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Barriers in access to care prevent many individuals from benefiting from mental health services. The purpose of the current project was to assess the effectiveness and utility of incorporating the Psychosocial Assessment Tool (PAT; Kazak et al., 2001) into standard evaluation procedures at a pediatric psychiatry clinic in a diverse urban setting. As a secondary objective, PAT results were used to develop case management interventions to address identified barriers with families during initial treatment sessions. Over 6 months, the PAT was administered to 87 families during their initial psychiatric evaluation appointment. Depending on their responses, families were stratified into three different risk levels and received case management intervention accordingly to address barriers. Treatment engagement (i.e., number of sessions attended in the first treatment quarter) was utilized as an outcome measure of the effectiveness of the intervention and was compared across an intervention group and a control sample. The majority of patients identified at least one barrier to engagement in mental health services, with the majority of families experiencing barriers related to caregiver mental health needs and a lack of resources (e.g., finances, unemployment, lack of child care). Initial outcome measures for families who completed the PAT and participated in intensive case management intervention indicate improved engagement in mental health services. The PAT is an easily implemented and evidence-based measure that facilitates assessment of potential barriers to treatment engagement. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Stigma is one of the main barriers for the full implementation of mental health services in low- and middle-income countries (LMICs). Recently, many initiatives to reduce stigma have been launched in these settings. Nevertheless, the extent to which these interventions are effective and culturally sensitive remains largely unknown. The present review addresses these two issues by conducting a comprehensive evaluation of interventions to reduce stigma toward mental illness that have been implemented in LMICs. We conducted a scoping review of scientific papers in the following databases: PubMed, Google Scholar, EBSCO, OVID, Embase, and SciELO. Keywords in English, Spanish, and Portuguese were included. Articles published from January 1990 to December 2017 were incorporated into this article. Overall, the studies were of low-to-medium methodological quality—most only included evaluations after intervention or short follow-up periods (1–3 months). The majority of programs focused on improving knowledge and attitudes through the education of healthcare professionals, community members, or consumers. Only 20% (5/25) of the interventions considered cultural values, meanings, and practices. This gap is discussed in the light of evidence from cultural studies conducted in both low and high income countries. Considering the methodological shortcomings and the absence of cultural adaptation, future efforts should consider better research designs, with longer follow-up periods, and more suitable strategies to incorporate relevant cultural features of each community.

This study examined clinician experiences and attitudes toward safety planning in a large urban pediatric psychiatry department serving primarily Latino youth. A total of 46 clinicians completed a survey assessing their experience with and attitudes toward safety planning with adolescents at-risk for suicide. The majority of clinicians were female (78%), non-Latino White (54%), and aged 30-39 (52%). Clinicians' attitudes were largely positive (M = 3.69 SD = 0.47, Range = 2.42-4.42). However, many clinicians (n = 24) were not convinced that safety planning reduces the imminent risk of suicidal behavior in patients. This study provides more depth to our understanding of the way in which safety planning is perceived by clinicians.

This study explores the beliefs and attitudes about the psychosocial mechanisms of peer support work among users who participated in Critical Time Intervention-Task Shifting (CTI-TS), which tested the acceptability and feasibility of a peer support work model to improve community-based mental health care for individuals with psychosis in Latin America. We conducted a secondary analysis of 15 in-depth interviews with CTI-TS participants in Chile, using the framework method and defined the framework domains based on five major mechanisms of peer support work identified by a recent literature review. The analysis revealed that users' perceptions of peer support work mechanisms were strongly shaped by personal motivations, beliefs about professional hierarchies, familial support, and the Chilean mental health system's incipient recovery orientation. The findings underscore the importance of adopting culturally tailored strategies to promote peer support work, such as involving mental health professionals and fostering equal-powered relationships between PSWs and users.

No study to date has examined the effectiveness of integrating clinical decision support tools, like electronic health record (EHR) alerts, into the clinical care of youth at-risk for suicide. This study aimed to examine the feasibility and acceptability of using an EHR alert to increase clinicians’ use of safety planning with youth at-risk for suicide in an outpatient pediatric psychiatry clinic serving an urban low-income Latino community. An alert intervention was developed to remind clinicians to complete a safety plan whenever they documented that their patient endorsed suicidal ideation, plan, or attempt during a visit in EHR notes. The alert appeared as a separate window containing a reminder message to complete a safety plan once a clinician finished visit documentation. There were 69 at-risk patients between the ages of 13–21 in the intervention period (M = 15.71; SD = 1.86; 66.7% female) and 64 (M = 15.38; SD = 1.93; 68.6% female) in the control period. Logistic regression analyses indicated that patients in the intervention period were significantly more likely than patients in the control period to receive a safety plan (p

