Critical Time Intervention-Task Shifting: Randomized Controlled Trial
Condition: Schizophrenia; Psychotic Disorder
MeSH terms: Schizophrenia; Mental Disorders; Psychotic Disorders
Study type: Interventional

Summary: 
      The study represents the research component of a broader initiative entitled "RedeAmericas".
      RedeAmericas (RA) is a collaborative effort of investigators from six cities across Latin
      America (Buenos Aires, Cordoba, Medellin, Neuquen, Rio de Janeiro, and Santiago) and Columbia
      University in New York.

      This is a pilot Randomized Controlled Trial (RCT) of Critical Time Intervention-Task Shifting
      (CTI-TS). It is designed to address a fundamental gap in the services offered by mental
      health clinics. These clinics are the primary locale for outpatient treatment of individuals
      with severe mental disorders in the urban areas of Latin America, and they offer some basic
      and important clinical care such as pharmacologic treatment onsite. Generally these clinics
      also have a major limitation; they have inadequate resources and training for the provision
      of in vivo community-based services, that is, services delivered outside of the clinic
      facility in homes or elsewhere in the community. In most urban areas, they also have weak
      links to primary health care and are not easily accessible to much of the population.

      CTI-TS, is a task shifting intervention that at the service user level provides support for
      better community living and promotes social integration, and at the system level strengthens
      the connections between mental health and primary care clinics. CTI-TS is a time-limited
      9-month intervention provided at the critical time when a person is first offered services at
      a mental health clinic. During this period CTI-TS workers forge relationships that will shape
      the continuing use of services and enhance the potential for recovery over the subsequent
      course of time. The overall goal of CTI-TS is to improve the lives of those with severe
      mental disorders who receive community-based mental health care.
    

Detailed description: 
      Critical Time Intervention-Task Shifting (CTI-TS)is delivered by lay Community Mental Health
      Workers (CMHWs) and Peer Support Workers (PSWs) based in mental health outpatient service
      programs (MHS) and supervised by mental health professionals. These workers provide community
      outreach and support to engage service users, their families, primary care practitioners,
      peers and other community members in the recovery process.

      The CTI-TS program is concerned with improving supports for people recovering from episodes
      of mental illness. Examples of areas where extra support may be provided include medication
      management, housing or crisis management, help with the family, help obtaining good services
      from mental health centers and primary health centers, and help developing social
      relationships in the community.

      The program is provided by a CTI-TS team, including a community mental health worker and a
      peer support worker (someone who has used mental health services in the past, and has
      recovered). All of the CTI-TS activities will last 9 months. The evaluation of how people
      fare will last 18 months. The activities of CTI-TS will be in addition to the usual care
      provided by the subject's local health service. Usual care might include meeting with a
      mental health professional, meeting with a social worker, and/or obtaining prescriptions for
      medicine. This study will compare how people fare who have participated in the CTI-TS
      activities against the group of people who received only the regular services of this
      community mental health center. As part of the study, a trained researcher will meet with
      each subject for an interview at the beginning of the project, again 9 months later, and
      again after 18 months. These interviews will ask questions about how the subject is doing
      with his/her health and quality of life, and if the subject is getting help or support with
      problems.
    

Intervention name(s): CTI-TS
Intervention type(s): Behavioral
Intervention description(s): The following briefly describes the three phases of CTI-TS:
Phase 1: Initiation: The client and CTI-TS team formulate a treatment plan that focuses on selected areas identified as crucial for strengthening stability and facilitating the assimilation of the individual into community living.
Phase 2: The Try-Out phase is devoted to testing and adjusting the support systems that have been established in the community.
Phase 3: The final phase, Transfer of Care, is devoted to making any necessary improvements in the network of supports of the individual.
Other intervention name(s): CTI-TS (Critical Time Intervention-Task Shifting)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: Schizophrenia and Disorders with Psychotic Features; Community Psychiatry