITY OF CRITICAL TIME INTERVENTION TO SUPPORT PEOPLE WITH SEVERE MENTAL ILLNESS FOLLOWING POST-ACUTE HOSPITAL DISCHARGE IN SOUTH AFRICA

为南非急性出院后严重精神疾病患者提供关键时间干预的可行性和可接受性

• 批准号: 10704627
• 负责人: Arvin Bhana
• 金额: $ 18.98万
• 依托单位: UNIVERSITY OF KWAZULU-NATAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10704627
• 关键词: Acute; Admission activity; Back; Caring; Cohort Studies; Collaborations; Communities; Community Developments; Community Health Aides; Community Healthcare; Complement; Consolidated Framework for Implementation Research; Continuity of Patient Care; Country; Data; Development; Effectiveness; Effectiveness of Interventions; Ethnography; Evidence based intervention; Evidence based practice; Evidence based program; Family; Family Relationship; Foundations; Frequencies; Guidelines; Health; Health system; Homelessness; Hospitalization; Hospitals; Income; Individual; Inpatients; Institution; International; Intervention; Local Government; Measures; Mental Health; Methods; Modeling; Municipalities; Nature; Outcome; Outcome Measure; Output; Pathway interactions; Personal Satisfaction; Persons; Prevention; Process Measure; Psyche structure; Psychiatric therapeutic procedure; Psychosocial Assessment and Care; Qualitative Research; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recurrence; Relapse; Research; Research Project Grants; Resource-limited setting; Resources; Services; Shapes; Social Workers; South Africa; South African; South America; Structure; Support Groups; Support System; System; Testing; Time; Training; Training Activity; Trauma; Vulnerable Populations; Work; acceptability and feasibility; base; community based care; community setting; effective intervention; effectiveness/implementation trial; evidence base; hospital readmission; implementation facilitators; implementation outcomes; implementation science; implementation strategy; improved; innovation; intervention effect; intervention program; low and middle-income countries; peer support; person centered; pilot test; prevent; primary outcome; psychosocial; recruit; secondary outcome; severe mental illness; social; social culture; stem; support network

PROJECT SUMMARY The development of appropriate and effective community-based care for people living with severe mental illness (SMIs) continues to be a global challenge, especially in low-and-middle income countries (LMICs). A particularly damaging cycle emerges when people with SMIs are admitted to hospital for acute psychiatric treatment, discharged back into community settings without appropriate support, only to be readmitted again due to psychiatric relapse. This “revolving door” phenomenon is a multilevel challenge to mental health systems, including in countries such as South Africa, with little to no formal community-based support systems for people living with SMIs. However, promising evidence has been produced that Critical Time Intervention (CTI), a time- limited psychosocial intervention with origins in the prevention of homelessness in the USA, could potentially improve individual and system outcomes by providing support to vulnerable service users during the difficult transition period from hospital to community settings. The proposed research project aims to build on a CTI version that draws from community health workers and peer support workers, adapted for low-resource settings in South America, to develop and pilot a locally appropriate intervention program for South Africa. Specifically, we will draw from partner project data, supplemented by additional qualitative research and collated to provide a contextual basis from which to adapt the CTI approach, its content and materials. In particular, we will seek out specific community resources that could be included in the development of support networks, including existing peer support groups, and, importantly, the involvement of traditional health practitioners. We will then conduct a pilot feasibility cohort study in the uMgungundlovu District Municipality in KwaZulu-Natal, South Africa. We will recruit and train five teams that each include an auxiliary social worker and a peer support worker to provide CTI support to 40 people with SMIs who are being discharged to community settings following acute psychiatric hospitalization. Quantitative and qualitative process measures in terms of the Consolidated Framework for Implementation Research (CFIR), and outcome measures in terms of Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) will be gathered at several intervals throughout the CTI piloting period. Our primary outcome will be the reduction in psychiatric readmission over a 16-month study period, relative to the previous 16-month period. Along with several secondary outcomes, these measures will provide the necessary data to establish feasibility, appropriateness, and limited effectiveness of the adapted CTI, and lay a foundation for further trial research.

项目总结