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Unützer J, Vredevoogd MA, Hoeft TJ, James K, Hinton L, Rath L, Chen S, Greene M, Hulst D, Jones F, Nau C, Rentas KG, Vierra W, Langston CA. Improving Care for Late-Life Depression Through Partnerships With Community-Based Organizations: Results From the Care Partners Project. Am J Geriatr Psychiatry 2024; 32:586-595. [PMID: 38184422 DOI: 10.1016/j.jagp.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 01/08/2024]
Abstract
OBJECTIVES Collaborative care (CC) has demonstrated effectiveness for improving late-life depression in primary care, but clinics offering this service can find it challenging to address unmet social needs that may be contributing to their patients' depression. Clinics may benefit from better coordination and communication with community-based organizations (CBO) to strengthen depression treatment and to address unmet social needs. We evaluated the feasibility of adding a CBO to enhance standard collaborative care and the impact of such partnered care on older adults. DESIGN Multisite, prepost evaluation. SETTING Eight (n = 8) partnerships between primary care clinics and community-based organizations in California. PARTICIPANTS A total of 707 depressed older adults (60 years or older) as evidenced by having a score of 10 or more on the Patient Health Questionnaire (PHQ-9) received care under the Care Partners project. INTERVENTION A CBO partner was added to augment CC for late-life depression in primary care. MEASUREMENTS The PHQ-9 was used to identify depressed older adults and to monitor depression symptom severity during a course of care. RESULTS At baseline, the average PHQ-9 depression score across the partnerships was 15, indicating moderate depression severity. Participating patients saw an average 7-point reduction in their PHQ-9 score, baseline to last score assessed, with nearly half of all participants (48.4%) experiencing a 50% or greater improvement from their baseline score. CONCLUSIONS Our findings suggest that partnering with a community-based organization is a feasible and effective way for primary care clinics to address late-life depression in their patients.
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Affiliation(s)
- Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences (JU, MAV, TJH, KJ), School of Medicine, University of Washington, Seattle, WA
| | - Melinda A Vredevoogd
- Department of Psychiatry and Behavioral Sciences (JU, MAV, TJH, KJ), School of Medicine, University of Washington, Seattle, WA.
| | - Theresa J Hoeft
- Department of Psychiatry and Behavioral Sciences (JU, MAV, TJH, KJ), School of Medicine, University of Washington, Seattle, WA
| | - Katherine James
- Department of Psychiatry and Behavioral Sciences (JU, MAV, TJH, KJ), School of Medicine, University of Washington, Seattle, WA
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences (LH), University of California, Davis, Sacramento, CA
| | - Laura Rath
- Archstone Foundation (LR, CAL), Long Beach, CA
| | - Shiyu Chen
- Fred Hutchinson Cancer Center (SC), Seattle, WA
| | | | - Douglas Hulst
- Depression and Bipolar Support Alliance (DH), Chicago, IL
| | - Felica Jones
- Healthy African American Families (FJ), Los Angeles, CA
| | | | - Karen G Rentas
- Providence Facey Medical Foundation (KGR), Mission Hills, CA
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Siddiq H, Jones F, Magnes Z, Booker-Vaughns J, Young-Brinn A, Williams C, Washington M, Agonafer E, Solomon O, Oliva A, Wells K, Heilemann MV. Using Community-Partnered Participatory Research to Value the "Community Lens" and Promote Equity in Community-Academic Partnerships. Health Equity 2023; 7:543-554. [PMID: 37731776 PMCID: PMC10507929 DOI: 10.1089/heq.2023.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 09/22/2023] Open
Abstract
Background Community input is crucial for identifying characteristics necessary for equitable, sustainable community-academic partnerships (CAPs). A November 2021 conference, honoring the late Dr. Loretta Jones and the Community-Partnered Participatory Research (CPPR) model, was held to gather input for designing a learning institute for community members as co-equal partners with academics in research, program, and policy initiatives. This created an opportunity to explore attendees' perspectives on challenges and opportunities related to CAPs with special focus on promoting equity. Methods Institutional Review Board approval was obtained. Five break-out discussion group sessions were conducted in November 2021 co-facilitated by both an academic and a community leader. After consent, discussions were recorded and transcribed. An iterative procedure for collaborative-group-thematic-analysis was developed. The six-phase process included rigorous coding, discussion, comparison of data with data, and development and refinement of themes and subthemes. Results A total of 38 racial-ethnically diverse participants volunteered from the total conference audience of 62 community and academic partners from various sectors including community-based organizations, health care, social services, academia, or policy within Los Angeles County. Analysis led to development of three themes: Being cautious with the extractive tendency of academia and the need for anti-racism within CAPs; Leveraging community power to resist the top-down lens of academia; and bridging two worlds through an equitably structured table. Discussion Participants described optimism about the future uses of CPPR to enhance CAPs, and the need to address barriers to equitable partnerships owing to unequal social contexts and entrenched power dynamics. Implications include addressing racism, evaluating financial equity in partnerships to promote accountability, and mentoring community leaders to promote equity. Conclusion Use of a "community lens" for developing sustainable, equitable CAPs is crucial to promote accountability and to responsibly implement authentic CPPR.
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Affiliation(s)
- Hafifa Siddiq
- College of Nursing, Charles R Drew University of Medicine and Science, Los Angeles, California, USA
- UCLA David Geffen School of Medicine, Division of General Internal Medicine and Health Services Research, Los Angeles, California, USA
| | - Felica Jones
- Healthy African American Families-II, Los Angeles, California, USA
| | - Zoe Magnes
- Healthy African American Families-II, Los Angeles, California, USA
| | - Juanita Booker-Vaughns
- Community Faculty, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | - Angela Young-Brinn
- Community Faculty, Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | | | | | - Etsemaye Agonafer
- Department of Health System Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, USA
| | - Olga Solomon
- USC UCEDD at Children's Hospital Los Angeles, Los Angeles, California, USA
- Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Adrian Oliva
- Healthy African American Families-II, Los Angeles, California, USA
| | - Kenneth Wells
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA
- UCLA David Geffen School of Medicine, Fielding School of Public Health, Los Angeles, California, USA
- Greater Los Angeles VA Health System, Los Angeles, California, USA
- UCLA National Clinician Scholars Program, David Geffen School of Medicine, Division of General Internal Medicine and Health Services Research, Los Angeles, California, USA
| | - MarySue V. Heilemann
- UCLA National Clinician Scholars Program, David Geffen School of Medicine, Division of General Internal Medicine and Health Services Research, Los Angeles, California, USA
- UCLA School of Nursing, Los Angeles, California, USA
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Ashby D, Yin L, Jones F, Wright AL, Williams H, Williams C, Deavenport-Saman A, Vanderbilt D, Solomon O. "She Is Stand-Offish Like That": Black Adults' Recognition of Child Behaviors Associated with Autism Spectrum Disorder. J Dev Behav Pediatr 2023; 44:e486-e492. [PMID: 37556597 DOI: 10.1097/dbp.0000000000001205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/09/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE The purpose of this study is to identify the sociocultural factors in the Black community that contribute to a delay in identification of Black children with autism spectrum disorder (ASD). METHODS Four focus groups with parents of typically developing children were conducted at 2 Black Churches using a community-partnered participatory research approach and the socioecological model. Participants completed sociodemographic surveys, viewed CDC Autism Training Videos of Black children with ASD, and reported on their behavioral observations. Focus groups were audio recorded and transcribed. Thematic data analysis was conducted using NVivo software. RESULTS At the individual level, participants interpreted ASD-associated behaviors as a problem of timing of developmental milestones in the course of normative development rather than a sign of a disorder and positive and negative characteristics. At the interpersonal level, the role of grandparents and extended family was important for monitoring child development. At the organizational level, racial concordance with health care providers was seen as critical because of historical mistrust. At the community level, fear of racism and child protective services and inequitable care emerged. At the policy level, there were concerns about access to affordable, high-quality care. CONCLUSION This study provides insight into the sociocultural factors in the faith-based Black community that may contribute to a delay in identification of Black children with ASD. Health care professionals need additional training to effectively serve Black children and families in the face of historical mistrust and health care inequity.
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Affiliation(s)
| | - Larry Yin
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
- University Center for Excellence in Developmental Disabilities at Children's Hospital Los Angeles, Los Angeles, CA
- USC Keck School of Medicine, Los Angeles, CA
| | | | - Aziza-Lucas Wright
- South Central Prevention Coalition
- Charles R. Drew University of Medicine and Science
| | | | | | - Alexis Deavenport-Saman
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
- University Center for Excellence in Developmental Disabilities at Children's Hospital Los Angeles, Los Angeles, CA
- USC Keck School of Medicine, Los Angeles, CA
| | - Douglas Vanderbilt
- USC Keck School of Medicine, Los Angeles, CA
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
| | - Olga Solomon
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
- University Center for Excellence in Developmental Disabilities at Children's Hospital Los Angeles, Los Angeles, CA
- USC Keck School of Medicine, Los Angeles, CA
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Wells K, Thames AD, Young AS, Zhang L, Heilemann MV, Romero DF, Oliva A, Jones F, Tang L, Brymer M, Elliott T, Arevian A. Engagement, Use, and Impact of Digital Mental Health Resources for Diverse Populations in COVID-19: Community-Partnered Evaluation. JMIR Form Res 2022; 6:e42031. [PMID: 36346902 DOI: 10.2196/42031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/04/2022] [Accepted: 11/04/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic increased disparities for communities burdened by structural barriers such as reduced affordable housing, with mental health consequences. Limited data are available on digital resources for public mental health prevention during the COVID-19 pandemic. OBJECTIVE The study aim was to evaluate engagement in and impact of free digital resources on the Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) website during COVID-19 in California. METHODS A pilot evaluation of T4W/Juntos was performed, with partner agencies inviting providers, clients, and partners to visit the website and complete surveys at baseline (September 20, 2021, to April 4, 2022) and at 4-6-week follow-up (October 22, 2021, to May 17, 2022). Website use was assessed by three engagement items (ease of use, satisfaction, relevance), comfort in use, and use of six resource categories. Primary outcomes at follow-up were depression and anxiety (scores≥3 on Patient Health Questionnaire-2 item [PHQ2] and Generalized Anxiety Disorder-2 item [GAD2] scales). Secondary outcomes were post-pre differences in PHQ2 and GAD2 scores, and use of behavioral health hotlines and services the month before follow-up. RESULTS Of 366 eligible participants, 315 (86.1%) completed baseline and 193 (61.3%) completed follow-up surveys. Of baseline participants, 72.6% identified as female, and 21.3% identified as lesbian, gay, bisexual, transgender, queer/questioning, and others (LGBTQ+). In terms of ethnicity, 44.0% identified as Hispanic, 17.8% as African American, 26.9% as non-Hispanic white, and 11.4% as other ethnicity. Overall, 32.7% had moderate anxiety or depression (GAD2/PHQ2≥3) at baseline. Predictors of baseline website engagement included being Hispanic versus other race/ethnicity (β=.27, 95% CI .10-.44; P=.002) and number of COVID-19-related behavior changes (β=.09, 95% CI .05-.13; P<.001). Predictors of comfort using the website were preferring English for website use (odds ratio [OR] 5.57, 95% CI 2.22-13.96; P<.001) and COVID-19-related behavior changes (OR 1.37, 95% CI 1.12-1.66; P=.002); receiving overnight behavioral health treatment in the prior 6 months (OR 0.15, 95% CI 0.03-0.69, P=.015) was associated with less comfort in website use. The main predictor of depression at follow-up (PHQ2≥3) was baseline depression (OR 6.24, 95% CI 2.77-14.09; P<.001). Engagement in T4W/Juntos was associated with lower likelihood of depression (OR 0.54, 95% CI 0.34-0.86; P=.01). Website use the month before follow-up was associated with a post-pre reduction in PHQ2 score (β=-.62, 95% CI -1.04 to -0.20; P=.004). The main predictor of GAD2≥3 at follow-up was baseline GAD2≥3 (OR 13.65, 95% CI 6.06-30.72; P<.001). Greater baseline website engagement predicted reduced hotline use (OR 0.36, 95% CI 0.18-0.71; P=.004). CONCLUSIONS Ethnicity/language and COVID-19-related behavior changes were associated with website engagement; engagement and use predicted reduced follow-up depression and behavioral hotline use. Findings are based on participants recommended by community agencies with moderate follow-up rates; however, significance was similar when weighting for nonresponse. This study may inform research and policy on digital mental health prevention resources.
