Craig M Landry1, Aurora P Jackson1, Lingqi Tang1, Jeanne Miranda1, Bowen Chung1, Felica Jones1, Michael K Ong1, Kenneth Wells1. 1. Dr. Landry is with the Center for Health Services and Society, University of California, Los Angeles (UCLA), Los Angeles (e-mail: cmlandry@ucla.edu ). Dr. Jackson is with the Department of Social Welfare, Luskin School of Public Affairs, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, Dr. Chung, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles. Dr. Tang, Dr. Miranda, and Dr. Chung are also with the Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, and Dr. Wells is also with the RAND Corporation, Santa Monica, California. Ms. Jones is with Healthy African American Families II, Los Angeles. Dr. Ong is with the Department of Medicine, David Geffen School of Medicine, UCLA, and the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles.
Abstract
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.
RCT Entities:
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.
Entities:
Keywords:
Case management; Community Engagement; Depression; Disparities; Quality Improvement; Staff training
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