Background: Latin America, and Chile in particular, has a rich tradition of community mental health services and programs. However, in vivo community-based psychosocial interventions, especially those with a recovery-oriented approach, remain scarce in the region. Between 2014 and 2015, a Critical Time Intervention-Task Shifting project (CTI-TS) was implemented in Santiago, Chile, as part of a larger pilot randomized control trial. CTI is a time-limited intervention delivered at a critical-time to users, is organized by phases, focuses on specific objectives and decreases in intensity over time. CTI-TS, which combines both the task-shifting strategy and the use of peers, introduces a novel approach to community mental health care that has not yet been tried in Chile. Aims: We aim to evaluate the feasibility, acceptability and applicability of such a community-based psychosocial intervention in urban settings in Latin America – specifically, in Santiago (Chile) from a user perspective. Method: We analyzed 15 in-depth interviews ( n = 15) with service users who participated in the intervention about their perceptions and experiences with CTI-TS through thematic analysis. Results: Three themes were revealed. The first was related to the structural characteristics of CTI-TS, especially regarding the timing, duration and phasic nature of the intervention. The second pertained to the acceptability of the in vivo community-based approach. The third theme dealt with the task-shifting aspect, that is, users’ perceptions of the peer support workers and the community mental health workers. Conclusions: CTI-TS was generally acceptable in this Latin American context. Users’ perspectives pointed to the need to make adjustments to some of the structural characteristics of the CTI model and to combine this type of intervention with others that can address stigma. Thus, future adaptations of CTI-TS or similar psychosocial interventions in Latin American contexts are feasible and can enhance community mental health in the region.

Background: Stigma towards severe mental illness manifests in different ways across cultures and only recently has a theoretical perspective emerged to understand such cultural differences. The ‘What Matters Most’ framework identifies culturally specific dimensions of stigma by identifying the interactions between cultural norms, roles, and values that impact personhood. Objective: This study explores the cultural underpinnings that create and maintain stigmatizing attitudes towards severe mental illness in Chile. Methods: In-depth interviews developed using the ‘Scale of Perceived Discrimination and Devaluation’, and the ‘What Matters Most’ framework were conducted with twenty people identified as having a severe mental illness. Interviews were coded and discussed until agreement was reached, then analyzed by an independent reviewer to determine inter-rater reliability. Results: A key factor shaping stigma among women was the loss of capacity to accomplish family roles (i.e. take care of children).or men, cultural notions of ‘Machismo’ prevented them from disclosing their psychiatric diagnosis as a means to maintain status and ability to work. A protective factor against stigma for men was their ability to guide and provide for the family, thus fulfilling responsibilities attributable to ‘Familismo’. Social appearances could play either a shaping or protecting role,contingent on the social status of the individual. Discussion: In Chilean culture, stigma is rooted in gendered social characteristics and shared familial roles. Interventions should aim to address these norms and incorporate culturally salient protective factors to reduce stigma experienced by individuals with serious mental illness in Chile and other Latin American settings. Resumen Antecedentes: Estigma hacia la enfermedad mental se manifiesta en diferentes formas dependiendo de la cultura, sin embargo solo recientemente se ha desarrollado una perspectiva teórica para entender dichas diferencias culturales. El abordaje de ‘what matter most’ es capaz de identificar dimensiones culturalmente específicas relativas al estigma por medio de la identificación y extracción de las normas culturales, roles y valores que impactan la identidad de las personas. Objetivo: El presente estudio explora los cimientos culturales que crean y mantienen las actitudes estigmatizantes hacia las enfermedades mentales en Chile. Métodos: Se desarrollaron 20 entrevistas en profundidad en personas con trastorno mental severo utilizando la ‘Escala de Discriminación y Devaluación Percibida’ y orientadas por el enfoque ‘What Matter Most’. Las entrevistas fueron codificadas y discutidas hasta alcanzar grados de acuerdo apropiados, cuestióndeterminada por un revisor independiente que calculó el grado de acuerdo inter-jueces. Resultados: Un aspecto clave para moldear la expresión del estigma entre mujeres fue la pérdida de la capacidad para cumplir con su rol de dueña de casa (i.e. cuidar de sus hijos), mientras en los hombres nociones culturales asociadas al ‘Machismo’ impidieron que ellos develaran sus respectivos diagnósticos psiquiátricos para mantener su estatus social y habilidad para trabajar. Por otra parte, un factor protector en contra del estigma en hombres fue mantener su habilidad para guiar y proveer a su familia, y así cumplir plenamente con las responsabilidades atribuidas al ‘Familismo’. Finalmente, las apariencias sociales pueden jugar tanto un rol moldeador o protector en contra del estigma, y esto parece ser contingente al estatus social del individuo. Discusión: Estigma se asocia a características sociales y roles familiares enraizadas en la cultura Chilena. Intervenciones deberían abordajes éstas dimensiones e incorporar aquellos factores protectores que son potenciales recursos para reducir el estigma hacia la enfermedades mentales en Chile y en otros contextos Latinoamericanos.