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Affiliation(s)
- Kenneth Wells
- Research Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - April Denise Thames
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Alexander S Young
- Research Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lily Zhang
- Research Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - MarySue V Heilemann
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, United States
| | - Daniela Flores Romero
- Research Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Adrian Oliva
- Healthy African American Families II, Los Angeles, CA, United States
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA, United States
| | - Lingqi Tang
- Research Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Melissa Brymer
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Thomas Elliott
- National Clinician Scholars Program, Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Armen Arevian
- Chorus Innovations, Inc, Long Beach, CA, United States
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Barceló NE, Castillo EG, Ijadi-Maghsoodi R, Goodsmith N, Tang L, Okikawa D, Jones F, Williams P, Benitez C, Chung B, Wells KB. Multi-Sector Assessment and Client-Perception of Social Need at Long-Term Follow-Up of a Group-Randomized Trial of Community-Engaged Collaborative Care for Adults with Depression. Int J Environ Res Public Health 2022; 19:10212. [PMID: 36011843 PMCID: PMC9407841 DOI: 10.3390/ijerph191610212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
Understanding client perceptions of need for underlying social determinant support may improve services for depression care. This secondary analysis examines perceptions of "social needs" related to housing and employment, financial, and legal (EFL) concerns among individuals with depression. Data were analyzed from Community Partners in Care, a randomized comparative effectiveness trial of multi-sector collaborative care for depression among a sample of people who were predominantly racial/ethnic minorities and low-income. Adults with depression (n = 980) in both interventions were surveyed at 36-month follow-up for (1) being asked about and (2) having social needs for housing or EFL concerns. In multivariate models, life difficulty and mental health visits in non-healthcare sectors predicted being asked about housing and EFL. Lower social determinants of health-related life satisfaction increased the odds of having unmet housing and EFL needs. These findings underscore the role of non-healthcare organizations as community resources for depression care and in screening and addressing social needs.
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Affiliation(s)
| | - Enrico G. Castillo
- Center for Social Medicine and Humanities, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90024, USA
- Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Roya Ijadi-Maghsoodi
- Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
- VA Health Service Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Nichole Goodsmith
- Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
- VA Health Service Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Lingqi Tang
- Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90024, USA
| | - David Okikawa
- UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA 90008, USA
| | - Pluscedia Williams
- Healthy African American Families II, Los Angeles, CA 90008, USA
- The Practice of Community Faculty, Charles R. Drew University of Science and Medicine, Los Angeles, CA 90059, USA
- Lundquist Institute, Harbor-UCLA Medical Center, Los Angeles, CA 90502, USA
- Emergency Medicine Palliative Care Access (EMPallA), NYU—Langone Health Care, New York City, NY 10016, USA
| | | | - Bowen Chung
- Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90024, USA
- Los Angeles County Department of Mental Health, Los Angeles, CA 90020, USA
- Department of Psychiatry, Harbor-UCLA Medical Center, Los Angeles Biomedical Research Institute, Los Angeles, CA 90502, USA
| | - Kenneth B. Wells
- UCLA National Clinician Scholars Program, Los Angeles, CA 90024, USA
- Psychiatry and Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
- VA Health Service Research and Development Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA 90024, USA
- UCLA David Geffen School of Medicine, Los Angeles, CA 90095, USA
- Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA
- Greater Los Angeles Veterans Administration Health System, Los Angeles, CA 90073, USA
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Cody E, Brunner H, Huang B, Qiu T, Devarajan P, Ramaswamy M, Sinibaldi D, Brohawn PZ, Knagenhjelm J, Jones F, Tummala R, Lindholm C, White W. POS0739 THE RENAL ACTIVITY INDEX FOR LUPUS (RAIL) DIFFERENTIATES ACTIVE AND INACTIVE NEPHRITIS IN ADULT PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS (SLE). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundLupus nephritis (LN) confers a poor prognosis, with lack of effective laboratory tests to diagnose and evaluate therapies. We have demonstrated that the RAIL score, based on a set of six urinary biomarkers (NGAL, KIM-1, MCP-1, adiponectin, hemopexin, ceruloplasmin) is sensitive and specific in adult patients with active LN, using renal biopsy as reference.1,2 RAIL has been shown in the pediatric population to be effective in distinguishing inactive vs active LN with no effect from mycophenolate mofetil (MMF) treatment. A comparable study has not been conducted in an adult population.ObjectivesTo assess the ability of RAIL to discriminate patients with active LN vs active non-renal SLE and to evaluate if RAIL performance varies by MMF treatment using urine samples from adult LN patients.MethodsUrine samples were obtained at baseline in two clinical trials: a phase 2 study in adult patients with biopsy-proven active Class III and IV LN (NCT02547922) and a subset of patients from the phase 3 trial in adults with active non-renal SLE (NCT02446912) who had baseline renal BILAG scores C, D, or E. RAIL biomarkers were assayed using single-plex assays. Patient demographics and clinical characteristics were compared between studies. Wilcoxon rank sum test was performed comparing the urinary biomarkers between the two studies and RAIL score was then calculated. Receiver operating characteristic (ROC) analyses were conducted assessing the ability for RAIL scores to distinguish patients with renal activity and involvement.ResultsComparison of the patient demographic, clinical characteristics, and biomarkers is in the Table 1. Wilcoxon rank sum test showed the six urinary biomarkers were significantly different between two groups of patients as demonstrated (Table 1). Each of the RAIL biomarker concentrations and the creatinine-adjusted median score were higher in the active LN group than the SLE group (P<0.001). ROC analyses including RAIL score showed an area under the ROC curve of 0.8 (Figure 1), with odds ratio of log-transformed RAIL 2.027 (95% CI [1.587, 2.589]). There were no significant interactions between RAIL and MMF. RAIL remained significant after adjusting for estimated glomerular filtration rate (eGFR), which was not statistically significant.Table 1.Study Demographics and BiomarkersVariablesLN study (N=131)SLE study (N=59)Observed NObserved Median (IQR) or %Observed NObserved Median (IQR) or %DemographicsAge13134 (25, 42)5936 (28, 44)Sex, Female10983.21%5593.22%Race, White5642.75%4576.27%Ethnicity, Hispanic or Latino6146.56%915.25%OCS use, yes12797.69%5796.61%MMF use, yes9572.52%2135.59%Spot UPCR (mg/mg)1282.13 (1.22, 4.04)591.11 (0.55, 2.61)eGFR13091.8 (63.1, 125)5998.06 (81.91, 116.54)Non-renal SLEDAI-2K score1304 (4, 6)5912 (9, 13)Renal SLEDAI-2K score1304 (4, 8)590 (0, 0)BiomarkersNGAL (ng/mL)12833.33 (17.55, 56.7)5819.47 (11.37, 42.05)MCP-1 (pg/mL)128658.24 (271.58, 1049.95)58275.62 (106.09, 481.99)Ceruloplasmin (ng/mL)12893.55 (44.5, 311.25)5847.2 (13.05, 231.25)Adiponectin (ng/mL)12842.45 (16.71, 139.64)589.33 (3.35, 25.51)Hemopexin (ng/mL)1281876.8 (745.07, 4743.4)58513.4 (236.36, 1388.74)KIM-1 (pg/mL)1281673.5 (772.5, 2767)58864 (394, 1480)Creatinine (mg/mL)1280.7 (0.46, 1.3)580.99 (0.46, 1.74)Adult RAIL score (creatinine adjusted)1285.59 (4.31, 6.47)583.57 (2.78, 4.47)eGFR, estimated glomerular filtration rate; IQR, interquartile range; KIM, kidney injury molecule; LN, lupus nephritis; MCP, monocyte chemotactic protein; MMF, mycophenolate mofetil; NGAL, neutrophil gelatinase-associated lipocalin; OCS, oral corticosteroid; SLEDAI-2K, SLE Disease Activity Index 2000; UPCR, urine protein/creatinine ratio.ConclusionThe analyses performed suggest that creatinine-corrected RAIL discriminates between active LN and non-renal adult SLE, with RAIL scores not influenced by MMF use.References[1]Brunner HI. Arthritis Care Res (Hoboken). 2016;68:1003–11.[2]Gulati G. Lupus. 2017;26:927–36.AcknowledgementsWriting assistance by Kelly M. Hunter, PhD (Fishawack). This study was sponsored by AstraZeneca.Disclosure of InterestsEllen Cody: None declared, Hermine Brunner Speakers bureau: Novartis, Pfizer, GSK, Consultant of: AbbVie, Astra Zeneca-Medimmune, Biogen, Boehringer, Bristol Myers Squibb, Celgene, Lilly,EMD Serono, Idorsia, Cerocor, Janssen, GSK, F. Hoffmann-La Roche, Merck, Novartis, R-Pharm, Sanofi, Grant/research support from: Pfizer, Bin Huang: None declared, Tingting Qiu: None declared, Prasad Devarajan Speakers bureau: Reata, Alnylam, Dicerna, Consultant of: BioPorto Inc, Madhu Ramaswamy Shareholder of: AstraZeneca, Employee of: AstraZeneca, Dominic Sinibaldi Shareholder of: AstraZeneca, Employee of: AstraZeneca, Philip Z Brohawn Shareholder of: AstraZeneca, Employee of: AstraZeneca, Jacob Knagenhjelm Shareholder of: AstraZeneca, Employee of: AstraZeneca, Frederick Jones Shareholder of: AstraZeneca, Employee of: AstraZeneca, Raj Tummala Shareholder of: AstraZeneca, Employee of: AstraZeneca, Catharina Lindholm Employee of: AstraZeneca, Wendy White Shareholder of: AstraZeneca, Employee of: AstraZeneca
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Agonafer EP, Jones F, Jones A, Carson S, Richards DL, Scannell C, Soderlund PD, Wells KB. Communities for Wellness Equity: Implementing a Partnered Symposium to Identify Social Determinants of Health Priorities. Prog Community Health Partnersh 2022; 16:105-117. [PMID: 35342115 DOI: 10.1353/cpr.2022.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Social determinants of health (SDoH) affect under-resourced communities. Such communities are seldom involved in defining and prioritizing local SDoH for policy action. OBJECTIVES Apply community-partnered, participatory research (CPPR) to identify community stakeholder priorities for addressing SDoH in South Los Angeles. METHODS Over 10 months, CPPR was applied to develop a multi-sector partnership and working group to plan and host a symposium for community stakeholders. 148 individuals and 16 organizations participated and engaged in focus and symposium-wide discussions. Themes were identified through collaborative inductive content analysis.Results and Lessons Learned: Participants identified ten specific SDoH, such as housing, with structural racism and discrimination as the underlying cause. CONCLUSIONS Using CPPR to gain community members' insight about local factors that drive individual and community health is feasible and viewed by the community as socially responsible, suggesting it holds promise to address root causes of health inequality in under-resourced communities.
