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SchizophreniaCTI-TS RCTNCT01995864

Critical Time Intervention-Task Shifting: Randomized Controlled Trial

A study testing CTI-TS in people with Schizophrenia and Psychotic Disorder, run by Columbia University at 2 sites in 2 countries.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The study represents the research component of a broader initiative entitled "RedeAmericas". RedeAmericas (RA) is a collaborative effort of investigators from six cities across Latin America (Buenos Aires, Cordoba, Medellin, Neuquen, Rio de Janeiro, and Santiago) and Columbia University in New York. Read more about this study

Who is it for?
Ages 21 to 65 years
Conditions the study is for
Schizophrenia, Psychotic Disorder
What is being tested?
CTI-TS
Could I receive a placebo?
No, everyone receives an active treatment
How many people
110 participants
Where
2 sitesin 2 countries
Study dates
Feb 2014to 1 Jun 2020
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 21 to 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • 21-65 years of age.
  • No longer than 6 months since the first visit to the MHS (excluding visits that took place more than one year ago).
  • Any psychotic disorder (chart diagnosis) from the following groups (ICD-10 criteria):
  • F20-29 including schizophrenia, delusional disorders, schizotypal disorders, acute polymorph psychotic disorders, schizoaffective disorders
  • F30-39 the following mood [affective] disorders with psychoses:
  • F30.2 Mania with psychotic symptoms F31.2 Bipolar affective disorder, current episode manic with psychotic symptoms F31.5 Bipolar affective disorder, current episode severe depression with psychotic symptoms F32.3 Severe depressive episode with psychotic symptoms F33.3 Recurrent depressive disorder, current episode severe with psychotic symptom

Who cannot join

  • Under age 21 or over age 65.
  • Active suicidal ideation.
  • Substance Abuse or Dependence alone (may have psychotic symptoms but does not meet criteria for diagnoses included).
  • Serious cognitive or other sensorial impairment which is likely to preclude reliable assessment via our interview procedures.

Trial locations and contacts

2 sites in 2 countries.

2 sites in 2 countries

Brazil1 site
  • Federal University of Rio de Janeiro

    Rio de Janeiro

Other trials in Brazil

Chile1 site
  • University of Chile

    Santiago

Other trials in Chile

About this study

Official title: A Pilot Multi-center Randomized Controlled Trial of Critical Time Intervention - Task Shifting (CTI-TS) Versus Usual Care for People With Psychotic Disorders

The study represents the research component of a broader initiative entitled "RedeAmericas". RedeAmericas (RA) is a collaborative effort of investigators from six cities across Latin America (Buenos Aires, Cordoba, Medellin, Neuquen, Rio de Janeiro, and Santiago) and Columbia University in New York.

This is a pilot Randomized Controlled Trial (RCT) of Critical Time Intervention-Task Shifting (CTI-TS). It is designed to address a fundamental gap in the services offered by mental health clinics. These clinics are the primary locale for outpatient treatment of individuals with severe mental disorders in the urban areas of Latin America, and they offer some basic and important clinical care such as pharmacologic treatment onsite. Generally these clinics also have a major limitation; they have inadequate resources and training for the provision of in vivo community-based services, that is, services delivered outside of the clinic facility in homes or elsewhere in the community. In most urban areas, they also have weak links to primary health care and are not easily accessible to much of the population.

CTI-TS, is a task shifting intervention that at the service user level provides support for better community living and promotes social integration, and at the system level strengthens the connections between mental health and primary care clinics. CTI-TS is a time-limited 9-month intervention provided at the critical time when a person is first offered services at a mental health clinic. During this period CTI-TS workers forge relationships that will shape the continuing use of services and enhance the potential for recovery over the subsequent course of time. The overall goal of CTI-TS is to improve the lives of those with severe mental disorders who receive community-based mental health care.

Read the detailed description

Critical Time Intervention-Task Shifting (CTI-TS)is delivered by lay Community Mental Health Workers (CMHWs) and Peer Support Workers (PSWs) based in mental health outpatient service programs (MHS) and supervised by mental health professionals. These workers provide community outreach and support to engage service users, their families, primary care practitioners, peers and other community members in the recovery process.

The CTI-TS program is concerned with improving supports for people recovering from episodes of mental illness. Examples of areas where extra support may be provided include medication management, housing or crisis management, help with the family, help obtaining good services from mental health centers and primary health centers, and help developing social relationships in the community.

