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Engaging the Community to Improve Outcomes

Engaging the Community to Improve Outcomes University of California-Los Angeles
South Los Angeles and Hollywood
Depression
African American, Latino, Underserved communities

Project

A community engagement approach is used to improve depression management skills and adoption of evidence-based depression quality improvement programs.

This project is based on a community-partnered participatory research design: community partners are considered equal partners with the academic staff members and are involved in every stage of the design and implementation of the intervention. The staff at lead community agencies are involved in grant-writing; identification and recruitment of other agencies, administrators and providers; and organizing and carrying out pre-implementation kick-off activities.

During implementation, communityagency representatives participate in biweekly planning meetings and the entire leadership team is involved in setting the agenda for subsequent meetings. The project leadership team includes a diverse set of community agencies including mental health agencies, faith-based organizations, social service agencies and substance-abuse agencies. Project participants include licensed mental health professionals and lay community health workers or agency administrators. Community members are invited to participate and co-lead several committees. Invitation to committees is based on expertise and interest.


Rationale

Many patients with depression do not receive mental health care. Those who do often receive their care through primary care, but primary care clinicians often do not detect depression and many patients do not receive evidence-based treatments.

Delivering evidence-based care for depression is challenging, particularly among the poor and ethnic minorities, due to organizational and financing factors like limited psychotherapy coverage or diversity in third-party management of services; clinical features of depression like social withdrawal; societal factors like social stigma; and clinician factors like limited knowledge or experience.

This community engagement approach hopes to increase agency and provider use of evidence-based depression treatment programs across the network, thereby increasing patient access to appropriate care, satisfaction with services, and health outcomes.

Community engagement promotes organizational and community member participation and leadership in goal setting, program development, implementation and evaluation by shifting the authority for action to the community. This intervention promotes community commitment and leadership to form a network committed to evidence-based, quality improvement.


Summary Results

Depression toolkits and provider resources developed using community engagement were significantly more effective than standard resources at improving mental health-related quality of life; increasing physical activity and depression care visits; and reducing risk factors for homelessness, hospitalizations for behavioral health conditions, and medication visits among mental health specialty users. However, there was no improvement in the rate that organizations used standard depression management techniques.


Publications

Participation in Training for Depression Care Quality Improvement: A Randomized Trial of Community Engagement or Technical Support
Psychiatric Services. 2015 May 1:appips201400099.
Full Article (subscription may be required)

Comorbid Depression and Substance Abuse Among Safety-net Clients in Los Angeles: A Community Participatory Study
Psychiatric Services. 2015 Mar 1;66(3):285-94. Published online 2014 Dec 1.
Full Article (subscription may be required)

12-Month Outcomes of Community Engagement Versus Technical Asistance to Implement Depression Collaborative Care: A Partnered, Cluster, Randomized, Comparative Effectiveness Trial
Annals of Internal Medicine. 2014;161(10 Suppl):S23-34.
Full Article

Community-Partnered Evaluation of Depression Services for Clients of Community-Based Agencies in Under-Resourced Communities in Los Angeles
Journal of General Internal Medicine. 2013;28(10):1279–1287. Published online 2013 May 14.
Full Article 

Community-Partnered Cluster-Randomized Comparative Effectiveness Trial of Community Engagement and Planning or Resources for Services to Address Depression Disparities
Journal of General Internal Medicine. 2013;28(10):1268-1278. Published online 2013 May 7.
Full Article 

Partnered Evaluation of a Community Engagement Intervention: Use of a “Kickoff” Conference in a Randomized Trial for Depression Care Improvement in Underserved Communities
Ethnicity & Disease. 
2011 Summer;21(3 0 1): S1–78-88.
Full Article 

Community Partners in Care: Leveraging Community Diversity to Improve Depression Care for Underserved Populations
International Journal of Diversity in Organisations, Communities and Nations. 2009;9(2):167–182. 
Full Article 


Additional Resources

Principal Investigator

  • Michael Ong, MD