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Ellis K, Jones F. An initial evaluation of narrative exposure therapy as a treatment of posttraumatic stress disorder among Sudanese refugees in Cairo, delivered by lay counselors. Middle East Curr Psychiatry 2022. [DOI: 10.1186/s43045-022-00194-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The growing worldwide refugee crisis highlights the needs for increased access to mental health services, including in the large urban cities in the Middle East to which refugees are frequently displaced and in which access to such services is limited. The current study offers an initial evaluation of narrative exposure therapy as a treatment for posttraumatic stress disorder among Sudanese refugees in Cairo, delivered by lay counselors. Sudanese refugees with no prior background in counseling were given 27 h of training in narrative exposure therapy. They then delivered this to seven members of the same refugee community with a diagnosis of posttraumatic stress disorder at a local community center, and this was evaluated using a pre-post design and a focus-group with the intervention recipients.
Results
Despite the small sample size, over the course of the intervention there was significant decrease in trauma and anxiety symptoms, and a close to significant decrease in depression. Moreover, the focus group participants generally spoke positively about their experiences.
Conclusions
To the best of the authors’ knowledge, this is the first study to examine the viability of lay counselors delivering narrative exposure therapy to refugees with posttraumatic stress disorder in a complex urban setting. The findings suggest that this approach has promise and support the case for a randomized control trial of narrative exposure therapy delivered in this manner in such a setting.
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Aguilar-Gaxiola S, Ahmed SM, Anise A, Azzahir A, Baker KE, Cupito A, Eder M, Everette TD, Erwin K, Felzien M, Freeman E, Gibbs D, Greene-Moton E, Hernández-Cancio S, Hwang A, Jones F, Jones G, Jones M, Khodyakov D, Michener JL, Milstein B, Oto-Kent DS, Orban M, Pusch B, Shah M, Shaw M, Tarrant J, Wallerstein N, Westfall JM, Williams A, Zaldivar R. Assessing Meaningful Community Engagement: A Conceptual Model to Advance Health Equity through Transformed Systems for Health: Organizing Committee for Assessing Meaningful Community Engagement in Health & Health Care Programs & Policies. NAM Perspect 2022; 2022:202202c. [PMID: 35891775 PMCID: PMC9303007 DOI: 10.31478/202202c] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Elmer Freeman
- Center for Community Health Education Research and Service
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10
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Goodsmith N, Moore EM, Siddiq H, Barceló SE, Ulloa-Flores E, Loera G, Jones F, Aguilar-Gaxiola S, Wells K, Arevian A. Community-Partnered Development of a Digital Mental Health Resource Website to Support Diverse Communities During the COVID-19 Pandemic. J Health Care Poor Underserved 2022; 33:506-516. [PMID: 35153238 PMCID: PMC10036170 DOI: 10.1353/hpu.2022.0039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A state-academic-community partnership formed in response to the mental health needs fueled by the COVID-19 pandemic and the disproportionate effects on marginalized communities. Taking a community-partnered approach and using a health equity lens, the partnership developed a website to guide users through digital mental health resources, prioritizing accessibility, engagement, and community needs.
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11
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Bellmunt J, Powles T, van der Heijden M, Galsky M, He P, Wang Z, Xiao F, Jones F, Scott M, Walker J, Angra N, Gupta A, Drakaki A, Kimura G, Mizokami A, Wildsmith S. 708P PD-L1 as a predictor of survival in patients with metastatic urothelial carcinoma (mUC) from the phase III DANUBE trial of durvalumab (D) or durvalumab plus tremelimumab (D+T) versus standard of care chemotherapy (SoC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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12
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Nguyen BT, Brown AL, Jones F, Jones L, Withers M, Ciesielski KM, Franks JM, Wang C. "I'm not going to be a guinea pig:" Medical mistrust as a barrier to male contraception for Black American men in Los Angeles, CA. Contraception 2021; 104:361-366. [PMID: 34118271 DOI: 10.1016/j.contraception.2021.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Racial disparities in unintended pregnancy and contraceptive use in the United States are not mediated by access to family planning services alone. Rather, a history of medical mistrust underlies Black Americans' adoption of new medical technologies, inclusive of contraception. Efforts to develop hormonal male contraceptives need to incorporate Black Americans' experiences and perspectives so that new contraceptives enable their reproductive goals and promote gender equity. STUDY DESIGN Working with our community-based partner, Healthy African American Families in Los Angeles, California, we conducted six 60-minute focus group discussions with 39 Black men over age 18, in ongoing heterosexual relationships, to explore attitudes towards and willingness to use hormonal male contraceptives. RESULTS Just over one-third (35%) of respondents reported willingness to use or rely on hormonal male contraceptives. The majority held negative attitudes about hormonal male contraceptives, citing concerns about side effects and safety. Several respondents expressed mistrust of the medical community and medical research, noting that hormonal male contraceptives could be used against Black communities; several expressed unwillingness to trial hormonal male contraceptives without years of testing. However, all groups described scenarios where they would use them despite stated concerns. CONCLUSIONS Black men's hypothetical willingness to use hormonal male contraceptives is limited by medical mistrust, which may be overcome by their concerns about the unreliability of current options or the contraceptive behaviors of female partners. Nevertheless, addressing Black Americans' history of medical mistreatment and exploitation will be essential for hormonal male contraceptives to positively contribute to Black men's reproductive options and agency. IMPLICATIONS While the development of reversible, hormonal male contraception intends to fulfill unmet global needs for contraception, the utility of these hormonal male contraceptive methods among Black men living on low incomes in Los Angeles, California cannot be fully realized until developers address and overcome historical and ongoing medical mistrust.
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Affiliation(s)
- Brian T Nguyen
- Department of Obstetrics & Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles CA.
| | | | - Felica Jones
- Healthy African American Families Phase II, Los Angeles, CA
| | - Loretta Jones
- Healthy African American Families Phase II, Los Angeles, CA
| | - Mellissa Withers
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles CA
| | - Katharine M Ciesielski
- Department of Obstetrics & Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles CA
| | - Jennifer M Franks
- Department of Obstetrics & Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles CA; Department of Obstetrics & Gynecology, Kern Medical Center, Bakersfield, CA
| | - Christina Wang
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA
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13
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Salerno J, Coleman KJ, Jones F, Peters ES. The ethical challenges and opportunities of implementing engagement strategies in health research. Ann Epidemiol 2021; 59:37-43. [PMID: 33894383 DOI: 10.1016/j.annepidem.2021.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/10/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The American College of Epidemiology (ACE) held its 2019 Annual Meeting in Pasadena, California, September 7-10 with a theme of "Real-World Epidemiologic Evidence in Policy and Practice". The ACE Ethics Committee hosted a symposium session at the annual meeting on the ethical challenges of stakeholder engagement in the health research setting. The purpose of this paper is to further examine the design and conduct of stakeholder engagement and reflect on the ethical challenges with the goal of offering best practices and identifying areas where future guidance, critical reflection and teaching may be needed. METHODS Three speakers with diverse affiliations were selected to present on the opportunities and ethical challenges of stakeholder engagement in epidemiology and community health. Dr. K Coleman presented an "Overview of Stakeholder-Engaged Research Strategies" and "Engaging Stakeholders in Retrospective Observational Studies"; Dr. J Salerno presented on "An Ethical Perspective to Optimize Engagement Strategies"; and Ms. F Jones presented on the "Structure of Community-Partnered Participatory Research". RESULTS Three main insights were identified: (1) the need for a unifying framework of ethical principles for the implementation of stakeholder engagement, (2) an expanded set of research activities for stakeholders aligned with their engagement in epidemiology studies, and (3) strengths of a community-based partnership model of stakeholder engagement in community health, known as community-partnered participatory research (CPPR). CONCLUSIONS There is a need to broaden the dialogue and understanding of stakeholder engagement for researchers who are increasingly faced with the ethical challenges of implementing approaches and strategies to engage patients, communities, policy makers and the public as stakeholders. To address current challenges, we offered a unifying framework to guide best practices of stakeholder engagement by integrating the core ethical principles of research conduct involving human subjects with the guiding principles of patient engagement. We shared 2 model overviews of implementing stakeholder engagement: (1) a 4-staged model when implementing stakeholder engagement using an epidemiological study design, (2) a stakeholder engagement model rooted in authentic academic-community partnerships, known as community-partnered participatory research (CPPR) to address depression disparities. By critically reflecting on stakeholder engagement across disciplines and appraising the opportunities and ethical challenges of implementing stakeholder engagement in health research, we have provided insights on how to operationalize, conduct and implement stakeholder engagement and have contributed to moving this important field forward.
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Affiliation(s)
- Jennifer Salerno
- Aging, Community and Health Research Unit, School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; McMaster Institute for Research on Aging
- Collaborative for Health and Aging, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
| | - Karen J Coleman
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Edward S Peters
- Epidemiology Program, School of Public Health, Louisiana State University, New Orleans, LA
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14
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Mendel P, O'Hora J, Zhang L, Stockdale S, Dixon EL, Gilmore J, Jones F, Jones A, Williams P, Sharif MZ, Masongsong Z, Kadkhoda F, Pulido E, Chung B, Wells KB. Engaging Community Networks to Improve Depression Services: A Cluster-Randomized Trial of a Community Engagement and Planning Intervention. Community Ment Health J 2021; 57:457-469. [PMID: 32430557 PMCID: PMC7906961 DOI: 10.1007/s10597-020-00632-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 05/06/2020] [Indexed: 11/27/2022]
Abstract
This paper explores the effects of a group-randomized controlled trial, Community Partners in Care (CPIC), on the development of interagency networks for collaborative depression care improvement between a community engagement and planning (CEP) intervention and a resources for services (RS) intervention that provided the same content solely via technical assistance to individual programs. Both interventions consisted of a diverse set of service agencies, including health, mental health, substance abuse treatment, social services, and community-trusted organizations such as churches and parks and recreation centers. Participants in the community councils for the CEP intervention reflected a range of agency leaders, staff, and other stakeholders. Network analysis of partnerships among agencies in the CEP versus RS condition, and qualitative analysis of perspectives on interagency network changes from multiple sources, suggested that agencies in the CEP intervention exhibited greater growth in partnership capacity among themselves than did RS agencies. CEP participants also viewed the coalition development intervention both as promoting collaboration in depression services and as a meaningful community capacity building activity. These descriptive results help to identify plausible mechanisms of action for the CPIC interventions and can be used to guide development of future community engagement interventions and evaluations in under-resourced communities.
