Community Partners in Care is a Research Project Funded by the National Institutes of Health
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Depression |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 4/21/2016 |
| Start Date: | January 2009 |
| End Date: | June 2016 |
CPIC is a Community Partnered Participatory Research (CPPR) Project of Community and Academic Partners Working Together to Learn the Best Way to Reduce Depression in Our Communities.
CPIC is a community initiative and research study funded by the NIH. CPIC was developed and
is being run by community and academic partners in Los Angeles underserved communities of
color. CPIC compares two ways of supporting diverse health and social programs in
under-resourced communities to improve their services to depressed clients. One approach is
time-limited expert technical assistance coupled with culturally-competent community
outreach to individual programs, on how to use quality improvement toolkits for depression
that have already been proven to be effective or helpful in primary care settings, but
adapted for this study for use in diverse community-based programs in underserved
communities. The other approach brings different types of agencies and members in a
community together in a 4 to 6-month planning process, to fit the same depression quality
improvement programs to the needs and strengths of the community and to develop a network of
programs serving the community to support clients with depression together. The study is
designed to determine the added value of community engagement and planning over and above
what might be offered through a community-oriented, disease management company. Both
intervention models are based on the same quality improvement toolkits that support team
leadership, care management, Cognitive Behavioral Therapy, medication management, and
patient education and activation. Investigators hypothesized that the community engagement
approach would increase agency and clinician participation in evidence-based trainings and
improve client mental health-related quality of life. In addition, during the design phase,
community participants prioritized adding as outcomes indicators of social determinants of
mental health, including physical functioning, risk factors for homelessness and employment.
Investigators hypothesized by activating community agencies that can address health and
social services needs to engage depressed clients, these outcomes would also be improved
more in the collaboration condition. Investigators also hypothesized that the collaboration
approach would increase use of services.
is being run by community and academic partners in Los Angeles underserved communities of
color. CPIC compares two ways of supporting diverse health and social programs in
under-resourced communities to improve their services to depressed clients. One approach is
time-limited expert technical assistance coupled with culturally-competent community
outreach to individual programs, on how to use quality improvement toolkits for depression
that have already been proven to be effective or helpful in primary care settings, but
adapted for this study for use in diverse community-based programs in underserved
communities. The other approach brings different types of agencies and members in a
community together in a 4 to 6-month planning process, to fit the same depression quality
improvement programs to the needs and strengths of the community and to develop a network of
programs serving the community to support clients with depression together. The study is
designed to determine the added value of community engagement and planning over and above
what might be offered through a community-oriented, disease management company. Both
intervention models are based on the same quality improvement toolkits that support team
leadership, care management, Cognitive Behavioral Therapy, medication management, and
patient education and activation. Investigators hypothesized that the community engagement
approach would increase agency and clinician participation in evidence-based trainings and
improve client mental health-related quality of life. In addition, during the design phase,
community participants prioritized adding as outcomes indicators of social determinants of
mental health, including physical functioning, risk factors for homelessness and employment.
Investigators hypothesized by activating community agencies that can address health and
social services needs to engage depressed clients, these outcomes would also be improved
more in the collaboration condition. Investigators also hypothesized that the collaboration
approach would increase use of services.
Underserved communities of color in low income, largely ethnic-minority neighborhoods face
an excessive burden of illness from depression due to higher prevalence of depression and
lower access to quality care. Evidence-based quality improvement (QI) programs for
depression in primary care settings—where many low-income and minority patients receive
their only mental health care—can enhance quality of depression care and improve health
outcomes. These programs are under-utilized in community-based health care settings, and
have not been adapted for use across diverse agencies (social service, faith based, primary
and specialty care) that could partner to support disease management for depression.
Partners in Care (PIC)and WE Care are interventions designed to improve access to
evidence-based depression treatments (medication management or psychotherapy) for primary
care patients and, in WE Care, social service clients. PIC evaluated a services delivery
intervention while WE Care was an effectiveness trial with study-provided treatments. Both
studies promoted use of the same evidence-based treatments. Both PIC and WE Care programs
improved use of evidence-based treatments for depression and health outcomes for African
Americans and Latinos. The PIC interventions reduced health outcome disparities evident in
usual care in the first follow-up year and at five-year follow-up. While these findings
offer hope to underserved communities, such communities have poor resources to support
implementation of these programs, and may have historical distrust in research and health
care settings. There is no evidence-based approach to support agency networks in underserved
communities in implementing QI programs for depression. To address this information gap,
investigators created Community Partners in Care (CPIC), a group-level randomized,
controlled trial, with randomization at the level of an agency site or "unit." The trial is
being fielded in two underserved communities, Hollywood and South Los Angeles, and conducted
through a community- participatory, partnered research (CPPR) approach.
