Implementing a community-based task-shifting psychosocial intervention for individuals with psychosis in Chile: Perspectives from users

Martin Agrest, Phuong Thao D. Le, Larry Yang, Franco Mascayano, Silvia Alves-Nishioka, Saloni Dev, Tanvi Kankan, Thamara Tapia-Muñoz, Samantha Sawyer, Josefina Toso-Salman, Gabriella A. Dishy, Maria Jose Jorquera, Sara Schilling, Charissa Pratt, Le Shawndra Price, Eliecer Valencia, Sarah Conover, Ruben Alvarado, Ezra S. Susser

Research output: Contribution to journalArticle

Abstract

Background: Latin America, and Chile in particular, has a rich tradition of community mental health services and programs. However, in vivo community-based psychosocial interventions, especially those with a recovery-oriented approach, remain scarce in the region. Between 2014 and 2015, a Critical Time Intervention-Task Shifting project (CTI-TS) was implemented in Santiago, Chile, as part of a larger pilot randomized control trial. CTI is a time-limited intervention delivered at a critical-time to users, is organized by phases, focuses on specific objectives and decreases in intensity over time. CTI-TS, which combines both the task-shifting strategy and the use of peers, introduces a novel approach to community mental health care that has not yet been tried in Chile. Aims: We aim to evaluate the feasibility, acceptability and applicability of such a community-based psychosocial intervention in urban settings in Latin America – specifically, in Santiago (Chile) from a user perspective. Method: We analyzed 15 in-depth interviews (n = 15) with service users who participated in the intervention about their perceptions and experiences with CTI-TS through thematic analysis. Results: Three themes were revealed. The first was related to the structural characteristics of CTI-TS, especially regarding the timing, duration and phasic nature of the intervention. The second pertained to the acceptability of the in vivo community-based approach. The third theme dealt with the task-shifting aspect, that is, users’ perceptions of the peer support workers and the community mental health workers. Conclusions: CTI-TS was generally acceptable in this Latin American context. Users’ perspectives pointed to the need to make adjustments to some of the structural characteristics of the CTI model and to combine this type of intervention with others that can address stigma. Thus, future adaptations of CTI-TS or similar psychosocial interventions in Latin American contexts are feasible and can enhance community mental health in the region.

Original languageEnglish (US)
Pages (from-to)38-45
Number of pages8
JournalInternational Journal of Social Psychiatry
Volume65
Issue number1
DOIs
StatePublished - Feb 1 2019

Fingerprint

Chile
Psychotic Disorders
Mental Health
Latin America
Community Mental Health Services
Social Adjustment
Community Health Services
Interviews

Keywords

  • Community mental health
  • Critical Time Intervention
  • Latin America
  • task shifting
  • user perspective

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Implementing a community-based task-shifting psychosocial intervention for individuals with psychosis in Chile : Perspectives from users. / Agrest, Martin; Le, Phuong Thao D.; Yang, Larry; Mascayano, Franco; Alves-Nishioka, Silvia; Dev, Saloni; Kankan, Tanvi; Tapia-Muñoz, Thamara; Sawyer, Samantha; Toso-Salman, Josefina; Dishy, Gabriella A.; Jorquera, Maria Jose; Schilling, Sara; Pratt, Charissa; Price, Le Shawndra; Valencia, Eliecer; Conover, Sarah; Alvarado, Ruben; Susser, Ezra S.

In: International Journal of Social Psychiatry, Vol. 65, No. 1, 01.02.2019, p. 38-45.

