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Rede Americas – “RA”

Rede Americas – “RA”. Network for Mental Health Research in the Americas. Six urban areas in Latin America Buenos Aires Cordoba Medellin Neuquen Rio de Janeiro Santiago and New York City. Rede Americas – “RA”. Executive Group Alvarado, Galea, Rojas, Susser, Tavares-Cavalcanti

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Rede Americas – “RA”

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  1. RedeAmericas – “RA” Network for Mental Health Research in the Americas • Six urban areas in Latin America • Buenos Aires • Cordoba • Medellin • Neuquen • Rio de Janeiro • Santiago • and New York City

  2. RedeAmericas – “RA” Executive Group Alvarado, Galea, Rojas, Susser, Tavares-Cavalcanti Non-voting: Fader, Valencia Leadership Group Representatives from each of the seven sites. Cores and Working Groups Members from across sites.

  3. 5 Regional Hubs

  4. RA founding principles • Adopt a regional approach • Develop public mental health • Promote community mental health care Complements other regional initiatives PAHO/WHO Latin MH network Other

  5. 1. Adopt a regional approach • Feasible in Latin America • Overall trend ~25 years toward: • political democracies • strong economies • large urban areas • community mental health centers • Movement toward regional alliances • Precedents set by PAHO/WHO

  6. RA starts with urban populations • Commonalities such as: • large marginalized communities • growing numbers of mental health centers • vibrant cultural and intellectual life

  7. Two cities, two views Rio de Janeiro Santiago

  8. 2. Develop public mental health • Start with joint effort of public health and psychiatry • All RA sites have done or are doing this Santiago Rio de Janeiro

  9. 3. Promote community mental health care • close to communities that use them • accessible to all people and their families • include but not limited to primary health care • active involvement of affected individuals, • their families, their communities

  10. Specific goals of RA • Trial of a task shifting intervention • Capacity building for mental health research • Creation of a cohesive regional network

  11. 1. Task shifting intervention for people with psychoses • Two crucial gaps in community care • primary care • community based care (outside clinic) • How do we address these gaps across the region? • No randomized trials- • of any approach feasible for regional scale-up

  12. Adaptation of Critical Time Intervention (CTI) • Critical Time Intervention or “CTI” • tested and widely used in high-income countries • Core elements • done in vivo i.e. community-based outreach and care • for points of transition • time-limited with an enduring effect

  13. Early origins of CTI New York City 1985

  14. Why might CTI be adaptable for Latin America? • time-limited: allows for wider application • general principles adaptable to local services • potential for regional use • 5-year pilot and adaptation in Rio

  15. CTI-Task Shifting or “CTI-TS” • Some key components: • Pairing of two types of workers • “peer support workers” & “community mental health workers” • Offered at entry to mental health services • a key point of transition with long-term consequences • Emphasis on primary as well as secondary care • For further explanation, presentation by Ruben Alvarado

  16. CTI-TS trials in 3 cities

  17. Central challenge: doing a regional trial 3 countries with different service systems Also other differences across the 3 sites Requires • protocol with specified adaptability to site • close coordination across sites • ongoing dialogue and consensus across RA

  18. 2. Capacity building for mental health research • RA “Awardees” • annual selection of 5-7 • two-year training program • formal applications • specified selection criteria • Non-Awardees • courses, practica • offered at each RA site • available to trainees from other sites

  19. 7 Awardees selected year one

  20. 2 year training program for Awardees Key components • 2 mentors: 1 Latin America and 1 US • basic training in epidemiology • summer courses at CU and U Chile • university courses at other sites • research opportunities • practical experiences All components are individually tailored e.g. choice of mentors and courses

  21. Examples of other capacity building Practicum in Neuquen, Argentina IEA Epi Course Lima, Peru Young investigators meet monthly in Santiago Sponsored by “RA Chile”

  22. 3. Creation of a cohesive regional network • Work by consensus with frequent interchange • Biweekly conference calls • of all site leaders • of 5-person exec • of ~10 working groups • “El CorreoSemanal” • Also much informal interchange

  23. Biannual meetings attended by all sites • September 2011: Buenos Aires • launch of RA • March 2012: Rio de Janeiro • six-month review • November 2012: Cordoba • tied to Latin American Congress of Public Health • Ongoing • next one in Santiago

  24. Rapid development of regional connections • Some of the people in the network Rio Neuquen Medellin Santiago Buenos Aires Cordoba

  25. The broad vision • Contribute to • evidence base for community-based mental health care • capacity for mental health workers at all levels • self-sustaining and inclusive regional networks • social movement to advocate for mental health reforms

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