The specific aims of the study are:
1. To engage two underserved communities in improving safety-net care for depression.
2. To examine the effects of a community-engagement approach to implementing
evidence-based depression quality improvement toolkits (PIC/WE Care) through a
community collaborative network across services sectors, compared to technical
assistance to individual programs from the same services sectors coupled with
culturally-competent outreach to implement the same toolkits. The outcomes are: a)
client access to care, quality of care and health outcomes, with the primary outcome
being mental-health related quality of life and additional outcomes reflecting social
determinants of mental health of interest to the community (physical health,
homelessness risk factors, employment); b) services utilization and costs; c) agency
adoption of PIC/WE Care; d) and provider attitudes, knowledge and practice.
3. To describe the process of implementation of the community engagement intervention.
CPIC was awarded funds from the Patient Centered Outcomes Research Institute (PCORI) in 2013
to accomplish the following 3 aims:
1. To compare the long-term (3-year) effectiveness of community engagement and planning
versus agency technical assistance to implement depression QI and improve depressed
clients' health status and risk for homelessness
2. To determine how depressed clients in under-resourced communities prioritize diverse
health and social outcomes and identify their preferences for services to address
priority outcomes
3. To identify capacities of providers to respond to depressed clients' priorities and to
generate recommendations for building capacity to better address clients'priorities.
We hypothesize that community engagement and planning will be more effective than technical
assistance in improving 3-year outcomes and that clients will prioritize quality of life. We
expect to find gaps in provider capacities to address client priorities that network
strategies could address.
Our primary outcome for the long-term follow-up is mental health related quality of life and
secondary outcomes are use of healthcare and community services for depression and physical
functioning and homeless risk factors.
In 2014, CPIC was awarded funds from the National Institute on Minority Health and Health
Disparities (NIMHD) to use existing quantitative CPIC data and collect new qualitative data
to describe pathways to reducing disparities. The funding allows us to longitudinally track
the implementation of the CEP model in a new county-wide initiative to develop community
networks to promote healthy neighborhoods. The aims under this additional funding are:
1. To determine pathways to reducing mental health and social disparities by conducting
community-academic partnered analyses of CPIC data by 1) examining intervention effects
for disparity subgroups (African Americans, Latinos, gender groups, insurance and
housing status groups); 2) identifying predictors and mediators of barriers to
access/services and client outcomes; 3) analyzing intervention effects on provider
workforce diversity; and 4) generating explanatory models for intervention effects and
their sustainability by interviewing CPIC administrators and providers, as well as
prior and current clients.
2. To explore the generalizability and replicability of the CPIC partnered model and, more
broadly, to inform the process of incorporating science into policy by conducting a
longitudinal case study of the CEP model implementation in a county-wide "neighborhood
health" initiative in Los Angeles to reduce mental health and social disparities.
As a result of this study, we will be able to explain how community-engaged and
participatory models of intervention implementation can reduce health and social disparities
and ultimately achieve public health impact. Study findings will be disseminated widely
using traditional academic, community-valued, and policy-relevant dissemination channels.
an excessive burden of illness from depression due to higher prevalence of depression and
lower access to quality care. Evidence-based quality improvement (QI) programs for
depression in primary care settings—where many low-income and minority patients receive
their only mental health care—can enhance quality of depression care and improve health
outcomes. These programs are under-utilized in community-based health care settings, and
have not been adapted for use across diverse agencies (social service, faith based, primary
and specialty care) that could partner to support disease management for depression.
