OnTrack Chile for people with early psychosis: a study protocol for a Hybrid Type 1 trial
Authors: Mascayano Franco , Bello Iruma , Andrews Howard , Arancibia Diego , Arratia Tamara , Burrone María Soledad , Conover Sarah , Fader Kim , Jorquera Maria Jose , Gomez Mauricio , Malverde Sergio , Martínez-Alés Gonzalo , Ramírez Jorge , Reginatto Gabriel , Restrepo-Henao Alexandra , Rosencheck Robert A. , Schilling Sara , Smith Thomas E. , Soto-Brandt Gonzalo , Tapia Eric , Tapia Tamara , Velasco Paola , Wall Melanie M. , Yang Lawrence H. , Cabassa Leopoldo J. , Susser Ezra , Dixon Lisa , Alvarado Rubén 
Published: September 2022

Abstract
Background
Substantial data from high-income countries support early interventions in the form of evidence-based Coordinated Specialty Care (CSC) for people experiencing First Episode Psychosis (FEP) to ameliorate symptoms and minimize disability. Chile is unique among Latin American countries in providing universal access to FEP services through a national FEP policy that mandates the identification of FEP individuals in primary care and guarantees delivery of community-based FEP treatments within a public health care system. Nonetheless, previous research has documented that FEP services currently provided at mental health clinics do not provide evidence-based approaches. This proposal aims to address this shortfall by first adapting OnTrackNY (OTNY), a CSC program currently being implemented across the USA, into OnTrackChile (OTCH), and then examine its effectiveness and implementation in Chile.

Methods
The Dynamic Adaptation Process will be used first to inform the adaptation and implementation of OTCH to the Chilean context. Then, a Hybrid Type 1 trial design will test its effectiveness and cost and evaluate its implementation using a cluster-randomized controlled trial (RCT) (N = 300 from 21 outpatient clinics). The OTCH program will be offered in half of these outpatient clinics to individuals ages 15-35. Usual care services will continue to be offered at the other clinics. Given the current COVID-19 pandemic, most research and intervention procedures will be conducted remotely. The study will engage participants over the course of 2 years, with assessments administered at enrollment, 12 months, and 24 months. Primary outcomes include implementation (fidelity, acceptability, and uptake) and service outcomes (person-centeredness, adherence, and retention). Secondary outcomes comprise participant-level outcomes such as symptoms, functioning, and recovery orientation. Over the course of the study, interviews and focus groups with stakeholders will be conducted to better understand the implementation of OTCH.

Discussion
Findings from this study will help determine the feasibility, effectiveness, and cost for delivering CSC services in Chile. Lessons learned about facilitators and barriers related to the implementation of the model could help inform the approach needed for these services to be further expanded throughout Latin America.

Trial registration
www.ClinicalTrials.govNCT04247711. Registered 30 January 2020.

Trial status
The OTCH trial is currently recruiting participants. Recruitment started on March 1, 2021, and is expected to be completed by December 1, 2022. This is the first version of this protocol (5/12/2021).