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

项目摘要 为严重精神病患者提供适当和有效的社区护理 （SMIs）仍然是一个全球性挑战，特别是在低收入和中等收入国家（LMIC）。一个特别 当患有SMI的人入院接受急性精神病治疗时， 出院回到社区环境，没有适当的支持，只是再次入院，由于 精神病复发这种“旋转门”现象是对精神卫生系统的多层次挑战， 包括在南非等国家，几乎没有为人们提供正式的社区支持系统， 与SMIs一起生活然而，有希望的证据已经产生，关键时间干预（CTI），一个时间- 有限的心理社会干预与起源于预防无家可归在美国，可能 通过在困难时期向弱势服务用户提供支持，改善个人和系统的成果。 从医院到社区的过渡期。拟议的研究项目旨在建立一个气候技术倡议， 从社区卫生工作者和同伴支持工作者那里汲取经验的版本，适用于低资源环境 在南美洲，为南非制定和试行适合当地情况的干预方案。具体地说， 我们将从合作伙伴的项目数据中提取，并辅以其他定性研究和整理， 一个上下文基础，从适应气候技术倡议的方法，其内容和材料。特别是，我们将寻求 提供可纳入支助网络发展的具体社区资源，包括 现有的同侪支助团体，以及重要的是，传统保健从业人员的参与。然后我们将 在南非夸祖鲁-纳塔尔的uMgungundlovu区进行试点可行性群组研究。 我们会招募及训练五支队伍，每队包括一名辅助社工及一名朋辈支援工作者， 为40名患有重度精神疾病的患者提供CTI支持，这些患者在急性 精神病院从综合的角度衡量定量和定性过程 实施研究框架（CFIR），以及在覆盖范围、有效性、 采用、实施和维护（RE-AIM）将在整个CTI期间以几个时间间隔进行收集 试点期间。我们的主要结果将是在16个月的研究中减少精神病再入院 与前16个月相比。沿着几个次要结果，这些措施将 提供必要的数据，以确定适应性CTI的可行性、适当性和有限有效性， 为进一步的试验研究奠定基础。

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.