A trial of two depression care quality improvement (QI) interventions in underresourced communities suggests that Community Engagement and Planning can be used as a model to include unlicensed case managers in QI efforts.
The Effects of Collaborative Care Training on Case Managers' Perceived Depression-Related Services Delivery
Published in: Psychiatric Services, 2016
Posted on RAND.org on September 29, 2016
- Which of two programs, Community Engagement and Planning (CEP) or Resources for Services (RS), was more effective in implementing a depression care quality improvement (QI) intervention among unlicensed case managers in underresourced communities?
OBJECTIVE: This study examined the effects of a depression care quality improvement (QI) intervention implemented by using Community Engagement and Planning (CEP), which supports collaboration across health and community-based agencies, or Resources for Services (RS), which provides technical assistance, on training participation and service delivery by primarily unlicensed, racially and ethnically diverse case managers in two low-income communities in Los Angeles. METHODS: The study was a cluster-randomized trial with program-level assignment to CEP or RS for implementation of a QI initiative for providing training for depression care. Staff with patient contact in 84 health and community-based programs that were eligible for the provider outcomes substudy were invited to participate in training and to complete baseline and one-year follow-up surveys; 117 case managers (N=59, RS; N=58, CEP) from 52 programs completed follow-up. Primary outcomes were time spent providing services in community settings and use of depression case management and problem-solving practices. Secondary outcomes were depression knowledge and attitudes and perceived system barriers. RESULTS: CEP case managers had greater participation in depression training, spent more time providing services in community settings, and used more problem-solving therapeutic approaches compared with RS case managers (p<.05). CONCLUSIONS: Training participation, time spent providing services in community settings, and use of problem-solving skills among primarily unlicensed, racially and ethnically diverse case managers were greater in programs that used CEP rather than RS to implement depression care QI, suggesting that CEP offers a model for including case managers in communitywide depression care improvement efforts.
- Case managers in CEP programs participated in training programs nearly three times more than case managers in RS programs.
- In comparison to those in RS programs, case managers in CEP programs spent more time delivering community services and were more likely to use therapeutic problem-solving skills for depression.
- CEP program participants were able to demonstrate greater knowledge of depression and reported fewer system barriers to care than RS participants, but the differences were small.
- No difference was found between the programs in the use of intervention case management tasks or case managers' attitude toward depression.
- The effects shown with the CEP program suggest that depression QI programs can improve care given by unlicensed case managers in underresourced communities.
Future research should examine ways to build and sustain capacity for depression services in underresourced communities, including policy mechanisms to help case managers gain certification, develop partnerships, and access funding.