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Affiliation(s)
- Peter Mendel
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | - Jennifer O'Hora
- Center for Health Services and Society, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, USA
| | - Lily Zhang
- Center for Health Services and Society, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, USA
| | - Susan Stockdale
- Greater Los Angeles Veteran's Affairs, Los Angeles, USA
- Departments of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, USA
| | | | - Jim Gilmore
- Behavioral Health Services, Gardena, CA, USA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA, USA
| | - Andrea Jones
- Healthy African American Families II, Los Angeles, CA, USA
| | | | - Mienah Zulfacar Sharif
- Centre for Social Research and Methods, College of Arts and Social Sciences, Australian National University, Canberra, Australia
| | - Zoe Masongsong
- Healthy African American Families II, Los Angeles, CA, USA
| | - Farbod Kadkhoda
- Center for Health Services and Society, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, USA
| | | | - Bowen Chung
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
- Center for Health Services and Society, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, USA
- Departments of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, USA
- Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Kenneth B Wells
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
- Center for Health Services and Society, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, USA
- Departments of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, USA
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Sathyanarayan P, Sloane H, Edelstein D, Jones F, Preston J, Wu S, Los J, Holtrup F, Quinn H, Feller-Kopman D. 164P Rapid liquid biopsy genotyping in NSCLC patients. J Thorac Oncol 2021. [DOI: 10.1016/s1556-0864(21)02006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Goodsmith N, Zhang L, Ong MK, Ngo VK, Miranda J, Hirsch S, Jones F, Wells K, Chung B. Implementation of a Community-Partnered Research Suicide-Risk Management Protocol: Case Study From Community Partners in Care. Psychiatr Serv 2021; 72:281-287. [PMID: 33502218 PMCID: PMC7920897 DOI: 10.1176/appi.ps.202000095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Suicidality is common among participants in clinical trials and health services research, but approaches to suicide risk assessment and mitigation vary widely. Studies involving vulnerable populations with limited access to care raise additional ethical concerns. The authors applied a community-partnered approach to develop and implement a suicide-risk management protocol (SRMP) in a depression study in an underresourced setting in Los Angeles. METHODS Using a community-partnered participatory research framework, the authors designed and adapted the SRMP. Qualitative data regarding SRMP implementation included notes from SRMP development meetings and from study clinicians conducting outreach calls to study participants. Analyses included baseline and 6- and 12-month telephone survey data from 1,018 enrolled adults with moderate to severe depressive symptoms (8-item Patient Health Questionnaire score ≥10), of whom 48% were Black and 40% Latino. RESULTS Community stakeholders prioritized a robust SRMP to ensure participant safety. Features included rapid telephone outreach by study clinicians in all cases of reported recent suicidality and expedited treatment access. Using a suicidality timeframe prompt of "in the past 2 weeks," endorsement of suicidality was common (15% at baseline, 32% cumulative). Midway through the study, the SRMP was modified to assess for present suicidality, which reduced the frequency of clinician involvement. Overall, 318 outreach calls were placed, with none requiring an emergency response. Treatment referrals were provided in 157 calls, and outreach was well received. CONCLUSIONS SRMP implementation in research involving underresourced and vulnerable communities merits additional considerations. Partnering with community stakeholders can facilitate the development of acceptable and feasible SRMP procedures.
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Affiliation(s)
- Nichole Goodsmith
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
| | - Lily Zhang
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
| | - Michael K Ong
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
| | - Victoria K Ngo
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
| | - Jeanne Miranda
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
| | - Susan Hirsch
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
| | - Felica Jones
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
| | - Kenneth Wells
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
| | - Bowen Chung
- U.S. Department of Veterans Affairs (VA) Center for the Study of Healthcare Innovation, Implementation, and Policy (Goodsmith) and Department of Medicine (Ong), VA Greater Los Angeles Healthcare System, Los Angeles; National Clinician Scholars Program (Goodsmith), Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine (Zhang, Miranda, Hirsch), Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine (Ong), Department of Health Policy and Management, Jonathan and Karin Fielding School of Public Health (Miranda), and Center for Health Services and Society, Jane and Terry Semel Institute for Neuroscience and Human Behavior (Wells, Chung), University of California, Los Angeles; Graduate School of Public Health and Health Policy, City University of New York, New York City (Ngo); RAND Corporation, Santa Monica, California (Ngo, Wells); Healthy African American Families II, Los Angeles (Jones); County of Los Angeles Department of Mental Health, Los Angeles (Chung)
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17
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Arevian AC, Jones F, Moore EM, Goodsmith N, Aguilar-Gaxiola S, Ewing T, Siddiq H, Lester P, Cheung E, Ijadi-Maghsoodi R, Gabrielian S, Sugarman OK, Bonds C, Benitez C, Innes-Gomberg D, Springgate B, Haywood C, Meyers D, Sherin JE, Wells K. Mental Health Community and Health System Issues in COVID-19: Lessons from Academic, Community, Provider and Policy Stakeholders. Ethn Dis 2020; 30:695-700. [PMID: 32989370 PMCID: PMC7518533 DOI: 10.18865/ed.30.4.695] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The coronavirus pandemic of 2019 (COVID-19) has created unprecedented changes to everyday life for millions of Americans due to job loss, school closures, stay-at-home orders and health and mortality consequences. In turn, physicians, academics, and policymakers have turned their attention to the public mental health toll of COVID-19. This commentary reporting from the field integrates perceptions of academic, community, health system, and policy leaders from state, county, and local levels in commenting on community mental health needs in the COVID-19 pandemic. Stakeholders noted the broad public health scope of mental health challenges while expressing concern about exacerbation of existing disparities in access and adverse social determinants, including for communities with high COVID-19 infection rates, such as African Americans and Latinos. They noted rapid changes toward telehealth and remote care, and the importance of understanding impacts of changes, including who may benefit or have limited access, with implications for future services delivery. Needs for expanded workforce and training in mental health were noted, as well as potential public health value of expanding digital resources tailored to local populations for enhancing resilience to stressors. The COVID-19 pandemic has led to changes in delivery of health care services across populations and systems. Concerns over the mental health impact of COVID-19 has enhanced interest in remote mental care delivery and preventive services, while being mindful of potential for enhanced disparities and needs to address social determinants of health. Ongoing quality improvement across systems can integrate lessons learned to enhance a public mental well-being.
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Affiliation(s)
- Armen C. Arevian
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Health Services and Society, Los Angeles, CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Elizabeth M. Moore
- VA Greater Los Angeles Healthcare System HSR&D Center for the Study of Healthcare Innovation Implementation & Policy, Los Angeles, CA
- UCLA National Clinician Scholars Program, Los Angeles, CA
| | - Nichole Goodsmith
- VA Greater Los Angeles Healthcare System HSR&D Center for the Study of Healthcare Innovation Implementation & Policy, Los Angeles, CA
- UCLA National Clinician Scholars Program, Los Angeles, CA
| | - Sergio Aguilar-Gaxiola
- Department of Clinical Internal Medicine, School of Medicine, and Center for Reducing Health Disparities, UC Davis, Davis, CA
| | - Toby Ewing
- California Mental Health Services Oversight and Accountability Commission, Sacramento, CA
| | - Hafifa Siddiq
- UCLA National Clinician Scholars Program, Los Angeles, CA
- UCLA Resource Center for Minority Aging Research, Resource Centers for Minority Aging and for Health Improvement of Minority Elderly, Los Angeles, CA
| | - Patricia Lester
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Division of Population Behavioral Health, Los Angeles, CA
| | - Erick Cheung
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Roya Ijadi-Maghsoodi
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- VA Greater Los Angeles Healthcare System HSR&D Center for the Study of Healthcare Innovation Implementation & Policy, Los Angeles, CA
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Division of Population Behavioral Health, Los Angeles, CA
- UCLA/VA Center of Excellence for Veteran Resilience and Recovery, Los Angeles, CA
| | - Sonya Gabrielian
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- VA Greater Los Angeles Healthcare System HSR&D Center for the Study of Healthcare Innovation Implementation & Policy, Los Angeles, CA
- UCLA/VA Center of Excellence for Veteran Resilience and Recovery, Los Angeles, CA
| | - Olivia K. Sugarman
- Louisiana State University Health Sciences Center – New Orleans School of Medicine and School of Public Health, New Orleans, LA
| | - Curley Bonds
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Los Angeles County Department of Mental Health, Los Angeles, CA
| | - Christopher Benitez
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Los Angeles County Department of Mental Health, Los Angeles, CA
| | | | - Benjamin Springgate
- Louisiana State University Health Sciences Center – New Orleans School of Medicine and School of Public Health, New Orleans, LA
| | | | | | - Jonathan E. Sherin
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Los Angeles County Department of Mental Health, Los Angeles, CA
- University of Southern California, Los Angeles, CA
| | - Kenneth Wells
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- VA Greater Los Angeles Healthcare System HSR&D Center for the Study of Healthcare Innovation Implementation & Policy, Los Angeles, CA
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Division of Population Behavioral Health, Los Angeles, CA
- UCLA/VA Center of Excellence for Veteran Resilience and Recovery, Los Angeles, CA
- UCLA Fielding School of Public Health, Los Angeles, CA
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Health Services and Society, Los Angeles, CA
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18
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Abstract
Ethn Dis. 2020;30(3):433-436; doi:10.18865/ed.30.3.433
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Affiliation(s)
- Kenneth Brooks Wells
- Center for Health Services and Society, Jane and Terry Semel Institute, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Department of Health Policy and Management, Fielding School of Public Health at UCLA, Los Angeles, CA.,RAND Corporation Health Program, Los Angeles, CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Keith C Norris
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA
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19
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Arevian AC, Jones F, Tang L, Sherbourne CD, Jones L, Miranda J. Depression Remission From Community Coalitions Versus Individual Program Support for Services: Findings From Community Partners in Care, Los Angeles, California, 2010-2016. Am J Public Health 2020; 109:S205-S213. [PMID: 31242001 DOI: 10.2105/ajph.2019.305082] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To explore effects of coalitions (Community Engagement and Planning [CEP]) versus technical assistance (Resources for Services [RS]) for depression collaborative care and the effects of social determinants on long-term remission outcomes. Methods. We randomized 95 health care and community programs in Los Angeles County, California, to CEP or RS. In 2010, 1246 depressed (Patient Health Questionnaire [PHQ-8] ≥ 10) adults enrolled and were invited for baseline and 6-, 12-, and 36-month surveys. Of 598 3-year completers, 283 participated at 4 years (2016). We examined effects of CEP versus RS, social factors (e.g., family income, food insecurity) on time to and periods in clinical (PHQ-8 < 10) and community-defined (PHQ-8 < 10 or PHQ-2 < 3; mental health composite score [MCS-12] > 40, or mental wellness) remission during the course of 3 years, and at 4 years. Results. We found that CEP versus RS increased 4-year depression remission and, for women, community-defined remission outcomes during the course of 3 years. Social factors and clinical factors predicted remission. Conclusions. At 4 years, CEP was more effective than RS at increasing depression remission. Public Health Implications. Coalitions may improve 4-year depression remission, while addressing social and clinical factors associated with depression may hold potential to enhance remission.
