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Evaluation of the Connections to Care (C2C) Initiative

Interim Report

by Lynsay Ayer, Michael Stephen Dunbar, Monique Martineau, Clare Stevens, Dana Schultz, Wing Yi Chan, Michele Abbott, Rebecca Weir, Harry H. Liu, Daniel Siconolfi, Vivian L. Towe

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Research Questions

  1. How were the C2C program strategies implemented?
  2. How did mental health providers (MHPs) train and support CBOs over time?
  3. To what extent did CBOs identify clients with mental health or substance use and misuse issues as a result of C2C implementation?
  4. What are the key facilitators of and barriers to effective implementation of C2C program strategies within and across CBO and MHP partnerships?

At least one in five adult New Yorkers is likely to meet the criteria for a mental health diagnosis, yet most do not receive mental health services to treat these problems. Mental health problems, such as depression and anxiety, disproportionately affect historically underserved segments of the population, such as racial/ethnic minority and low-income individuals, and these groups are least likely to receive mental health services. The Connections to Care (C2C) Collaborative developed the C2C program, which integrates mental health support into the work of nonclinical community-based organizations (CBOs) through task shifting; task shifting is an approach extending evidence-informed health care skills to community-based partners under the oversight of trained professionals to expand the health care workforce. This report uses data from interviews, surveys, and CBO-provided progress indicators to describe how C2C has been implemented within and across the 15 CBOs. This report also describes study methods and a description of the baseline sample for the impact evaluation at the time of writing.

Key Findings

CBO-MHP relationships

  • CBOs and MHPs overcame initial cultural and communication challenges to develop working relationships.
  • MHP presence on-site at CBOs and familiarity-building activities strengthened relationships.

Training

  • More than 1,200 staff and supervisors trained in at least one core C2C skill; almost 250 trained in all four core skills.
  • MHPs delivered the bulk of training, especially in year 1.
  • More than two-thirds of staff were satisfied with training and wanted more.

Coaching and supervision

  • Most of the 2,110 coaching hours were logged in year 2.
  • About half of survey respondents received coaching or supervision once or twice; 20 percent never received coaching or supervision; and 6 percent received coaching or supervision more than ten times.

Staff readiness

  • About half of CBO staff reported high confidence in using a given mental health skill.
  • About one year in, trained individuals felt most comfortable delivering mental health first aid and motivational interviewing.
  • Around 75-80 percent of CBO staff felt they had the resources and support to deliver C2C skills and to refer clients to intensive treatment when needed.

C2C delivery

  • Core C2C skills had been delivered to 16,701 unique clients as of March 2018.
  • CBO staff members had delivered services to 70 percent of clients by year 2.
  • As of March 2018, CBOs had referred over 2,000 clients for mental health treatment; 60 percent of referrals resulted in at least one visit to an MHP.

Early perceptions of impact

  • Staff and leadership perceive that C2C has a positive effect on clients' mental health issues.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Evaluation Methods

  • Chapter Three

    Interim Implementation Evaluation Findings

  • Chapter Four

    Interim Impact Evaluation Progress and Baseline Descriptive Data

  • Chapter Five

    Summary of Interim Report

  • Appendix A

    Methods and Measures

Research conducted by

This research was sponsored by the Mayor's Fund to Advance New York City and conducted by the Access and Delivery Program within RAND Health Care.

This report is part of the RAND Corporation research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.