Community-Partnered Evaluation of Depression Services for Clients of Community-Based Agencies in Under-Resourced Communities in Los Angeles

Abstract

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...

The Healthy Community Neighborhood Initiative: Rationale and Design

“…[20][21][22][23][24] Community-partnered participatory research (CPPR) refers to partnering with communities to conduct research 25,26 that facilitates knowledge-sharing between community and academic partners; incorporates community priorities into all phases of research; and builds community and academic capacity for conducting partnered research. [26][27][28] Although community-engaged approaches show promise for improving population health and reducing disparities, there is only limited evidence on the impact and sustainability of these efforts.…”

“…[26][27][28] Although community-engaged approaches show promise for improving population health and reducing disparities, there is only limited evidence on the impact and sustainability of these efforts. 20,22,23,29,30 We present the rationale and design of the Healthy Community Neighborhood Initiative (HCNI), a CPPR project designed to address health disparities in a low-income bi-ethnic community in South Los Angeles (LA). The HCNI employs shared community and academic responsibility and authority to guide the selection, design, implementation, evaluation, and dissemination of efforts to intervene on local health inequalities ( Figure 1).…”

Community Partners in Care: 6-Month Outcomes of Two Quality Improvement Depression Care Interventions in Male Participants

“…Details on study design, baseline information, six-month and 12-month follow-up results for the overall cohort are described elsewhere. [28][29][30] The two implementation approaches used were Resources for Services (RS) and Community Engagement and Planning (CEP). Both supported implementation of evidence-based depression toolkits from prior studies and adapted for use in health care and communitybased settings.…”

The Los Angeles Healthy Community Neighborhood Initiative: A Ten Year Experience in Building and Sustaining a Successful Community-Academic Partnership

“…This decreased the time required to build trust and familiarity in a CAP. Moreover, the community partners have spearheaded or collaborated on nationally recognized work on the theory and practice of CBPR/CPPR [6,[8][9][10][27][28][29][30]. Despite these prior activities, sustaining the work going forward is always challenging.…”