Research output: Contribution to journalArticle

Agrest, M, Le, PTD, Yang, L, Mascayano, F, Alves-Nishioka, S, Dev, S, Kankan, T, Tapia-Muñoz, T, Sawyer, S, Toso-Salman, J, Dishy, GA, Jorquera, MJ, Schilling, S, Pratt, C, Price, LS, Valencia, E, Conover, S, Alvarado, R & Susser, ES 2019, 'Implementing a community-based task-shifting psychosocial intervention for individuals with psychosis in Chile: Perspectives from users', International Journal of Social Psychiatry, vol. 65, no. 1, pp. 38-45. https://doi.org/10.1177/0020764018815204
Agrest, Martin ; Le, Phuong Thao D. ; Yang, Larry ; Mascayano, Franco ; Alves-Nishioka, Silvia ; Dev, Saloni ; Kankan, Tanvi ; Tapia-Muñoz, Thamara ; Sawyer, Samantha ; Toso-Salman, Josefina ; Dishy, Gabriella A. ; Jorquera, Maria Jose ; Schilling, Sara ; Pratt, Charissa ; Price, Le Shawndra ; Valencia, Eliecer ; Conover, Sarah ; Alvarado, Ruben ; Susser, Ezra S. / Implementing a community-based task-shifting psychosocial intervention for individuals with psychosis in Chile : Perspectives from users. In: International Journal of Social Psychiatry. 2019 ; Vol. 65, No. 1. pp. 38-45.
@article{e63b0cdf36364acea91f425dd0715964,
title = "Implementing a community-based task-shifting psychosocial intervention for individuals with psychosis in Chile: Perspectives from users",
abstract = "Background: Latin America, and Chile in particular, has a rich tradition of community mental health services and programs. However, in vivo community-based psychosocial interventions, especially those with a recovery-oriented approach, remain scarce in the region. Between 2014 and 2015, a Critical Time Intervention-Task Shifting project (CTI-TS) was implemented in Santiago, Chile, as part of a larger pilot randomized control trial. CTI is a time-limited intervention delivered at a critical-time to users, is organized by phases, focuses on specific objectives and decreases in intensity over time. CTI-TS, which combines both the task-shifting strategy and the use of peers, introduces a novel approach to community mental health care that has not yet been tried in Chile. Aims: We aim to evaluate the feasibility, acceptability and applicability of such a community-based psychosocial intervention in urban settings in Latin America – specifically, in Santiago (Chile) from a user perspective. Method: We analyzed 15 in-depth interviews (n = 15) with service users who participated in the intervention about their perceptions and experiences with CTI-TS through thematic analysis. Results: Three themes were revealed. The first was related to the structural characteristics of CTI-TS, especially regarding the timing, duration and phasic nature of the intervention. The second pertained to the acceptability of the in vivo community-based approach. The third theme dealt with the task-shifting aspect, that is, users’ perceptions of the peer support workers and the community mental health workers. Conclusions: CTI-TS was generally acceptable in this Latin American context. Users’ perspectives pointed to the need to make adjustments to some of the structural characteristics of the CTI model and to combine this type of intervention with others that can address stigma. Thus, future adaptations of CTI-TS or similar psychosocial interventions in Latin American contexts are feasible and can enhance community mental health in the region.",
keywords = "Community mental health, Critical Time Intervention, Latin America, task shifting, user perspective",
author = "Martin Agrest and Le, {Phuong Thao D.} and Larry Yang and Franco Mascayano and Silvia Alves-Nishioka and Saloni Dev and Tanvi Kankan and Thamara Tapia-Mu{\~n}oz and Samantha Sawyer and Josefina Toso-Salman and Dishy, {Gabriella A.} and Jorquera, {Maria Jose} and Sara Schilling and Charissa Pratt and Price, {Le Shawndra} and Eliecer Valencia and Sarah Conover and Ruben Alvarado and Susser, {Ezra S.}",
year = "2019",
month = "2",
day = "1",
doi = "10.1177/0020764018815204",
language = "English (US)",
volume = "65",
pages = "38--45",
journal = "International Journal of Social Psychiatry",
issn = "0020-7640",
publisher = "SAGE Publications Ltd",
number = "1",

}

TY - JOUR

T1 - Implementing a community-based task-shifting psychosocial intervention for individuals with psychosis in Chile

T2 - Perspectives from users

AU - Agrest, Martin

AU - Le, Phuong Thao D.

AU - Yang, Larry

AU - Mascayano, Franco

AU - Alves-Nishioka, Silvia

AU - Dev, Saloni

AU - Kankan, Tanvi

AU - Tapia-Muñoz, Thamara

AU - Sawyer, Samantha

AU - Toso-Salman, Josefina

AU - Dishy, Gabriella A.