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Affiliation(s)
- Armen C Arevian
- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
| | - Felica Jones
- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
| | - Lingqi Tang
- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
| | - Cathy D Sherbourne
- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
| | - Loretta Jones
- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
| | - Jeanne Miranda
- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
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- Armen C. Arevian, Jeanne Miranda, and Lingqi Tang are with the Jane and Terry Semel Institute for Neuroscience and Human Behavior and the Center for Health Services and Society, University of California Los Angeles (UCLA), Los Angeles, CA. At the time of the study, Felica Jones and Loretta Jones were with Healthy African American Families II, Los Angeles. Cathy D. Sherbourne is with RAND Corporation, Santa Monica, CA
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20
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Morton I, Hurley B, Castillo EG, Tang L, Gilmore J, Jones F, Watkins K, Chung B, Wells K. Outcomes of two quality improvement implementation interventions for depression services in adults with substance use problems. Am J Drug Alcohol Abuse 2020; 46:251-261. [PMID: 31935133 DOI: 10.1080/00952990.2019.1708085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Comorbid depression and substance use disorders (SUDs) are associated with poor health and social outcomes disproportionately affecting under-resourced communities.Objectives: To test the hypothesis that a coalition approach to collaborative care (CC) for depression would improve outcomes of hazardous drinking and behavioral health hospitalizations, relative to technical assistance, for individuals with comorbid substance use problems. Substance use problems were defined by meeting criteria for DSM-IV substance abuse or dependence, hazardous drinking by AUDIT-C, or treatment in a SUD program within the prior 6 months.Methods: Two depression CC implementation approaches were compared: Resources for Services (RS) provided expert technical support for CC toolkits to individual programs. Community engagement and planning (CEP) supported multi-sector coalitions in collaborating in planning, adapting, implementing and monitoring CC toolkits. One thousand eighteen individuals with depression (PHQ-8 ≥10) enrolled. Regression analyses estimated intervention effects in participants with comorbid substance use problems (n = 588, 281 females, 307 males). Substance use problems were defined by meeting criteria for DSM-IV substance abuse or dependence, hazardous drinking by AUDIT-C, or treatment in a SUD program within the prior 6 months.Results: There were no significant baseline differences by intervention status among participants with depression and substance use problems. Intervention effects on primary outcomes including depression were not significant at 6 months. Compared to RS, CEP significantly reduced alcohol consumption (CEP = 1.6, RS = 2.1, p = .038), probability of behavioral health hospitalizations (OR = 0.50, p = .036), and use of specialty mental health visits (IRR = 0.52, p = .027), while increasing use of faith-based depression services (IRR = 3.4, p = .001).Conclusions: Given feasibility and possible benefits, CEP should be considered a promising approach to implementing depression CC with potential benefits to adults with comorbid substance use problems.
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Affiliation(s)
- Isabella Morton
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Brian Hurley
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Enrico G Castillo
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Center for Social Medicine and Humanities, UCLA, Los Angeles, CA, USA.,Los Angeles County Department of Mental Health, Los Angeles, CA, USA
| | - Lingqi Tang
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Center for Health Services and Society, UCLA, Los Angeles, CA, USA
| | | | - Felica Jones
- Healthy African American Families II, Los Angeles, CA, USA
| | | | - Bowen Chung
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Los Angeles County Department of Mental Health, Los Angeles, CA, USA.,Center for Health Services and Society, UCLA, Los Angeles, CA, USA.,Healthy African American Families II, Los Angeles, CA, USA.,The RAND Corporation, Santa Monica, CA, USA
| | - Kenneth Wells
- Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Center for Health Services and Society, UCLA, Los Angeles, CA, USA.,The RAND Corporation, Santa Monica, CA, USA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA.,Greater Los Angeles Veterans Affairs West Los Angeles Medical Center, Los Angeles, CA, USA
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21
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Castillo EG, Ijadi-Maghsoodi R, Shadravan S, Moore E, Mensah MO, Docherty M, Aguilera Nunez MG, Barcelo N, Goodsmith N, Halpin LE, Morton I, Mango J, Montero AE, Koushkaki SR, Bromley E, Chung B, Jones F, Gabrielian S, Gelberg L, Greenberg JM, Kalofonos I, Kataoka SH, Miranda J, Pincus HA, Zima BT, Wells KB. Community Interventions to Promote Mental Health and Social Equity. Focus (Am Psychiatr Publ) 2020; 18:60-70. [PMID: 32015729 PMCID: PMC6996071 DOI: 10.1176/appi.focus.18102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
(Reprinted with permission from Current Psychiatry Reports (2020) 21: 35).
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22
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Vargas SM, Wennerstrom A, Alfaro N, Belin T, Griffith K, Haywood C, Jones F, Lunn MR, Meyers D, Miranda J, Obedin-Maliver J, Pollock M, Sherbourne CD, Springgate BF, Sugarman OK, Rey E, Williams C, Williams P, Chung B. Resilience Against Depression Disparities (RADD): a protocol for a randomised comparative effectiveness trial for depression among predominantly low-income, racial/ethnic, sexual and gender minorities. BMJ Open 2019; 9:e031099. [PMID: 31641001 PMCID: PMC6830623 DOI: 10.1136/bmjopen-2019-031099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Depression is the leading cause of adult disability and common among sexual and gender minority (SGM) adults. The current study builds on findings showing the effectiveness of depression quality improvement (QI) and delivery of cognitive behavioural therapy (CBT) skills provided by community health workers in reducing depression. Depression QI approaches across healthcare and social/community services in safety-net settings have shown improvements in mental wellness, mental health quality of life and depression over 12 months. Further, a randomised study showed improved depression among low-income racial/ethnic minorities enrolled in a CBT-informed resiliency class (Building Resilience and Increasing Community Hope (B-RICH)). The current protocol describes a comparativeness effectiveness study to evaluate whether predominantly low-income, SGM racial/ethnic minority adults randomised to a CBT-informed resiliency class have improvements in depressive symptoms over and above community-engaged QI resources and training only. METHODS AND ANALYSIS The study approached three clusters of four to five programs serving predominantly SGM and racial/ethnic minority communities in the USA: two clusters in Los Angeles, California, and one in New Orleans, Louisiana. Clusters are comprised of one primary care, one mental health and two to three community agencies (eg, faith-based, social services/support, advocacy). All programs received depression QI training. The current study employed a community-partnered participatory research model to adapt the CBT-informed resiliency class, B-RICH+, to SGM communities. Study participants were screened and recruited in person from participating programs, and will complete baseline, 6- and 12-month survey follow-ups. Participants were depressed adults (8-item Patient Health Questionnaire ≥10; ≥18 years of age) who provided contact information. Enrolled participants were individually randomised to B-RICH+ or depression QI alone. Primary outcomes are depressive symptoms; secondary outcomes are mental health quality of life, mental wellness and physical health quality of life. Data collection for this study is ongoing. ETHICS AND DISSEMINATION The current study was approved by the UCLA Institutional Review Board. Study findings will be disseminated through scientific publications and community conferences. TRIAL REGISTRATION NUMBER https://clinicaltrials.gov/ct2/show/NCT02986126.
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Affiliation(s)
- Sylvanna Maria Vargas
- Psychology, University of Southern California, Los Angeles, California, USA
- Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California, USA
- Preventive Medicine, University of Southern California, Los Angeles, California, United States
| | - Ashley Wennerstrom
- School of Medicine, Tulane University, New Orleans, Louisiana, USA
- LSU Health Sciences Center New Orleans, Louisiana State University, New Orleans, Louisiana, United States
| | - Nancy Alfaro
- Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California, USA
| | - Thomas Belin
- Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California, USA
- Department of Biostatistics, Fielding School of Public Health, UCLA, Los Angeles, California, USA
| | - Krystal Griffith
- Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California, USA
| | - Catherine Haywood
- Tulane Prevention Research Center, Tulane University, New Orleans, Louisiana, USA
- Women with a Vision, Inc, New Orleans, Louisiana, USA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, California, USA
| | - Mitchell R Lunn
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- The PRIDE Study, Stanford University School of Medicine, Stanford, California, United States
| | - Diana Meyers
- Saint Anna's Episcopal Church, New Orleans, Louisiana, USA
| | - Jeanne Miranda
- Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California, USA
- Health Policy and Management, Fielding School of Public Health, UCLA, Los Angeles, California, United States
| | - Juno Obedin-Maliver
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
- The PRIDE Study, Stanford University School of Medicine, Stanford, California, United States
| | - Miranda Pollock
- Section of Community and Population Medicine, Department of Medicine, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | | | - Benjamin F Springgate
- Section of Community and Population Medicine, Department of Medicine, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | - Olivia K Sugarman
- Section of Community and Population Medicine, Department of Medicine, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
- Center for Health Care Value and Equity, LSU Health Sciences Center, New Orleans, Louisiana, United States
- School of Public Health, LSU Health Sciences Center, New Orleans, California, United States
| | - Emily Rey
- LGBT Community Center, New Orleans, Louisiana, USA
- Let's Hatch Media, New Orleans, Louisiana, USA
| | | | - Pluscedia Williams
- Healthy African American Families II, Los Angeles, California, USA
- Department of Preventive and Social Medicine, Charles R Drew University of Medicine and Science, Los Angeles, California, USA
| | - Bowen Chung
- Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, UCLA, Los Angeles, California, USA
- RAND Corporation, Los Angeles, California, USA
- Department of Psychiatry, Harbor-UCLA Medical Center, Torrance, California, United States
- Department of Mental Health, County of Los Angeles, Los Angeles, California, United States
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23
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Nangia C, Soon-Shiong P, Rabizadeh S, Lee J, Sender L, Jones F, Kistler M, Niazi K, Seery T, Rock A, Jafari O. Complete responses in patients with second-line or greater metastatic triple negative breast cancer (TNBC) following first-in-human immunotherapy combining NK and T cell activation with off-the-shelf high-affinity CD16 NK cell line (haNK). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz242.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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24
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Affiliation(s)
- F Jones
- Centre for Colorectal Disease, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Ireland
| | - G A Doherty
- Centre for Colorectal Disease, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Ireland
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25
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Gulsrud A, Carr T, Williams J, Panganiban J, Jones F, Kimbrough J, Shih W, Kasari C. Developmental screening and early intervention in a childcare setting for young children at risk for autism and other developmental delays: A feasibility trial. Autism Res 2019; 12:1423-1433. [PMID: 31241851 DOI: 10.1002/aur.2160] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 05/01/2019] [Accepted: 05/20/2019] [Indexed: 11/09/2022]
Abstract
Efforts to decrease disparity in diagnosis and treatment for under-resourced children with developmental delays, such as autism spectrum disorder, have led to increased interest in developing programs in community settings. One potential setting that has already demonstrated feasibility in conducting universal screening is the childcare setting. The current study conducted developmental screening in a total of 116 children ages 16-80 months of age in an urban low-income community childcare center. Parents of 20 children who screened positive were enrolled in the intervention phase of the study, where children received a staff-delivered targeted early intervention or a waitlist control condition. Given the small and imbalanced sample sizes, confidence intervals from mixed effect models were used to measure changes across time for each group. Of the children who received treatment, there was an average increase in child initiated joint engagement, symbolic play, and language use. This study provides initial feasibility data for the implementation of a screening and early intervention program to service a predominantly low-resource and ethnically diverse population within the childcare system in a large metropolitan city. Autism Res 2019, 12: 1423-1433. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Identifying and delivering treatment services for young children with developmental delays, such as autism spectrum disorder, may be most successful in community settings, especially for those children from under-resourced areas. This study found preliminary evidence that the childcare setting is a good place to conduct screening and deliver early interventions for children at risk for autism and other developmental delays.
