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. 2023 Dec;3(4):325-339.
doi: 10.1007/s43477-023-00090-7. Epub 2023 Jul 6.

Critical Time Intervention - Task-Shifting for Individuals with Psychosis in Latin America: A Multi-stakeholder Qualitative Analysis of Implementation Barriers and Facilitators

PhuongThao D Le  1 , Martín Agrest  2   3 , Tanvi Kankan  4 , Saloni Dev  5 , Franco Mascayano  6   7 , Catarina Dahl  8 , Flávia Mitkiewicz  8 , Sara Schilling  9 , Sarah Conover  10 , Alicia Ruth Fernández  11 , María Soledad Burrone  12 , José Lumerman  13 , María José Jorquera Gonzalez  14 , Kim Fader  6 , María Tavares Cavalcanti  8 , Rubén Alvarado  15 , Lawrence H Yang  1   7 , Ezra S Susser  6   7
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Critical Time Intervention - Task-Shifting for Individuals with Psychosis in Latin America: A Multi-stakeholder Qualitative Analysis of Implementation Barriers and Facilitators

PhuongThao D Le et al. Glob Implement Res Appl. 2023 Dec.

Abstract

This article presents the results of a qualitative study conducted to understand the barriers and facilitators in implementing a pilot trial of Critical Time Intervention-Task-Shifting-a time-limited, community-based, recovery-oriented intervention for individuals with psychosis-in Rio de Janeiro, Brazil, and Santiago, Chile. Data included 40 semi-structured interviews with service users, task-shifting providers, and administrators. Analysis proceeded in three iterative phases and combined inductive and deductive approaches. Coding frameworks for implementation factors, and whether or not they acted as barriers and facilitators, were developed and refined using many domains and constructs from the Consolidated Framework for Implementation Research. Barriers and facilitators were ultimately grouped into five domains: 1-Personal; 2-Interpersonal; 3-Intervention; 4-Mental Health System; and 5-Contextual. A rating system was also developed and applied, which enabled comparisons across stakeholders and study sites. Major facilitators included intervention characteristics such as the roles of the task-shifting providers and community-based care. Top barriers included mental health stigma and community conditions (violence). Nevertheless, the findings suggest that Critical Time Intervention-Task-Shifting is largely acceptable and feasible, and could contribute to efforts to strengthen community mental health systems of care for individuals with psychosis in Latin America, especially in advancing the task-shifting strategy and the recovery-oriented approach.

Keywords: Critical time intervention; Evidence-based intervention; Implementation science; Latin America; Serious mental illness; Task-shifting.

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Conflict of interest statement

Conflict of interest The authors have no competing interests to declare that are relevant to the content of this article.

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