The program is provided by a CTI-TS team, including a community mental health worker and a peer support worker (someone who has used mental health services in the past, and has recovered). All of the CTI-TS activities will last 9 months. The evaluation of how people fare will last 18 months. The activities of CTI-TS will be in addition to the usual care provided by the subject's local health service. Usual care might include meeting with a mental health professional, meeting with a social worker, and/or obtaining prescriptions for medicine. This study will compare how people fare who have participated in the CTI-TS activities against the group of people who received only the regular services of this community mental health center. As part of the study, a trained researcher will meet with each subject for an interview at the beginning of the project, again 9 months later, and again after 18 months. These interviews will ask questions about how the subject is doing with his/her health and quality of life, and if the subject is getting help or support with problems.

Being tested
CTI-TS
Keywords
Schizophrenia and Disorders with Psychotic Features, Community Psychiatry
Medical subject headings
Schizophrenia, Psychotic Disorders, Schizophrenia Spectrum and Other Psychotic Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • CTI-TSBehavioural

    Also called CTI-TS (Critical Time Intervention-Task Shifting)

    The following briefly describes the three phases of CTI-TS:

    Phase 1: Initiation: The client and CTI-TS team formulate a treatment plan that focuses on selected areas identified as crucial for strengthening stability and facilitating the assimilation of the individual into community living.

    Phase 2: The Try-Out phase is devoted to testing and adjusting the support systems that have been established in the community.

    Phase 3: The final phase, Transfer of Care, is devoted to making any necessary improvements in the network of supports of the individual.

Study groups in NCT01995864
Study groupRoleWhat they receive
CTI-TSExperimentalCTI-TS is a time-limited, 9-month long intervention, provided at the critical time when a person is first offered services at a mental health clinic, or, at the similarly critical time when a person first seeks to reconnect with a mental health clinic after a long lapse.
Receives: Behavioral: CTI-TS
Usual CareNo interventionThe Usual Care group will receive mental health services as provided by the local mental health services clinic.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Camberwell Assessment of Need (CAN)

    Used to assess the needs of people with severe mental illness.

    Measured: 18 months

  2. World Health Organization Quality of Life, Short Form (WHOQOL-BREF)

    Used to provide a quality of life measurement.

    Measured: 18 months

Secondary outcomes (6)
  1. World Health Organization Disability Assessment Schedule II (WHODAS 2.0)

    Measures level of disability

    Measured: 18 months

  2. Recovery Assessment Scale (RAS)

    Assessment tool to measure factors important to recovery

    Measured: 18 months

  3. Continuity of care and course of illness

    CONNECT, a measure of continuity of care, and the Life Chart Schedule are used.

    Measured: 18 months

  4. Perceived stigma

    Perceived Discrimination and Devaluation Scale (PDD) is used for this outcome

    Measured: 18 months

  5. Self-stigma

    Internalized stigma of mental illness (ISMI) is the measure used.

    Measured: 18 months

  6. Substance use

    ASSIST, the WHO Alcohol, Smoking and Substance Involvement Screening Test is used for this measure.

    Measured: 18 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted27 Nov 2013 (estimated)
  2. Study startFeb 2014
  3. Primary completion1 Jun 2020
  4. Study completion1 Jun 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Health services research
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
110 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01995864
Sponsor's protocol ID
AAAI1845
Other IDs
U19MH095718
Acronym
CTI-TS RCT
Status last verified
Jun 2020
First submitted
18 Nov 2013
Last updated
25 Jun 2020
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • Yang LH, Valencia E, Alvarado R, Link B, Huynh N, Nguyen K, Morita K, Saavedra M, Wong C, Galea S, Susser E. A theoretical and empirical framework for constructing culture-specific stigma instruments for Chile. Cad Saude Colet. 2013;21(1):71-79. doi: 10.1590/s1414-462x2013000100011.

    PubMed 23990755
  • Baumgartner JN, Susser E. Social integration in global mental health: what is it and how can it be measured? Epidemiol Psychiatr Sci. 2013 Mar;22(1):29-37. doi: 10.1017/S2045796012000303. Epub 2012 May 25.

    PubMed 22794167
  • Minoletti A, Galea S, Susser E. Community Mental Health Services in Latin America for People with Severe Mental Disorders. Public Health Rev. 2012;34(2):http://www.publichealthreviews.eu/show/a/116. doi: 10.1007/BF03391681.

    PubMed 25339792
  • Herman D, Opler L, Felix A, Valencia E, Wyatt RJ, Susser E. A critical time intervention with mentally ill homeless men: impact on psychiatric symptoms. J Nerv Ment Dis. 2000 Mar;188(3):135-40. doi: 10.1097/00005053-200003000-00002.