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Affiliation(s)
| | - Themba Carr
- The University of California, San Diego, California
| | | | | | - Felica Jones
- Healthy African American Families, Los Angeles, California
| | - Jackie Kimbrough
- The Children's Collective, Incorporated, Los Angeles, California
| | - Wendy Shih
- Loma Linda University, Loma Linda, California
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26
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Arevian AC, Jones F, Chung B. Mental Health Disparities and Technology: New Risks and Opportunities. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20190416-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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27
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Barceló NE, Lopez A, Tang L, Aguilera Nunez MG, Jones F, Miranda J, Chung B, Arevian A, Bonds C, Izquierdo A, Dixon E, Wells K. Community Engagement and Planning versus Resources for Services for Implementing Depression Quality Improvement: Exploratory Analysis for Black and Latino Adults. Ethn Dis 2019; 29:277-286. [PMID: 31057313 PMCID: PMC6478049 DOI: 10.18865/ed.29.2.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Racial/ethnic minorities experience disparities in depression1 and there is a paucity of evidence-based interventions to improve depression care access and outcomes. Community Partners in Care (CPIC) is a community-partnered study of depression care quality improvement (QI) in under-resourced, urban communities: Community Engagement and Planning (CEP) for multi-sector coalitions, and Resources for Services (RS) for program technical assistance.2 CEP demonstrated benefits for the overall CPIC study population; effects for Black and Latino sub-populations are unknown. Methods This sub-analysis examines outcomes for 409 Latino and 488 Black (non-Latino) adults recruited from 90 programs who completed baseline or 6-month follow-up. Regression analyses were used to estimate CEP vs RS intervention effects on primary (Mental Health Related Quality of Life [MHRQL], Patient Health Questionnaire-9 [PHQ-9]) and community-prioritized (mental wellness, physical activity, risk for homelessness) outcomes at 6-months. Results Baseline characteristics did not differ significantly by intervention in either group. In the adjusted analysis for Black adults, CEP resulted in decreased odds of poor MHRQL (OR: .62, 95% CI=.41-.94, P=.028) with a trend for reducing homelessness risk (OR: .60, .35-1.05, P=.69). For Latino adults, CEP resulted in greater probability of mental wellness (OR: 1.81, 1.05-3.13, P=.034) and a trend for increased physical activity (OR: 1.52, .93-2.49, P=.091). Conclusions Exploratory analyses of CEP for depression quality improvement suggests significant 6-month benefits in mental health outcomes for Black and Latino participants and trends for improvement in community-prioritized outcomes for both groups. Findings may inform research in multi-sector coalitions to promote equity in depression care.
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Affiliation(s)
- Nicolás E. Barceló
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA
| | - Alma Lopez
- David Geffen School of Medicine at UCLA, Los Angeles CA
| | - Lingqi Tang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA
| | - Maria Gabriela Aguilera Nunez
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA
| | - Felica Jones
- Healthy African American Families Phase II, Los Angeles, CA
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA
| | - Bowen Chung
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA; Los Angeles County Department of Mental Health, Los Angeles CA
| | - Armen Arevian
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA
| | - Curley Bonds
- Los Angeles County Department of Mental Health, Los Angeles, CA
| | - Adriana Izquierdo
- Department of Medicine, David Geffen School of Medicine at UCLA; VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | | | - Kenneth Wells
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA; Department of Health Policy and Management, Fielding School of Public Health; RAND Health Program; Greater Los Angeles Veteran Affairs Health Care System, Los Angeles CA
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28
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Castillo EG, Ijadi-Maghsoodi R, Shadravan S, Moore E, Mensah MO, Docherty M, Aguilera Nunez MG, Barcelo N, Goodsmith N, Halpin LE, Morton I, Mango J, Montero AE, Rahmanian Koushkaki S, Bromley E, Chung B, Jones F, Gabrielian S, Gelberg L, Greenberg JM, Kalofonos I, Kataoka SH, Miranda J, Pincus HA, Zima BT, Wells KB. Community Interventions to Promote Mental Health and Social Equity. Curr Psychiatry Rep 2019; 21:35. [PMID: 30927093 PMCID: PMC6440941 DOI: 10.1007/s11920-019-1017-0] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW We review recent community interventions to promote mental health and social equity. We define community interventions as those that involve multi-sector partnerships, emphasize community members as integral to the intervention, and/or deliver services in community settings. We examine literature in seven topic areas: collaborative care, early psychosis, school-based interventions, homelessness, criminal justice, global mental health, and mental health promotion/prevention. We adapt the social-ecological model for health promotion and provide a framework for understanding the actions of community interventions. RECENT FINDINGS There are recent examples of effective interventions in each topic area. The majority of interventions focus on individual, family/interpersonal, and program/institutional social-ecological levels, with few intervening on whole communities or involving multiple non-healthcare sectors. Findings from many studies reinforce the interplay among mental health, interpersonal relationships, and social determinants of health. There is evidence for the effectiveness of community interventions for improving mental health and some social outcomes across social-ecological levels. Studies indicate the importance of ongoing resources and training to maintain long-term outcomes, explicit attention to ethics and processes to foster equitable partnerships, and policy reform to support sustainable healthcare-community collaborations.
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Affiliation(s)
- Enrico G Castillo
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
- Center for Social Medicine and Humanities, UCLA, Los Angeles, CA, USA.
- Los Angeles County Department of Mental Health, Los Angeles, CA, USA.
| | - Roya Ijadi-Maghsoodi
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Division of Population Behavioral Health, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- VA Health Service Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Sonya Shadravan
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Elizabeth Moore
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Michael O Mensah
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Mary Docherty
- Harkness Fellow in Healthcare Policy and Practice, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Maria Gabriela Aguilera Nunez
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Nicolás Barcelo
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Nichole Goodsmith
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Laura E Halpin
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Isabella Morton
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Joseph Mango
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
| | - Alanna E Montero
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
| | - Sara Rahmanian Koushkaki
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
| | - Elizabeth Bromley
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- UCLA Department of Anthropology, Los Angeles, CA, USA
- Rand Corporation, Santa Monica, CA, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Bowen Chung
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- Rand Corporation, Santa Monica, CA, USA
- Los Angeles Biomedical Research Institute, Los Angeles, CA, USA
- Healthy African American Families II, Los Angeles, CA, USA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA, USA
| | - Sonya Gabrielian
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- VA Health Service Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Lillian Gelberg
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Family Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- UCLA Jonathan Fielding School of Public Health, Los Angeles, CA, USA
| | - Jared M Greenberg
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- VA Health Service Research and Development Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Ippolytos Kalofonos
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Social Medicine and Humanities, UCLA, Los Angeles, CA, USA
- UCLA International Institute, Los Angeles, CA, USA
| | - Sheryl H Kataoka
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- Division of Child and Adolescent Psychiatry, UCLA, Los Angeles, CA, USA
| | - Jeanne Miranda
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- UCLA Jonathan Fielding School of Public Health, Los Angeles, CA, USA
| | - Harold A Pincus
- Rand Corporation, Santa Monica, CA, USA
- Department of Psychiatry, Columbia University Medical Center, New York State Psychiatric Institute, NewYork-Presbyterian Hospital, Irving Institute for Clinical and Translational Research, New York, NY, USA
| | - Bonnie T Zima
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- Division of Child and Adolescent Psychiatry, UCLA, Los Angeles, CA, USA
| | - Kenneth B Wells
- Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Center for Health Services and Society, UCLA, Los Angeles, CA, USA
- Rand Corporation, Santa Monica, CA, USA
- UCLA Jonathan Fielding School of Public Health, Los Angeles, CA, USA
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Barceló NE, Lopez A, Tang L, Aguilera Nunez MG, Jones F, Miranda J, Chung B, Arevian A, Bonds C, Izquierdo A, Dixon E, Wells K. Community Engagement and Planning versus Resources for Services for Implementing Depression Quality Improvement: Exploratory Analysis for Black and Latino Adults. Ethn Dis 2019; 29. [PMID: 31057313 PMCID: PMC6478049 DOI: 10.18865/ed.29.2.277 10.18865/ed.29.2.277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE Racial/ethnic minorities experience disparities in depression1 and there is a paucity of evidence-based interventions to improve depression care access and outcomes. Community Partners in Care (CPIC) is a community-partnered study of depression care quality improvement (QI) in under-resourced, urban communities: Community Engagement and Planning (CEP) for multi-sector coalitions, and Resources for Services (RS) for program technical assistance.2 CEP demonstrated benefits for the overall CPIC study population; effects for Black and Latino sub-populations are unknown. METHODS This sub-analysis examines outcomes for 409 Latino and 488 Black (non-Latino) adults recruited from 90 programs who completed baseline or 6-month follow-up. Regression analyses were used to estimate CEP vs RS intervention effects on primary (Mental Health Related Quality of Life [MHRQL], Patient Health Questionnaire-9 [PHQ-9]) and community-prioritized (mental wellness, physical activity, risk for homelessness) outcomes at 6-months. RESULTS Baseline characteristics did not differ significantly by intervention in either group. In the adjusted analysis for Black adults, CEP resulted in decreased odds of poor MHRQL (OR: .62, 95% CI=.41-.94, P=.028) with a trend for reducing homelessness risk (OR: .60, .35-1.05, P=.69). For Latino adults, CEP resulted in greater probability of mental wellness (OR: 1.81, 1.05-3.13, P=.034) and a trend for increased physical activity (OR: 1.52, .93-2.49, P=.091). CONCLUSIONS Exploratory analyses of CEP for depression quality improvement suggests significant 6-month benefits in mental health outcomes for Black and Latino participants and trends for improvement in community-prioritized outcomes for both groups. Findings may inform research in multi-sector coalitions to promote equity in depression care.
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Affiliation(s)
- Nicolás E. Barceló
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA
- Address correspondence to Nicolás E. Barceló, MD; 10920 Wilshire
Blvd., Suite 300; Los Angeles, CA 90024; 310.794.2051;
| | - Alma Lopez
- David Geffen School of Medicine at UCLA, Los Angeles CA
| | - Lingqi Tang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA
| | - Maria Gabriela Aguilera Nunez
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA
| | - Felica Jones
- Healthy African American Families Phase II, Los Angeles, CA
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA
| | - Bowen Chung
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA; Los Angeles County Department of Mental Health, Los Angeles CA
| | - Armen Arevian
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA, Los Angeles, CA
| | - Curley Bonds
- Los Angeles County Department of Mental Health, Los Angeles, CA
| | - Adriana Izquierdo
- Department of Medicine, David Geffen School of Medicine at UCLA; VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | | | - Kenneth Wells
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Jane and Terry Semel Institute for Neuroscience and Human Behavior at UCLA; Department of Health Policy and Management, Fielding School of Public Health; RAND Health Program; Greater Los Angeles Veteran Affairs Health Care System, Los Angeles CA
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30
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Chung B, Ong M, Ettner SL, Jones F, Gilmore J, McCreary M, Ngo VK, Sherbourne C, Tang L, Dixon E, Koegel P, Miranda J, Wells KB. 12-Month Cost Outcomes of Community Engagement Versus Technical Assistance for Depression Quality Improvement: A Partnered, Cluster Randomized, Comparative-Effectiveness Trial. Ethn Dis 2018; 28:349-356. [PMID: 30202187 DOI: 10.18865/ed.28.s2.349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To compare community engagement and planning (CEP) for coalition support to implement depression quality improvement (QI) to resources for services (RS) effects on service-use costs over a 12-month period. Design Matched health and community programs (N=93) were cluster-randomized within communities to CEP or RS. Setting Two Los Angeles communities. Participants Adults (N=1,013) with depressive symptoms (Patient Health Questionnaire (PHQ-8) ≥10); 85% African American and Latino. Interventions CEP and RS to support programs in depression QI. Main Outcome Measures Intervention training and service-use costs over 12 months. Results CEP planning and training costs were almost 3 times higher than RS, largely due to greater CEP provider training participation vs RS, with no significant differences in 12-month service-use costs. Conclusions Compared with RS, CEP had higher planning and training costs with similar service-use costs.
