BACKGROUNDDepression contributes to disability and there are ethnic/racial disparities in access and outcomes of care. Quality improvement (QI) programs for depression in primary care improve outcomes relative to usual care, but health, social and other community-based service sectors also support clients in under-resourced communities. Little is known about effects on client outcomes of strategies to implement depression QI across diverse sectors.OBJECTIVETo compare the effectiveness of Community Engagement and Planning (CEP) and Resources for Services (RS) to implement depression QI on clients’ mental health-related quality of life (HRQL) and services use.DESIGNMatched programs from health, social and other service sectors were randomized to community engagement and planning (promoting inter-agency collaboration) or resources for services (individual program technical assistance plus outreach) to implement depression QI toolkits in Hollywood-Metro and South Los Angeles.PARTICIPANTSFrom 93 randomized programs, 4,440 clients were screened and of 1,322 depressed by the 8-item Patient Health Questionnaire (PHQ-8) and providing contact information, 1,246 enrolled and 1,018 in 90 programs completed baseline or 6-month follow-up.MEASURESSelf-reported mental HRQL and probable depression (primary), physical activity, employment, homelessness risk factors (secondary) and services use.RESULTSCEP was more effective than RS at improving mental HRQL, increasing physical activity and reducing homelessness risk factors, rate of behavioral health hospitalization and medication visits among specialty care users (i.e. psychiatrists, mental health providers) while increasing depression visits among users of primary care/public health for depression and users of faith-based and park programs (each p < 0.05). Employment, use of antidepressants, and total contacts were not significantly affected (each p > 0.05).CONCLUSIONCommunity engagement to build a collaborative approach to implementing depression QI across diverse programs was more effective than resources for services for individual programs in improving mental HRQL, physical activity and homelessness risk factors, and shifted utilization away from hospitalizations and specialty medication visits toward primary care and other sectors, offering an expanded health-home model to address multiple disparities for depressed safety-net clients.Electronic supplementary materialThe online version of this article (doi:10.1007/s11606-013-2484-3) contains supplementary material, which is available to authorized users.

Context Although depression frequently co-occurs with substance abuse, few individuals entering substance abuse treatment have access to effective depression treatment. Objective The Building Recovery by Improving Goals, Habits and Thoughts (BRIGHT) study is a community-based effectiveness trial that compared residential substance abuse treatment to residential treatment plus group cognitive behavioral therapy (CBT) for depression delivered by substance abuse treatment counselors. The authors hypothesized that intervention clients would have improved depression and substance use outcomes as compared to clients receiving usual care. Design A nonrandomized controlled trial using a quasi-experimental intent-to-treat design in which four sites were assigned to alternate between the intervention and usual care conditions every four months over a two-and-a-half-year period. Setting Four treatment programs in Los Angeles County Participants 1,262 clients were screened for persistent depressive symptoms (Beck Depression Inventory-II (BDI-II) >17). 299 clients were assigned to receive either usual care (N=159) or usual care plus the intervention (N=140). Follow-up rates at three and six months after the baseline interview were 88.1% and 86.2% for usual care and 85.7% and 85.0% for the intervention group. Intervention Sixteen two-hour group sessions of CBT for depression Main Outcome Measures Change in depression symptoms, mental health functioning, and days of alcohol and substance use. Results BRIGHT clients reported significantly fewer depressive symptoms (p<0.001 at three and six months) and had improved mental health functioning (p<0.001 at three-months and p<0.01 at six months). At six months, BRIGHT clients reported fewer drinking days (p<0.05) and fewer days of problem substance use (p<0.05) on days available. Conclusions Providing group CBT for depression to clients with persistent depressive symptoms receiving residential substance abuse treatment is associated with improved depression and substance use outcomes. These results provide support for a new model of integrated care.

IMPORTANCE Auricular reconstruction is a unique blend of cosmesis and functionality. The choice of the optimal framework material to use is an important decision for the patient with microtia.OBJECTIVE To evaluate and compare the outcomes of reconstruction of microtia using porous polyethylene implants and rib cartilage grafts.