Partners in Care (PIC)and WE Care are interventions designed to improve access to
evidence-based depression treatments (medication management or psychotherapy) for primary
care patients and, in WE Care, social service clients. PIC evaluated a services delivery
intervention while WE Care was an effectiveness trial with study-provided treatments. Both
studies promoted use of the same evidence-based treatments. Both PIC and WE Care programs
improved use of evidence-based treatments for depression and health outcomes for African
Americans and Latinos. The PIC interventions reduced health outcome disparities evident in
usual care in the first follow-up year and at five-year follow-up. While these findings
offer hope to underserved communities, such communities have poor resources to support
implementation of these programs, and may have historical distrust in research and health
care settings. There is no evidence-based approach to support agency networks in underserved
communities in implementing QI programs for depression. To address this information gap,
investigators created Community Partners in Care (CPIC), a group-level randomized,
controlled trial, with randomization at the level of an agency site or "unit." The trial is
being fielded in two underserved communities, Hollywood and South Los Angeles, and conducted
through a community- participatory, partnered research (CPPR) approach.
The specific aims of the study are:
1. To engage two underserved communities in improving safety-net care for depression.
2. To examine the effects of a community-engagement approach to implementing
evidence-based depression quality improvement toolkits (PIC/WE Care) through a
community collaborative network across services sectors, compared to technical
assistance to individual programs from the same services sectors coupled with
culturally-competent outreach to implement the same toolkits. The outcomes are: a)
client access to care, quality of care and health outcomes, with the primary outcome
being mental-health related quality of life and additional outcomes reflecting social
determinants of mental health of interest to the community (physical health,
homelessness risk factors, employment); b) services utilization and costs; c) agency
adoption of PIC/WE Care; d) and provider attitudes, knowledge and practice.
3. To describe the process of implementation of the community engagement intervention.
CPIC was awarded funds from the Patient Centered Outcomes Research Institute (PCORI) in 2013
to accomplish the following 3 aims:
1. To compare the long-term (3-year) effectiveness of community engagement and planning
versus agency technical assistance to implement depression QI and improve depressed
clients' health status and risk for homelessness
2. To determine how depressed clients in under-resourced communities prioritize diverse
health and social outcomes and identify their preferences for services to address
priority outcomes
3. To identify capacities of providers to respond to depressed clients' priorities and to
generate recommendations for building capacity to better address clients'priorities.
We hypothesize that community engagement and planning will be more effective than technical
assistance in improving 3-year outcomes and that clients will prioritize quality of life. We
expect to find gaps in provider capacities to address client priorities that network
strategies could address.
Our primary outcome for the long-term follow-up is mental health related quality of life and
secondary outcomes are use of healthcare and community services for depression and physical
functioning and homeless risk factors.
In 2014, CPIC was awarded funds from the National Institute on Minority Health and Health
Disparities (NIMHD) to use existing quantitative CPIC data and collect new qualitative data
to describe pathways to reducing disparities. The funding allows us to longitudinally track
the implementation of the CEP model in a new county-wide initiative to develop community
networks to promote healthy neighborhoods. The aims under this additional funding are:
1. To determine pathways to reducing mental health and social disparities by conducting
community-academic partnered analyses of CPIC data by 1) examining intervention effects
for disparity subgroups (African Americans, Latinos, gender groups, insurance and
housing status groups); 2) identifying predictors and mediators of barriers to
access/services and client outcomes; 3) analyzing intervention effects on provider
workforce diversity; and 4) generating explanatory models for intervention effects and
their sustainability by interviewing CPIC administrators and providers, as well as
prior and current clients.
2. To explore the generalizability and replicability of the CPIC partnered model and, more
broadly, to inform the process of incorporating science into policy by conducting a
longitudinal case study of the CEP model implementation in a county-wide "neighborhood
health" initiative in Los Angeles to reduce mental health and social disparities.
As a result of this study, we will be able to explain how community-engaged and
participatory models of intervention implementation can reduce health and social disparities
and ultimately achieve public health impact. Study findings will be disseminated widely
using traditional academic, community-valued, and policy-relevant dissemination channels.
Inclusion Criteria:
Administrators
- Age 18 and above
- Work or volunteer for an enrolled program in the study and be designated as a liaison
by the program
Providers
- Age 18 and above
- Have direct contact with patients/clients
Clients
- Age 18 and above
- Score 10 or greater on modified Patient Health Questionnaire (PHQ-8)
Exclusion Criteria: grossly disorganized by screener staff assessment Not providing
personal contact information
Administrators - Under age 18
Providers
- Under age 18
Clients
- Under age 18
- Gross cognitive disorganization by screener staff assessment
- Providing no contact information
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