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

项目总结 为严重精神疾病患者发展适当和有效的社区护理 中小收入国家仍然是一项全球性挑战，特别是在中低收入国家。一个特别的问题 当患有SMI的人被送往医院进行急性精神治疗时，就会出现破坏循环， 在没有适当支持的情况下被遣送回社区，但由于以下原因再次入院 精神病复发。这种“旋转门”现象是对心理健康系统的多层面挑战， 包括在南非等国家，几乎没有正式的基于社区的支持系统 和自闭症患者一起生活。然而，有令人振奋的证据表明，关键时间干预(CTI)，一种时间- 在美国，有限的心理社会干预起源于防止无家可归者，可能潜在地 通过在困难时期向易受伤害的服务用户提供支持，改善个人和系统成果 从医院到社区的过渡期。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行支持工作者的版本，适用于低资源环境 在南美，为南非制定和试行一项适合当地的干预计划。具体来说， 我们将利用合作伙伴项目数据，辅以其他定性研究并进行整理，以提供 适应CTI方法、其内容和材料的背景基础。特别是，我们将寻求 提供可包括在发展支助网络中的具体社区资源，包括 现有的同伴支持小组，以及重要的是，传统保健从业者的参与。到时候我们会的 在南非夸祖鲁-纳塔尔的乌姆贡贡德洛武区进行试点可行性队列研究。 我们将招募和培训五支队伍，每支队伍包括一名辅助社会工作者和一名朋辈支援工作者，以 为40名患有SMI的患者提供CTI支持，这些患者在急性呼吸道感染后出院至社区环境 精神科住院治疗。关于合并的定量和定性过程测量 实施研究框架(CFIR)，以及覆盖范围、有效性、 采用、实施和维护(RE-AIM)将在整个CTI中以几个间隔收集 试飞期。我们的主要结果将是在16个月的研究中减少精神病患者的再住院率。 期间，相对于前16个月期间。连同几个次要结果，这些措施将 提供必要的数据，以确定调整后的CTI的可行性、适当性和有限的有效性； 为进一步的试验研究奠定了基础。

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.