AU - Jorquera, Maria Jose

AU - Schilling, Sara

AU - Pratt, Charissa

AU - Price, Le Shawndra

AU - Valencia, Eliecer

AU - Conover, Sarah

AU - Alvarado, Ruben

AU - Susser, Ezra S.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Background: Latin America, and Chile in particular, has a rich tradition of community mental health services and programs. However, in vivo community-based psychosocial interventions, especially those with a recovery-oriented approach, remain scarce in the region. Between 2014 and 2015, a Critical Time Intervention-Task Shifting project (CTI-TS) was implemented in Santiago, Chile, as part of a larger pilot randomized control trial. CTI is a time-limited intervention delivered at a critical-time to users, is organized by phases, focuses on specific objectives and decreases in intensity over time. CTI-TS, which combines both the task-shifting strategy and the use of peers, introduces a novel approach to community mental health care that has not yet been tried in Chile. Aims: We aim to evaluate the feasibility, acceptability and applicability of such a community-based psychosocial intervention in urban settings in Latin America – specifically, in Santiago (Chile) from a user perspective. Method: We analyzed 15 in-depth interviews (n = 15) with service users who participated in the intervention about their perceptions and experiences with CTI-TS through thematic analysis. Results: Three themes were revealed. The first was related to the structural characteristics of CTI-TS, especially regarding the timing, duration and phasic nature of the intervention. The second pertained to the acceptability of the in vivo community-based approach. The third theme dealt with the task-shifting aspect, that is, users’ perceptions of the peer support workers and the community mental health workers. Conclusions: CTI-TS was generally acceptable in this Latin American context. Users’ perspectives pointed to the need to make adjustments to some of the structural characteristics of the CTI model and to combine this type of intervention with others that can address stigma. Thus, future adaptations of CTI-TS or similar psychosocial interventions in Latin American contexts are feasible and can enhance community mental health in the region.

AB - Background: Latin America, and Chile in particular, has a rich tradition of community mental health services and programs. However, in vivo community-based psychosocial interventions, especially those with a recovery-oriented approach, remain scarce in the region. Between 2014 and 2015, a Critical Time Intervention-Task Shifting project (CTI-TS) was implemented in Santiago, Chile, as part of a larger pilot randomized control trial. CTI is a time-limited intervention delivered at a critical-time to users, is organized by phases, focuses on specific objectives and decreases in intensity over time. CTI-TS, which combines both the task-shifting strategy and the use of peers, introduces a novel approach to community mental health care that has not yet been tried in Chile. Aims: We aim to evaluate the feasibility, acceptability and applicability of such a community-based psychosocial intervention in urban settings in Latin America – specifically, in Santiago (Chile) from a user perspective. Method: We analyzed 15 in-depth interviews (n = 15) with service users who participated in the intervention about their perceptions and experiences with CTI-TS through thematic analysis. Results: Three themes were revealed. The first was related to the structural characteristics of CTI-TS, especially regarding the timing, duration and phasic nature of the intervention. The second pertained to the acceptability of the in vivo community-based approach. The third theme dealt with the task-shifting aspect, that is, users’ perceptions of the peer support workers and the community mental health workers. Conclusions: CTI-TS was generally acceptable in this Latin American context. Users’ perspectives pointed to the need to make adjustments to some of the structural characteristics of the CTI model and to combine this type of intervention with others that can address stigma. Thus, future adaptations of CTI-TS or similar psychosocial interventions in Latin American contexts are feasible and can enhance community mental health in the region.

KW - Community mental health

KW - Critical Time Intervention

KW - Latin America

KW - task shifting

KW - user perspective

UR - http://www.scopus.com/inward/record.url?scp=85059569084&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85059569084&partnerID=8YFLogxK

U2 - 10.1177/0020764018815204

DO - 10.1177/0020764018815204

M3 - Article

VL - 65

SP - 38

EP - 45

JO - International Journal of Social Psychiatry

JF - International Journal of Social Psychiatry

SN - 0020-7640

IS - 1

ER -