Depression is a leading cause of disability, as it affects patients' ability to function similar to that of major conditions such as a heart disease. Depression often goes undiagnosed and untreated, especially in persons from under-resourced communities of color. Most depressed patients can be successfully treated with antidepressant medication or psychotherapy. Quality improvement programs in primary care help to improve recognition and treatment of depression and outcomes, including for minority patients and adolescents as well as adults.
But under-resourced communities of color have limited access to such programs. To determine how to better serve these communities, RAND and UCLA investigators collaborated with partners over the last decade to apply an engagement model developed by Healthy African American Families (PDF). That partnership led to Community Partners in Care, a research study co-led by RAND, UCLA and 25 community-based organizations in Los Angeles including Healthy African American Families II, QueensCare Health and Faith Partnership, and Behavioral Health Services. The project was funded by the National Institute of Mental Health, the Robert Wood Johnson Foundation, and the California Community Foundation.
Community Partners in Care examines whether a community engagement and planning model that brings agencies together to address depression as a network is more effective than time-limited expert technical assistance coupled with outreach, where both models promote the use of toolkits proven to improve depression outcomes in prior studies.
In designing the study, community members recommended that in addition to healthcare programs, the study include homeless-serving, prisoner re-entry, family preservation, and faith-based programs, barber shops, exercise clubs, and senior centers. We selected 95 programs/locations in South Los Angeles and Hollywood-Metropolitan Los Angeles at which to test the interventions. In the technical assistance approach, individual programs were invited to attend webinars on quality improvement toolkits and had access to toolkits online. In the community engagement model, programs were also invited to bi-weekly meetings for 4 months to plan trainings and collaborate to implement the toolkits. Depressed clients were identified by screening that took place in each program and were surveyed at 6 and 12 months.
Depressed clients improved under both interventions, but the community engagement and planning approach was more effective in improving clients' mental health, quality of life and physical activity and reducing homelessness risk factors and behavioral health hospitalizations. In addition, the community engagement and planning approach shifted outpatient depression services away from specialty medication visits towards primary care, faith-based and senior center programs. But level of depressive symptoms and use of treatments for depression were similar across conditions.
The community engagement intervention may have improved outcomes by shifting therapeutic tasks to staff in alternative settings, or helping staff to provide social services to depressed clients who can be difficult to engage. The community engagement and planning approach brought a new capacity to the community to improve outcomes for depressed clients that the community itself helped to create.
Kenneth Wells, M.D., M.P.H. is an adjunct natural scientist at the nonprofit, nonpartisan RAND Corporation and the David Weil Professor of Psychiatry and Biobehavioral Sciences and Director of the Center for Health Services and Society at UCLA's Semel Institute; Loretta Jones, M.A. is the CEO of Healthy African American Families, II.