Recovery and Inclusion through Supported Employment for People Experiencing Psychosis in Low Resource Settings (RISE)

About This Grant

This application proposes extensive community engagement activities to adapt and pilot test an evidence-based intervention to improve employment outcomes for young adults experiencing early psychosis in Uganda called Individual Placement and Support (IPS). Psychosis usually starts during adolescence and young adulthood, a critical developmental period, and, despite its relatively low prevalence, accounts for a disproportionate number of global disability and level of caregiver burden. People with severe mental disorders, including psychosis, are seven times more likely to be unemployed than those without a disorder. While treatment for acute episodes is important, post-acute interventions are crucial for long term recovery and improved clinical and functional outcomes. Our research has demonstrated that Ugandan youth experiencing psychosis are eager to work and complete their education, yet there are no placement or support services like IPS available to them. Because IPS has never been systematically implemented in a low- and middle-income country (LMIC) in Africa, we anticipate that adaptations will be necessary to fit the local cultural, economic, and social context. Thus, we propose a systematic process of community engagement to adapt and pilot test IPS in the newly established early psychosis services in Kampala. Aim 1. We will engage with the community to identify barriers to and facilitators of IPS implementation in Uganda. We will conduct 45 qualitative interviews and focus group discussions with young people diagnosed with early psychosis and their relatives, potential employers, local alternative healers, mental health providers, and policymakers. Aim 2. Using Aim 1 findings, we will adapt IPS to the local context by conducting a multi-day workshop with 15 key stakeholders, featuring IPS demonstrations followed by surveys and group discussions. Based on this, an adapted IPS-Uganda draft will be developed and iteratively reviewed. After integrating all feedback, we will finalize the IPS manual and create a training scheme for personnel delivering the intervention during the trial. Aim 3. We will evaluate the potential methodology for a randomized controlled trial (RCT) and pilot test the adapted IPS intervention among 60 Ugandan patients experiencing early psychosis. We will conduct a pilot RCT to examine the feasibility, costs and acceptability of IPS. Participants will be randomized to receive IPS or treatment as usual. The follow-up period will be twelve months. This proposal is a collaboration between teams in Uganda and New York to address the pressing need to increase access to post-acute evidence-based recovery-oriented interventions that improve the lives people experiencing psychosis in LMICs. This project will lay the foundation for a larger trial in the future.