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Affiliation(s)
- Bowen Chung
- Department of Psychiatry, Harbor-UCLA Medical Center/Los Angeles Biomedical Research Institute, Los Angeles, CA.,Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA.,RAND Corporation, Los Angeles, CA
| | - Michael Ong
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.,Greater Los Angeles VA Health care System, Los Angeles, CA
| | - Susan L Ettner
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | | | - Michael McCreary
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | | | - Lingqi Tang
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | | | - Jeanne Miranda
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Kenneth B Wells
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Bio-behavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA.,RAND Corporation, Los Angeles, CA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
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31
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Khodyakov D, Sharif MZ, Jones F, Heller SM, Pulido E, Wells KB, Bromley E. Whole Person Care in Under-resourced Communities: Stakeholder Priorities at Long-Term Follow-Up in Community Partners in Care. Ethn Dis 2018; 28:371-380. [PMID: 30202190 DOI: 10.18865/ed.28.s2.371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective Depressed individuals may require help from different agencies to address health and social needs, but how such coordination occurs in under-resourced communities is poorly understood. This study sought to identify priorities of Latino and African American depressed clients, explore whether service providers understand client priorities, and describe how providers address them. Methods Between October 2014 and February 2015, we interviewed 104 clients stratified by depression history and 50 representatives of different programs in health and social community agencies who participated in Community Partners in Care, a cluster-randomized trial of coalition-building approaches to delivering depression quality improvement programs. Clients were queried about their most pressing needs; program representatives identified their clients' needs and explained how they addressed them. Results Physical and mental health were clients' top priorities, followed by housing, caring for and building relationships with others, and employment. While persistently depressed clients prioritized mental health, those with improved depression prioritized relationships with others. Program representatives identified housing, employment, mental health, and improving relationships with others as clients' top priorities. Needs assessment, client-centered services, and linkages to other agencies were main strategies used to address client needs. Conclusion Depressed clients have multiple health and social needs, and program representatives in under-resourced communities understand the complexity of clients' needs. Agencies rely on needs assessment and referrals to meet their clients' needs, which enhances the importance of agency partnership in "whole person" initiatives. Our results illustrate agency capacity to adopt integrated care models that will address clients' multiple needs through multi-sector collaboration and describe potential strategies to help reach the goal of whole person care.
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Affiliation(s)
| | | | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - S Megan Heller
- Center for Health Services and Society, University of California, Los Angeles, CA
| | | | - Kenneth B Wells
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; RAND Corporation; University of California, Los Angeles School of Public Health
| | - Elizabeth Bromley
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; Desert Pacific MIRECC Health Services Unit, VA Greater Los Angeles Healthcare System, Los Angeles, CA
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Abstract
Background Given national concern over rising mortality from opioid use disorders (OUD) and challenges to increasing OUD treatment access, a coalition approach may hold promise to improve access and outcomes for diverse populations. We present considerations of a community-partnered working group on adapting the Community Partners in Care (CPIC) study and coalition approach to OUD. Method During January 2016 through January 2017, academic, provider, consumer and policy stakeholders reviewed options to adapt CPIC's Resources for Services (RS) for individual program technical assistance and Community Engagement and Planning (CEP) for coalition support to OUD treatments, integrating stakeholder input into design options with estimated sample sizes. Findings The working group recommended Community Reinforcement and Family Treatment (CRAFT) as a stakeholder-support intervention to facilitate uptake and adherence to Medications for Addiction Treatment (MAT). Recommended implementation interventions for MAT/CRAFT were expert technical assistance supplemented by organizational readiness, and CEP for coalition support with a Learning Collaborative. Power estimation suggests that to compare implementation intervention effects on abstinence would require a somewhat larger enrolled sample and 3-4 times the screening sample as CPIC, and for mortality, at least 5-10 times the enrolled sample as CPIC. Discussion Stakeholders viewed the CPIC design and interventions as feasible and acceptable as community-wide approaches for addressing the opioid epidemic, but comparing impacts on mortality would require large, multi-site trials.
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Affiliation(s)
- Kenneth B. Wells
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute, Department of Health Policy and Management, Fielding School of Public Health, RAND Health Program, Greater Los Angeles Veteran Affairs Health Care System, Los Angeles CA
| | | | - Brian Hurley
- Los Angeles Country Department of Mental Health, Los Angeles, CA
| | - Lingqi Tang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Felica Jones
- Healthy African American Families Phase II, Los Angeles, CA
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33
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Bromley E, Figueroa C, Castillo EG, Kadkhoda F, Chung B, Miranda J, Menon K, Whittington Y, Jones F, Wells KB, Kataoka SH. Community Partnering for Behavioral Health Equity: Public Agency and Community Leaders' Views of its Promise and Challenge. Ethn Dis 2018; 28:397-406. [PMID: 30202193 DOI: 10.18865/ed.28.s2.397] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective To understand potential for multi-sector partnerships among community-based organizations and publicly funded health systems to implement health improvement strategies that advance health equity. Design Key stakeholder interviewing during HNI planning and early implementation to elicit perceptions of multi-sector partnerships and innovations required for partnerships to achieve system transformation and health equity. Setting In 2014, the Los Angeles County (LAC) Board of Supervisors approved the Health Neighborhood Initiative (HNI) that aims to: 1) improve coordination of health services for behavioral health clients across safety-net providers within neighborhoods; and 2) address social determinants of health through community-driven, public agency sponsored partnerships with community-based organizations. Participants Twenty-five semi-structured interviews with 49 leaders from LAC health systems, community-based organizations; and payers. Results Leaders perceived partnerships within and beyond health systems as transformative in their potential to: improve access, value, and efficiency; align priorities of safety-net systems and communities; and harness the power of communities to impact health. Leaders identified trust as critical to success in partnerships but named lack of time for relationship-building, limitations in service capacity, and questions about sustainability as barriers to trust-building. Leaders described the need for procedural innovations within health systems that would support equitable partnerships including innovations that would increase transparency and normalize information exchange, share agenda-setting and decision-making power with partners, and institutionalize partnering through training and accountability. Conclusions Leaders described improving procedural justice in public agencies' relationships with communities as key to effective partnering for health equity.
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Affiliation(s)
- Elizabeth Bromley
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; Desert Pacific MIRECC Health Services Unit, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Chantal Figueroa
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA
| | - Enrico G Castillo
- University of California, Los Angeles, David Geffen School of Medicine, Los Angeles County Department of Mental Health, Los Angeles, CA
| | - Farbod Kadkhoda
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA
| | - Bowen Chung
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; RAND Corporation; Los Angeles Biomedical Research Institute; Healthy African American Families II, Los Angeles, CA
| | - Jeanne Miranda
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA
| | - Kumar Menon
- Los Angeles County Department of Mental Health, Los Angeles, CA
| | | | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Kenneth B Wells
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; RAND Corporation; University of California, Los Angeles School of Public Health, Los Angeles, CA
| | - Sheryl H Kataoka
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; UCLA Division of Child and Adolescent Psychiatry, Los Angeles, CA
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34
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Belin TR, Jones A, Tang L, Chung B, Stockdale SE, Jones F, Wright A, Sherbourne CD, Perlman J, Pulido E, Ong MK, Gilmore J, Miranda J, Dixon E, Jones L, Wells KB. Maintaining Internal Validity in Community Partnered Participatory Research: Experience from the Community Partners in Care Study. Ethn Dis 2018; 28:357-364. [PMID: 30202188 DOI: 10.18865/ed.28.s2.357] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective With internal validity being a central goal of designed experiments, we seek to elucidate how community partnered participatory research (CPPR) impacts the internal validity of public health comparative-effectiveness research. Methods Community Partners in Care (CPIC), a study comparing a community-coalition intervention to direct technical assistance for disseminating depression care to vulnerable populations, is used to illustrate design choices developed with attention to core CPPR principles. The study-design process is reviewed retrospectively and evaluated based on the resulting covariate balance across intervention arms and on broader peer-review assessments. Contributions of the CPIC Council and the study's design committee are highlighted. Results CPPR principles contributed to building consensus around the use of randomization, creating a sampling frame, specifying geographic boundaries delimiting the scope of the investigation, grouping similar programs into pairs or other small blocks of units, collaboratively choosing random-number-generator seeds to determine randomized intervention assignments, and addressing logistical constraints in field operations. Study protocols yielded samples that were well-balanced on background characteristics across intervention arms. CPIC has been recognized for scientific merit, has drawn attention from policymakers, and has fueled ongoing research collaborations. Conclusions Creative and collaborative fulfillment of CPPR principles reinforced the internal validity of CPIC, strengthening the study's scientific rigor by engaging complementary areas of knowledge and expertise among members of the investigative team.
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Affiliation(s)
- Thomas R Belin
- UCLA Department of Biostatistics, Center for Health Sciences, Los Angeles, CA.,UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA.,UCLA Semel Institute Center for Health Services and Society, Los Angeles, CA
| | - Andrea Jones
- Healthy African American Families II, Los Angeles, CA
| | - Lingqi Tang
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA.,UCLA Semel Institute Center for Health Services and Society, Los Angeles, CA
| | - Bowen Chung
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA.,UCLA Semel Institute Center for Health Services and Society, Los Angeles, CA.,Harbor-UCLA Medical Center, Torrance, CA
| | - Susan E Stockdale
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA.,Greater Los Angeles VA Medical Center, Sepulveda, CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Aziza Wright
- Healthy African American Families II, Los Angeles, CA
| | | | | | | | - Michael K Ong
- Greater Los Angeles VA Medical Center, Sepulveda, CA.,UCLA Department of Medicine, Los Angeles, CA
| | | | - Jeanne Miranda
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA.,UCLA Semel Institute Center for Health Services and Society, Los Angeles, CA
| | | | - Loretta Jones
- Healthy African American Families II, Los Angeles, CA
| | - Kenneth B Wells
- UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA.,UCLA Semel Institute Center for Health Services and Society, Los Angeles, CA.,RAND Corporation, Santa Monica, CA.,UCLA Department of Health Policy and Management, Center for Health Sciences, Los Angeles, CA
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35
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Arevian AC, Springgate B, Jones F, Starks SL, Chung B, Wennerstrom A, Jones L, Kataoka SH, Griffith K, Sugarman OK, Williams P, Haywood C, Kirkland A, Meyers D, Pasternak R, Simmasalam R, Tang L, Castillo EG, Mahajan A, Stevens M, Wells KB. The Community and Patient Partnered Research Network (CPPRN): Application of Patient-Centered Outcomes Research to Promote Behavioral Health Equity. Ethn Dis 2018; 28:295-302. [PMID: 30202181 DOI: 10.18865/ed.28.s2.295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective We describe the rationale, development, and progress on the Community and Patient Partnered Research Network (CPPRN). The CPPRN builds on more than a decade of partnered work and is designed to promote health equity by developing partnered research on behavioral health and social risk factors in Los Angeles and New Orleans. Setting A community-academic partnership across Los Angeles County and New Orleans. Methods Review of rationale, history, structure, activities and progress in applying community partnered participatory research (CPPR) to CPPRN. Findings Patient and community stakeholders participated in all phases of development, including local and national activities. Key developments include partnered planning efforts, progress on aggregating a large, de-identified dataset across county agencies, and development of an information technology-supported screening approach for behavioral and social determinants in health care, social, and community-based settings. Conclusion The CPPRN represents a promising approach for research data networks, balancing the potential benefit of information technology and data analytic approaches while addressing potential risks and priorities of relevant stakeholders.
