The innovation integrates community outreach, screening, and evidence-based mental health interventions in a stepped-care fashion to improve efficiency. OSITA uses mixed methods (i.e. qualitative and quantitative) in two phases: 1) an initial qualitative phase, using mainly focus groups to gather vital information to refine the design of the intervention, and 2) a quantitative implementation phase that pilot tests the intervention.
Formative Phase: First Six Months
The first six months of the project were spent exploring and understanding the reality on the ground to better inform the development of the intervention. Activities during this phase included:
Conducting Focus Groups
At the start of the project, focus groups were conducted with three groups of participants: 10-15 IDWs, 10-15 IDP community leaders, and 10 healthcare providers representing the three stepped-care levels (community health workers, primary care personnel, mental health specialists).
Developing Intervention, Training, and Supervision Protocols
Local researchers and international experts initially drafted a preliminary version of the OSITA intervention, including training and supervision modules, followed by extensive discussions with local health authorities and community leaders.
Selection and Further Validation of Screening Questionnaires
Screening instruments were appropriately adapted for use in Colombia.
Developing Technology Support for Screening and Telemedicine Consultation
The technological platform was developed consisting of two components:
- A telemedicine system to provide support and supervision to healthcare staff delivering the intervention from experienced clinicians based at Universidad de Los Andes. Skype Premium is used to provide the support and supervision, particularly the group video calls feature and capacity to share documents. This is supplemented with a password protected database, stored at Universidad de Los Andes, for basic data on the person discussed in supervision and actions agreed upon. This database serves as a monitoring system as well as a reminder for the health workers.
- A smartphone or tablet to enter responses to questionnaires and obtain immediate scoring and corresponding advice as to what actions to take. Information captured by the device is uploaded to the central server when the health worker is in an area with internet access.
Developing vocational outreach/case management program
Till now, two IDWs have been hired and trained to serve as vocational outreach workers (VOWs) but also as mental health counselors. VOWs provide brief vocational skills assessment and review available vocational services, especially community income-generating projects and job training courses emanating from the Mayor’s office. VOWs also serve as mental health counselors which include the administration of the screening tests and the IPC intervention when needed.
Pilot Testing the Intervention Phase
This process started with the final preparations of the fieldwork including training all project personnel by the researchers. Currently, the preliminary model consists of:
Step 1: Recruitment of IDWs for the screening, basic psycho-education, and referral-as needed to the OSITA project team
Step 2: Further assessment and treatment for IDWs who screened moderate
Step 3: Psychiatrist-guided, treatment for the subsets of IDWs with a) severe CMD at screening, b) lack of response to treatment in primary care, or c) high suicide risk