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.

项目概要 为严重精神疾病患者提供适当且有效的社区护理 （SMI）仍然是一个全球性挑战，特别是在中低收入国家（LMIC）。一个特别 当 SMI 患者入院接受急性精神治疗时，就会出现破坏性循环， 在没有适当支持的情况下被释放回社区环境，但由于以下原因再次被重新接纳： 精神疾病复发。这种“旋转门”现象对心理健康系统提出了多层次的挑战， 包括南非等国家，几乎没有或根本没有正式的社区支持系统 与 SMI 一起生活。然而，有希望的证据表明，关键时间干预（CTI）是一种时间干预方法。 源于美国预防无家可归者的有限心理社会干预可能会 通过在困难时期向弱势服务用户提供支持来改善个人和系统的成果 从医院到社区环境的过渡期。拟议的研究项目旨在建立在 CTI 的基础上 来自社区卫生工作者和同伴支持工作者的版本，适合资源匮乏的环境 在南美洲，为南非制定并试点适合当地的干预计划。具体来说， 我们将从合作伙伴项目数据中获取数据，辅之以额外的定性研究并进行整理以提供 适应 CTI 方法、其内容和材料的上下文基础。特别是，我们将寻求 找出可纳入支持网络发展的具体社区资源，包括 现有的同伴支持团体，以及重要的是传统卫生从业者的参与。我们随后将 在南非夸祖鲁-纳塔尔省 uMgungundlovu 区市开展试点可行性队列研究。 我们将招募和培训五个团队，每个团队包括一名辅助社会工作者和一名同伴支持工作者，以 为 40 名患有 SMI 的人提供 CTI 支持，这些人在急性发作后正在出院到社区环境中 精神科住院治疗。根据综合指标进行定量和定性过程测量 实施研究框架 (CFIR)，以及影响范围、有效性、 采用、实施和维护 (RE-AIM) 将在整个 CTI 中定期收集 试点期间。我们的主要成果是在 16 个月的研究中减少精神病患者的再入院率 期间，相对于前 16 个月期间。除了一些次要成果外，这些措施还将 提供必要的数据来确定调整后的 CTI 的可行性、适当性和有限有效性， 并为进一步的试验研究奠定基础。