Review of Early Intervention Programmes in Psychosis: Implementation Proposal for Peru

Critical Time Intervention - Task-Shifting for Individuals with Psychosis in Latin America: A Multi-stakeholder Qualitative Analysis of Implementation Barriers and Facilitators

This article presents the results of a qualitative study conducted to understand the barriers and facilitators in implementing a pilot trial of Critical Time Intervention-Task-Shifting-a time-limited, community-based, recovery-oriented intervention for individuals with psychosis-in Rio de Janeiro, Brazil, and Santiago, Chile. Data included 40 semi-structured interviews with service users, task-shifting providers, and administrators. Analysis proceeded in three iterative phases and combined inductive and deductive approaches. Coding frameworks for implementation factors, and whether or not they acted as barriers and facilitators, were developed and refined using many domains and constructs from the Consolidated Framework for Implementation Research. Barriers and facilitators were ultimately grouped into five domains: 1-Personal; 2-Interpersonal; 3-Intervention; 4-Mental Health System; and 5-Contextual. A rating system was also developed and applied, which enabled comparisons across stakeholders and study sites. Major facilitators included intervention characteristics such as the roles of the task-shifting providers and community-based care. Top barriers included mental health stigma and community conditions (violence). Nevertheless, the findings suggest that Critical Time Intervention-Task-Shifting is largely acceptable and feasible, and could contribute to efforts to strengthen community mental health systems of care for individuals with psychosis in Latin America, especially in advancing the task-shifting strategy and the recovery-oriented approach.

Implementation of early psychosis services in Latin America: A scoping review

AIM

The evidence of the effectiveness and cost-effectiveness of early intervention for psychosis (EIP) services has motivated their implementation worldwide. However, complex interventions of such EIP services require local adaptations to successfully match population needs and cultural differences. Latin America is a heterogenous region where EIP services are progressively being adopted. Our aim is to map such initiatives in the region with a focus on implementation outcomes.

METHODS

A scoping review following the Preferred Reporting Items for Systematic review and Meta-Analysis extension for Scoping Reviews guidelines was conducted. International and regional databases were searched for publications describing EIP programmes in the region. Besides mapping the services, we described implementation outcomes based on the Standards for Reporting Implementation Studies Checklist.

RESULTS

Ten articles describing seven EIP initiatives from the region were found. Four countries were represented: Argentina, Brazil, Chile and Mexico. The implementation outcomes reporting was heterogenous, although it was possible to ascertain EIP services are feasible and adequate for the region's context. Also, there is some evidence of effectiveness in terms of reducing hospitalizations and improving symptoms. Information about fidelity measures was scarce and there was no information about costs or cost-effectiveness.

CONCLUSIONS

Only a small proportion of Latin American countries have adopted EIP services. Although these programmes seem to be feasible and effective, data on other implementation outcomes, such as fidelity, cultural appropriateness, cost-effectiveness and affordability are not available. This might in part explain why this effective approach has not been yet scaled-up at nationwide levels.