Substantial data support early interventions for people experiencing First Episode Psychosis (FEP) to ameliorate symptoms and minimize disability. FEP programs have been widely and successfully implemented in high-income countries. With the partial exception of Chile, however, there is not a single low-and-middle income country (LMIC) that offers universal access to FEP services. Chile is unique among LMICs in having created a platform for the implementation of FEP services, including 1) a FEP policy that mandates identification of FEP individuals at primary care and delivery of community-based FEP treatments at Community Mental Health Centers (CMHCs), and 2) a public health care system within which this mandate can be fulfilled. Nonetheless, we have documented that FEP services provided at CMHCs do not conform to recently established evidence-based approaches. Therefore, the overarching goal of this proposal is to address the shortfall in evidence-based practices for FEP in Chile by first adapting OnTrackChile (OTCH) from OnTrackNY (OTNY), a coordinated specialty care program for FEP currently being implemented across the US, and then implementing OTCH on a wide scale. Like most FEP programs, OTNY is clinically effective, but unlike most others, it also has a well-established training and technical assistance infrastructure, and a proven track record of being scaled up in large urban areas. To achieve our main goal, we will use the Dynamic Adaptation Process to first inform the adaptation and implementation of OTCH in the Chilean context. We will then use a Hybrid Trial design to evaluate the implementation of OTCH as well as its effectiveness and cost in a cluster-RCT (N = 300 from 20 CMHCs). The cluster- RCT will include: blinded interviews with clients (baseline, 12, 24 months); detailed information about service use (every 3 months, needed for cost estimates); assessments of CMHC providers (6,12,18, 24 months, needed for fidelity measures); and ongoing mixed methods evaluation of the implementation process.
Absent early intervention, psychotic disorders tend to become long-term disabling conditions with profound impacts on individuals, their families, and society at large. The current project aims to address the shortfall in evidence-based treatments for people with first episode psychosis (FEP) in Chile. This shortfall is pervasive in most middle-income countries, which means that the Chilean experience in addressing it with OnTrackChile (OTCH) will be widely relevant, especially since these countries are also rapidly expanding their primary care and mental health infrastructure.