Background Depression collaborative care implementation using community engagement and planning (CEP) across programs compared to technical assistance to individual programs (Resources for Services, RS) in minority communities improves 6-month client outcomes. However, 12-month outcomes are unknown. Objective To compare effects of CEP and RS collaborative care implementation interventions on depressed clients’ mental health-related quality of life (MHRQL) and services use at 12-months. Design Matched health and community programs (n=93) in two communities randomized to CEP or RS. Measurements Self-reported client MHRQL, and services use at baseline, 6, and 12-months. Setting Los Angeles. Patients Adults (n=1018) with depressive symptoms (8-item Patient Health Questionnaire [PHQ-8]≥10); 85% ethnic minority. Interventions CEP and RS to implement depression collaborative care. Measurements Primary outcome: Poor MHRQL (12-item Mental Composite Score [MCS-12]≤40) at baseline, 6, and 12-months; Secondary outcomes: 12-months services use. Results At 6-months, the finding that CEP outperformed RS to reduce poor MHRQL was significant, but sensitive to underlying statistical assumptions. Similarly, at 12-months, some analyses suggested that CEP was advantageous on MHRQL, while other analyses did not confirm a significant difference favoring CEP. The finding that CEP reduced behavioral health hospitalizations at 6-months was not clear at 12-months with findings sensitive to underlying statistical assumptions. Other services use was not significantly different between interventions at 12-months. Limitations Self-reported data. Findings are sensitive to modeling assumptions. Conclusions In contrast to 6-month results, our findings did not show consistent CEP effects on reducing the likelihood of poor client MHRQL and behavioral health hospitalizations at 12-months. Still given under-resourced communities’ needs, CEP's favorable profile, and the absence of evidence-based alternatives, community engagement remains a viable strategy for policymakers and community to consider.

BACKGROUND:As medical homes are developing under health reform, little is known regarding depression services need and use by diverse safety-net populations in under-resourced communities. For chronic conditions like depression, primary care services may face new opportunities to partner with diverse community service providers, such as those in social service and substance abuse centers, to support a collaborative care model of treating depression. OBJECTIVE: To understand the distribution of need and current burden of services for depression in underresourced, diverse communities in Los Angeles. DESIGN: Baseline phase of a participatory trial to improve depression services with data from client screening and follow-up surveys. PARTICIPANTS: Of 4,440 clients screened from 93 programs (primary care, mental health, substance abuse, homeless, social and other community services) in 50 agencies, 1,322 were depressed according to an eight-item Patient Health Questionnaire (PHQ-8) and gave contact information; 1,246 enrolled and 981 completed surveys. Ninety-three programs, including 17 primary care/public health, 18 mental health, 20 substance abuse, ten homeless services, and 28 social/other community services, participated. MAIN MEASURES:Comparisons by setting in 6-month retrospective recall of depression services use. KEY RESULTS: Depression prevalence ranged from 51.9 % in mental health to 17.2 % in social-community programs. Depressed clients used two settings on average to receive depression services; 82 % used any setting. More clients preferred counseling over medication for depression treatment. CONCLUSIONS: Need for depression care was high, and a broad range of agencies provide depression care. Although most participants had contact with primary care, most depression services occurred outside of primary care settings, emphasizing the need to coordinate and support the quality of community-based services across diverse community settings.KEY WORDS: depression services; community-partnered; participatory research; CPPR; CBPR; community-based; under-resourced. J Gen Intern Med 28(10):1279-87 DOI: 10.1007/s11606-013-2480-7 © Society of General Internal Medicine 2013 BACKGROUND Current healthcare reforms call for expansions of primary care and integrated medical homes for safety-net populations. 1,2 Primary care is a "de facto" mental health setting, 3 where rates of recognition and treatment for depression are lower than in specialty mental health settings. 4 While collaborative care is effective for primary care depressed patients, [5][6][7] little is known about how to conceptualize depression management in neighborhoods with high rates of poverty and ethnic minority representation. 8 Neighborhood poverty is predictive of depression onset, 9 and while prevalence of depressive disorders is similar for Latinos and African Americans relative to non-Hispanic whites, 10,11 African Americans may have greater severity when depressed. 12 Ethnic and socioeconomic disparities in access to and quality of mental health...