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 under-resourced, 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.

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Acknowledgements

We thank the 25 participating agencies of the Council and their representatives: QueensCare Health and Faith Partnership; COPE Health Solutions; UCLA Center for Health Services and Society; Cal State University Dominquez Hills; RAND; Healthy African American Families II; Los Angeles Urban League; Los Angeles Christian Health Centers; Los Angeles County Department of Mental Health and West Central Mental Health Center; Homeless Outreach Program/Integrated Care System; National Alliance on Mental Illness (NAMI) Urban Los Angeles; Behavioral Health Services, Inc.; Avalon Carver Community Center; USC Keck School of Medicine Department of Psychiatry and Behavioral Sciences; Kaiser Watts Counseling and Learning Center; People Assisting the Homeless; Children’s Bureau; Saban Free Clinic; New Vision Church of Jesus Christ; Jewish Family Services of Los Angeles; St. John’s Well Child and Family Center; Charles Drew University of Medicine and Science; City of Los Angeles Department of Recreation and Parks; To Help Everyone Clinic; QueensCare Family Clinics and the National Institute of Mental Health (funder). We thank the participating Los Angeles programs, their providers and staff, and the clients who participated. We thank the RAND Survey Research Group and trained community members who conducted client data collection. We also thank Robert Brook and Jurgen Unutzer for helpful comments on earlier drafts.

Funding/Support

Community Partners in Care was funded by Award Numbers R01MENTAL HEALTH078853, P30MENTAL HEALTH082760, and P30MENTAL HEALTH068639 from the National Institute of Mental Health, and the Robert Wood Johnson Foundation (64244). The content is the responsibility of the authors and does not necessarily represent the views of the funders.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Correspondence to Jeanne Miranda PhD.

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Miranda, J., Ong, M.K., Jones, L. et al. Community-Partnered Evaluation of Depression Services for Clients of Community-Based Agencies in Under-Resourced Communities in Los Angeles. J GEN INTERN MED 28, 1279–1287 (2013). https://doi.org/10.1007/s11606-013-2480-7

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KEY WORDS

  • depression services
  • community-partnered
  • participatory research
  • CPPR
  • CBPR
  • community-based
  • under-resourced