A Recovery-Oriented Intervention for People With Psychosis: A Pilot Randomized Controlled Trial

Franco Mascayano, Ruben Alvarado, Howard F. Andrews, Joy N. Baumgartner, Maria Soledad Burrone, Jacqueline Cintra, Sarah Conover, Catarina M. Dahl, Kim M. Fader, Prakash Gorroochurn, Sandro Galea, Maria J. Jorquera, Giovanni M. Lovisi, Flavia Mitkiewicz de Souza, Charissa Pratt, Maria E. Restrepo-Toro, Graciela Rojas, Keli Rodrigues Sarução, Robert Rosenheck, Sara SchillingTom Shriver, Peter Stastny, Eric Tapia, Maria Tavares Cavalcanti, Eliecer Valencia, Lawrence H. Yang, Alexandra Restrepo Henao, Gonzalo Martínez-Alés, Victor Romero Pardo, Teresa Gomez Alemany, Ezra Susser

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVE: This pilot randomized controlled trial evaluated the effectiveness of critical time intervention-task shifting (CTI-TS) for people with psychosis in Santiago, Chile, and Rio de Janeiro. CTI-TS is a 9-month intervention involving peer support workers and is designed to maintain treatment effects up to 18 months. METHODS: A total of 110 people with psychosis were recruited when they enrolled in community mental health clinics (Santiago, N=60; Rio de Janeiro, N=50). Participants within each city were randomly assigned to either CTI-TS or usual care for 9 months. Primary outcomes were quality of life, measured with the World Health Organization Quality of Life Assessment-Brief Version (WHOQOL-BREF), and unmet needs, measured with the Camberwell Assessment of Need (CAN), at 18-month follow-up. Results were analyzed according to intention-to-treat guidelines. Generalized estimating equations, with observations clustered within cities, and multiple imputation for missing data were used. RESULTS: At 18 months, both groups showed improved primary outcomes. In both unadjusted and fully adjusted analyses, no significant differences between CTI-TS and usual care (WHOQOL-BREF question on quality of life and CAN mean number of unmet needs) were found. CONCLUSIONS: Three factors might explain the lack of difference between CTI-TS and usual care: first-contact enrollment precluded rapport prior to randomization, a minority of patients were uncomfortable with peers being on the treatment team, and primary outcome measures may not have been sensitive enough to capture the effects of a recovery-oriented intervention. The results have implications for the design of transitional services for people with psychosis, especially in Latin America.

Original languageEnglish (US)
Pages (from-to)1225-1231
Number of pages7
JournalHospital and Community Psychiatry
Volume73
Issue number11
DOIs
StatePublished - Nov 1 2022

Keywords

  • Community mental health centers
  • Community mental health services
  • Latin America
  • Peers
  • Pilot RCT
  • Psychoses

ASJC Scopus subject areas

  • Medicine(all)

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