    PubMed 10749277
  • Jones K, Colson PW, Holter MC, Lin S, Valencia E, Susser E, Wyatt RJ. Cost-effectiveness of critical time intervention to reduce homelessness among persons with mental illness. Psychiatr Serv. 2003 Jun;54(6):884-90. doi: 10.1176/appi.ps.54.6.884.

    PubMed 12773605
  • Herman DB, Conover S, Gorroochurn P, Hinterland K, Hoepner L, Susser ES. Randomized trial of critical time intervention to prevent homelessness after hospital discharge. Psychiatr Serv. 2011 Jul;62(7):713-9. doi: 10.1176/ps.62.7.pss6207_0713.

    PubMed 21724782
  • Susser E, Valencia E, Conover S, Felix A, Tsai WY, Wyatt RJ. Preventing recurrent homelessness among mentally ill men: a "critical time" intervention after discharge from a shelter. Am J Public Health. 1997 Feb;87(2):256-62. doi: 10.2105/ajph.87.2.256.

    PubMed 9103106
  • Agrest M, Le PD, Yang LH, Mascayano F, Alves-Nishioka S, Dev S, Kankan T, Tapia-Munoz T, Sawyer S, Toso-Salman J, Dishy GA, Jorquera MJ, Schilling S, Pratt C, Price L, Valencia E, Conover S, Alvarado R, Susser ES. Implementing a community-based task-shifting psychosocial intervention for individuals with psychosis in Chile: Perspectives from users. Int J Soc Psychiatry. 2019 Feb;65(1):38-45. doi: 10.1177/0020764018815204.

    PubMed 30791796
  • Baumgartner JN, da Silva TF, Valencia E, Susser E. Measuring social integration in a pilot randomized controlled trial of critical time: intervention-task shifting in Latin America. Cad Saude Colet. 2012 Jan;20(4):10.1590/S1414-462X2012000400005. doi: 10.1590/S1414-462X2012000400005.

    PubMed 24288454
  • Yang L, Pratt C, Valencia E, Conover S, Fernandez R, Burrone MS, Cavalcanti MT, Lovisi G, Rojas G, Alvarado R, Galea S, Price LN, Susser E. RedeAmericas: building research capacity in young leaders for sustainable growth in community mental health services in Latin America. Glob Ment Health (Camb). 2017 Feb 14;4:e3. doi: 10.1017/gmh.2017.2. eCollection 2017.

    PubMed 28596904
  • Mascayano F, Alvarado R, Andrews HF, Jorquera MJ, Lovisi GM, Souza FM, Pratt C, Rojas G, Restrepo-Toro ME, Fader K, Gorroochurn P, Galea S, Dahl CM, Cintra J, Conover S, Burrone MS, Baumgartner JN, Rosenheck R, Schilling S, Sarucao KR, Stastny P, Tapia E, Cavalcanti MT, Valencia E, Yang LH, Susser E. Implementing the protocol of a pilot randomized controlled trial for the recovery-oriented intervention to people with psychoses in two Latin American cities. Cad Saude Publica. 2019 May 2;35(4):e00108018. doi: 10.1590/0102-311X00108018.

    PubMed 31066775
  • Mascayano F, Alvarado R, Andrews HF, Baumgartner JN, Burrone MS, Cintra J, Conover S, Dahl CM, Fader KM, Gorroochurn P, Galea S, Jorquera MJ, Lovisi GM, Mitkiewicz de Souza F, Pratt C, Restrepo-Toro ME, Rojas G, Rodrigues Sarucao K, Rosenheck R, Schilling S, Shriver T, Stastny P, Tapia E, Cavalcanti MT, Valencia E, Yang LH, Restrepo Henao A, Martinez-Ales G, Romero Pardo V, Gomez Alemany T, Susser E. A Recovery-Oriented Intervention for People With Psychosis: A Pilot Randomized Controlled Trial. Psychiatr Serv. 2022 Nov 1;73(11):1225-1231. doi: 10.1176/appi.ps.202000843. Epub 2022 Jun 9.

    PubMed 35678081

Questions about this trial

What is this clinical trial studying?

A study testing CTI-TS in people with Schizophrenia and Psychotic Disorder, run by Columbia University at 2 sites in 2 countries.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 6 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 25 Jun 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 2 sites in Brazil, Chile. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Camberwell Assessment of Need (CAN) (time frame: 18 months). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01995864, which also lists 12 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Jun 2020.

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CTI-TS RCT Clinical Trial NCT01995864 | AzTrials