Community Partners in Care (CPIC)
Project type: |
Research Project
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Objectives: |
To compare the effectiveness of diverse safety net providers working together to implement depression Quality Improvement (QI) for quality of life and services use |
Brief description: |
A participatory network approach, and a technical assistance approach, to implement quality improvement (QI) on clients’ mental health-related quality of life (HRQL) and services use. |
Project status: |
Ongoing
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Social: |
Summary
Innovation summary
Depression is a common chronic condition—second to hypertension—and is estimated to be the leading cause of morbidity and disability worldwide. It is common across all age and cultural groups; but, under-resourced communities, especially communities of color, have less access to care and evidence-based treatments.
Community Partners in Care (CPIC) compared the effectiveness of diverse safety net providers working together using a participatory network approach, and a technical assistance approach, to implement quality improvement (QI) for clients’ mental health-related quality of life (HRQL) and services use.
Impact summary
- 4,440 clients screened; 1,322 clients identified as depressed
- Improved quality of life, increased physical activity and reduced homelessness risk factors, rate of behavioral health hospitalization and medication visits among specialty care users in clients part of the intervention arm of the trial
“Working with academia has increased my awareness of what researchers do. They are getting an understanding of what is important to patients, and collaborating with them has increased my trust in them.
- Patient partner
Innovation
Innovation details
Through CPIC, diverse safety net providers working together to a technical assistance model were compared through a rigorous randomized trial involving over 1000 depressed clients drawn from 93 healthcare and community-based programs. The clients were primarily African American and Latino, the majority met federal poverty criteria and had multiple chronic medical conditions, nearly half were uninsured and at high risk for being homeless and many had substance abuse problems.
The diverse safety net providers working together model
A model to bring together agency leaders and community members from diverse sectors of the community including mental health, primary care, public health, substance abuse, homeless-serving, other social services, and “trusted locations” like faith-based programs, community centers and hair salons. This collaboration is supported through 4 months of planning to review evidence-based approaches to improve depression services and outcomes, fit those programs to their agencies and community and create a network across agencies to provide more comprehensive support. The key feature of the approach is community engagement, with equal power sharing and authority in the planning process, to develop an evidence-based toolkit for depression. The planning is followed by training as directed and supervised by the community planning group, comprising strong community leaders and clinical experts.
The technical assistance model
A model focused primarily on healthcare sectors alone, using the same evidence-based toolkits to improve depression services and outcomes. The implementation is based on a technical assistance model, such as would be provided by a disease management consulting firm.
Key drivers
- Strong engagement of community stakeholders
Challenges
- Actual depression intervention was not always conducted
Continuation
Based on this study, LA County has developed a Healthy Neighborhoods initiative that is implementing the community engagement model to improve mental health across diverse neighborhoods.
Partners
- Behavioral Health Services, Inc.
- Charles Drew University
- City of Los Angeles Department of Recreation and Parks
- Healthy African American Families
- Los Angeles Christian Health Centers
- Los Angeles County Department of Mental Health
- Los Angeles Urban League
- National Alliance on Mental Illness (NAMI) Urban Los Angeles
- QueensCare Family Clinics
- QueensCare Health and Faith Partnership
- RAND Health
- T.H.E Clinic
- UCLA Center for Community Partnerships
- UCLA-Semel Institute Health Services Research Center
- University of Southern California (USC)
Funders
- National Institute of Mental Health (R01 MH 078853, P30MH082760, and P30MH068639)
- Robert Wood Johnson Foundation (64244)
- Patient Centered Outcomes Research Institute (PCORI 1845)
- National Institute of Health NIH UL1TR000124
- National Institue of Minority Health and Health Disparities (RO1 MD007721)
Impact
Evaluation methods
Community-partnered cluster- randomized comparative effectiveness trial assessing outcomes at baseline, 6-month, 12-month and 3-year follow up.
Impact details
From 93 randomized programs, 4,440 clients were screened and 1,322 clients were identified as depressed by the 8-item Patient Health Questionnaire (PHQ-8). 1,246 clients enrolled and 1,018 clients completed baseline or 6-month follow-up.
Results showed that diverse safety net providers working together was more effective than technical assistance at improving mental health-related quality of life (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).
In contrast to 6-month results, the findings did not show consistent effects on safety net providers working together to reduce the likelihood of poor client MHRQL and behavioral health hospitalizations at 12-months. Still given under-resourced communities’ needs, diverse safety net providers working together favorable profile, and the absence of evidence-based alternatives, community engagement remains a viable strategy for policymakers and community to consider.
Analysis of 3-year follow up findings is still under way.
References
Research
- Community-partnered cluster- randomized comparative effectiveness trial of community engagement and planning or resources [...]
- Community-partnered evaluation of depression services for clients of community-based agencies in underresourced communities[...]
- 12-month outcomes of community engagement versus technical assistance to implement depression collaborative care
- Community coalition-driven interventions to reduce health disparities among racial and ethnic minority populations