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

项目摘要/摘要 精神障碍是世界范围内导致残疾和发病的主要原因之一--这些情况 加上巨大的治疗缺口，据估计，70%需要心理健康护理的人没有 足够或根本不需要任何治疗。在巴西，尽管拥有一个由公共资金、免费、 以社区为基础的精神卫生治疗，估计只有26%的有精神疾病的人 成功连接到基于社区的护理。其余的人只在紧急或危急的情况下寻求治疗 条件，导致急诊科人满为患，精神科床位等待时间长， 精神寄宿，整体护理质量较差，以及过度依赖已经 负担过重(由于新冠肺炎，这种情况越来越严重)。这个问题日益严重，而且不成比例。 受影响的人患有严重精神疾病(SMI)，他们是穷人和非白人。恢复和重建的目标 社区中有意义的生活被稳定和症状控制的生活所笼罩。 造成这一心理健康治疗差距的因素很多(例如，耻辱和歧视、劳动力 短缺、经济差距、缺乏及时的后续行动和接触、不连续和支离破碎 护理环境之间的联系)，但解决办法很少。提议的项目采用参与式研究。 和适应设计，涉及利益相关者，包括SMI患者、家庭成员、临床医生、 社区服务工作人员和管理人员，贯穿项目开发和实施的所有阶段。 我们假设，成功调整和实施基于证据的同伴支持模式 对巴西文化来说，将有助于提高参与度，改善护理的连续性，以及 改善了巴西SMI患者的生活质量和幸福感。为此，我们建议 以下具体目标：1)与巴西坎皮纳斯的当地利益攸关方合作，适应 一种基于证据的同伴干预，旨在建立与同伴的联系，作为后参与的调解人 急性心理和身体保健；2)使用实验治疗学方法来确定 多水平靶点参与该途径的程度通过先导临床试验改善了结果； 3)评估适应的同龄人的可行性、可接受性、安全性、耐受性和传播潜力 多层次的干预。在这项研究之后，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、文化响应型、循证干预措施来提高护理质量 获得社区精神卫生治疗的重度精神障碍患者的比例。此外，通过耶鲁大学 坎皮纳斯伙伴关系，我们将促进国际合作作为开发创新技术的战略 这将为在拉丁美洲国家的贫困社区进行执行和有效性试验(R01)做好准备。 最后，本提案中制定的适应战略可用于其他LMIC，以适应EBPS。

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.