# The Implementation of Early Intervention Initiatives for Psychosis in Latin America and the Caribbean: A Case Study

## TL;DR

This study explores the challenges and strategies for implementing early psychosis intervention programs in Latin America and the Caribbean, highlighting cultural adaptations and resource limitations.

## Contribution

The paper provides new insights into implementing early psychosis interventions in low-resource settings by analyzing real-world initiatives and implementers' perspectives in Latin America and the Caribbean.

## Key findings

- EIP initiatives in LAC face challenges like resource shortages and cultural adaptation difficulties.
- Participants emphasized the importance of task-shifting and leveraging existing services for sustainability.
- Most initiatives struggled with sustainment due to reliance on international funding and limited policy support.

## Abstract

Psychosis is a serious mental illness, with onset in adolescence and young adulthood. Few early intervention for psychosis (EIP) programs exist in the Global South, where most of the world’s youth live. Addressing this gap requires understanding implementation contexts, pathways, and challenges. This study examines EIP initiatives in Latin America and the Caribbean (LAC) and explores implementers’ perspectives on scaling them. A single-case study design was employed. Guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, we conducted semi-structured interviews with EIP implementers across LAC and gathered policy documents. Data was coded and analyzed using thematic analysis. Twenty-five participants from 10 countries described 26 initiatives, including clinical and research programs, guidelines, and a technical standard. Themes were mapped onto the EPIS framework. In Exploration, participants highlighted key motivators, the influence of collaborations with foreign researchers, contextual adversity (e.g., poverty, stigma), and the role of Indigenous cosmologies and religious traditions in shaping care pathways. In Preparation, they emphasized difficulties in culturally adapting models from high-income countries (HICs), limited staff awareness, and resource shortages. In Implementation, participants described how initiatives operated in local contexts (e.g., research programs offering care to address unmet needs), how they were generally well received by patients and staff, and the shortage of psychosocial interventions. In sustainment, few initiatives persisted; participants pointed to dependence on international funding, limited policy support, capacity, and awareness. While EIP was valued, national dissemination of HIC-based programs was considered unfeasible. EIP development in LAC has occurred amid structural and resource limitations affecting many LMICs. Implementers’ proposals—task-shifting; simplified care packages; leveraging extant services; and enhancing early psychosis literacy— represent feasible strategies to support EIP across LAC. Recommendations for future research, including the involvement of service users and their families and the adaptation of implementation frameworks to context, are shared.