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Affiliation(s)
- Armen C Arevian
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | | | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Sarah L Starks
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Bowen Chung
- Los Angeles County Department of Mental Health Services; Harbor-UCLA Medical Center; UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | | | - Loretta Jones
- Healthy African American Families II; Charles R Drew University of Medicine and Science, Los Angeles, CA
| | - Sheryl H Kataoka
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Krystal Griffith
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Olivia K Sugarman
- LSU Health Sciences Center New Orleans School of Medicine, New Orleans, LA
| | - Pluscedia Williams
- Healthy African American Families II; Charles R Drew University of Medicine and Science, Los Angeles, CA
| | | | | | | | - Ryan Pasternak
- LSU Health Sciences Center New Orleans School of Medicine, New Orleans, LA
| | - Rubinee Simmasalam
- LSU Health Sciences Center New Orleans School of Medicine, New Orleans, LA
| | - Lingqi Tang
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Enrico G Castillo
- UCLA David Geffen School of Medicine; Los Angeles County Department of Mental Health, Los Angeles, CA
| | | | - Max Stevens
- Los Angeles County Chief Executive Office, Los Angeles, CA
| | - Kenneth B Wells
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
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36
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Jones L, Wells K, Lin HJ, Wang C, Alo AK, Williams P, Jones F, Dickson PI, Han S, Pardo D, Norris K, Jones A, Wright A, Young K, Rotter JI. Community Partnership in Precision Medicine: Themes from a Community Engagement Conference. Ethn Dis 2018; 28:503-510. [PMID: 30202204 DOI: 10.18865/ed.28.s2.503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Patient and community engagement in under-resourced communities is a key issue for precision medicine research. We report proceedings from a community-academic partnered conference in Los Angeles to promote community understanding of precision medicine and generate engagement recommendations. Methods Planning group review of planning, presentations, and audience discussions from facilitator notes and participant survey data from a one-day conference. Findings Community-academic planning broadened community participation and presentations. More than 80% of survey participants indicated they would participate in the national precision medicine initiative, and most were willing to share diverse sources of data. Discussions identified trust concerns related to historical research abuses, data privacy, potential effects of findings on health care, personal safety, research procedures, the time-frame for benefit, and confusion about different initiatives. Concerns were balanced by belief in science to improve health. Recommendations included a community partnered participatory approach with support for local community and academic teams to engage stakeholders with written/online resources and partnered workgroups addressing key concerns. Conclusion Conference participants expressed high willingness to participate in precision medicine studies, but discussions highlighted trust and transparency issues and suggested community partnered research with local capacity building.
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Affiliation(s)
- Loretta Jones
- Healthy African American Families Phase II, Los Angeles, CA.,Charles R. Drew University of Medicine and Science, Los Angeles, CA
| | - Kenneth Wells
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute, Department of Health Policy and Management, Fielding School of Public Health, RAND Health Program, Los Angeles, CA
| | - Henry J Lin
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA
| | - Christina Wang
- Clinical and Translational Science Institute, Los Angeles Biomedical Research Institute/ Harbor-UCLA Medical Center, Torrance, CA
| | - Audrey Kawaiopua Alo
- Pacific Islander Health Partnership, Director, UCLA Clinical and Translational Institute, External Advisory Committee, Patient Advocate, Los Angeles, CA
| | - Pluscedia Williams
- Healthy African American Families Phase II, Los Angeles, CA.,Charles R. Drew University of Medicine and Science, Los Angeles, CA.,Clinical and Translational Science Institute, Los Angeles Biomedical Research Institute/ Harbor-UCLA Medical Center, Torrance, CA
| | - Felica Jones
- Healthy African American Families Phase II, Los Angeles, CA
| | - Patricia I Dickson
- Clinical and Translational Science Institute, Los Angeles Biomedical Research Institute/ Harbor-UCLA Medical Center, Torrance, CA
| | - Sophia Han
- Clinical and Translational Science Institute, Los Angeles Biomedical Research Institute/ Harbor-UCLA Medical Center, Torrance, CA
| | | | - Keith Norris
- David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Andrea Jones
- Healthy African American Families Phase II, Los Angeles, CA.,Charles R. Drew University of Medicine and Science, Los Angeles, CA
| | - Aziza Wright
- Healthy African American Families Phase II, Los Angeles, CA.,Charles R. Drew University of Medicine and Science, Los Angeles, CA.,The RAND Corporation, Los Angeles, CA
| | - Kawen Young
- Native Hawaiian and Pacific Islander Alliance, Gardena, CA
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA
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Wennerstrom A, Springgate BF, Jones F, Meyers D, Henderson N, Brown A, Niyogi A, Martin D, Smith J, Kirkland AL, Jones L, Norris KC. Lessons on Patient and Stakeholder Engagement Strategies for Pipeline to Proposal Awards. Ethn Dis 2018; 28:303-310. [PMID: 30202182 DOI: 10.18865/ed.28.s2.303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The Patient Centered Outcomes Research Institute (PCORI) supports patient-centered clinical comparative effectiveness research (CER) including health disparities and engagement portfolios. In 2013, PCORI launched the Pipeline to Proposal (P2P) mechanism to support development of novel patient- and stakeholder-centered partnerships focused on designing clinical CER funding proposals. By providing a tiered structure of successive small contracts and technical assistance, the P2P mechanism encourages development of new research partnerships among diverse stakeholders. As a comparatively new field, patient-centered outcomes research (PCOR) has few well-delineated methods for engaging patients and other non-scientists in effective teams with academics or clinicians to develop and implement rigorous, scientific research proposals. Community partnered participatory research (CPPR) provides a useful framework for structuring new partnerships. In this article we highlight the origins, development, and prospects of three current examples of funded P2P initiatives based in New Orleans and Los Angeles. We outline how these projects - Prisoner to Patient, the NOLA Partnership, and Resilience Among African American Men - use CPPR principles. We also describe how they have collaborated with, and contributed to, a two-way learning and knowledge exchange among members of the PCORI-funded Community and Patient Partnered Research Network. Lessons learned may be applicable to other groups planning to create new partnerships focused on implementing PCOR.
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Affiliation(s)
| | | | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | | | | | - Anthony Brown
- Healthy African American Families II, Los Angeles, CA
| | - Anjali Niyogi
- Tulane University School of Medicine, New Orleans, LA
| | | | - Jessie Smith
- Tulane University School of Medicine, New Orleans, LA
| | | | - Loretta Jones
- Healthy African American Families II, Los Angeles, CA
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Arevian AC, O'Hora J, Jones F, Mango J, Jones L, Williams PG, Booker-Vaughns J, Jones A, Pulido E, Banner-Jackson D, Wells KB. Participatory Technology Development to Enhance Community Resilience. Ethn Dis 2018; 28:493-502. [PMID: 30202203 DOI: 10.18865/ed.28.s2.493] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To assess the feasibility of a novel, partnered technology development process to co-create mobile health applications (apps) addressing community health priorities, using psychoeducation of cognitive behavioral therapy (CBT) principles for enhancing resilience as an example. Design Stakeholder engagement, workgroups, pilot feasibility study using mixed methods during October 2013 through January 2016 over three phases: 1) defining the vision of the project and increasing technical capacity, 2) co-development and pilot testing of the app, and 3) planning for sustainability. Setting An academic-community partnership in South Los Angeles, California. Participants Eight stakeholders; 30 pilot participants from the community. Main Outcome Measures Qualitative analysis of audio-recordings of the app development process and stakeholder interviews, surveys of stakeholders' perception of the development process, app use data, and feedback from pilot participants. Results The participatory technology development process resulted in creation and pilot-testing of a resiliency-focused text messaging app. Of the 1,107 messages sent, 23 out of 30 (77%) app users responded to explore interactive content. Stakeholders reported increased perceived competency in creating mobile apps and that the process fostered a culture of co-leadership. There was also sustained engagement in mobile app development by stakeholders beyond the initial project period. Conclusions This is the first study, to our knowledge, to demonstrate the feasibility of participatory technology development, an approach involving direct participation in the development, tailoring and maintenance of a mobile app by a broad set of stakeholders with high representation from racial/ethnic minorities from an under-resourced community. Participatory technology development is a promising approach for creating sustainable, relevant and engaging health technologies across different technological, clinical and community settings.
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Affiliation(s)
| | | | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Joseph Mango
- UCLA Center for Health Services and Society, Semel Institute, Los Angeles, CA
| | - Loretta Jones
- Healthy African American Families II, Los Angeles, CA
| | | | | | - Andrea Jones
- Healthy African American Families II, Los Angeles, CA
| | | | | | - Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, Geffen School of Medicine at UCLA, Los Angeles, CA
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Springgate B, Tang L, Ong M, Aoki W, Chung B, Dixon E, Johnson MD, Jones F, Landry C, Lizaola E, Mtume N, Ngo VK, Pulido E, Sherbourne C, Wright AL, Whittington Y, Williams P, Zhang L, Miranda J, Belin T, Gilmore J, Jones L, Wells KB. Comparative Effectiveness of Coalitions Versus Technical Assistance for Depression Quality Improvement in Persons with Multiple Chronic Conditions. Ethn Dis 2018; 28:325-338. [PMID: 30202185 DOI: 10.18865/ed.28.s2.325] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Significance Prior research suggests that Community Engagement and Planning (CEP) for coalition support compared with Resources for Services (RS) for program technical assistance to implement depression quality improvement programs improves 6- and 12-month client mental-health related quality of life (MHRQL); however, effects for clients with multiple chronic medical conditions (MCC) are unknown. Objective To explore effectiveness of CEP vs RS in MCC and non-MCC subgroups. Design Secondary analyses of a cluster-randomized trial. Setting 93 health care and community-based programs in two neighborhoods. Participants Of 4,440 clients screened, 1,322 depressed (Patient Health Questionnaire, PHQ8) provided contact information, 1,246 enrolled and 1,018 (548 with ≥3 MCC) completed baseline, 6- or 12-month surveys. Intervention CEP or RS for implementing depression quality improvement programs. Outcomes and Analyses Primary: depression (PHQ9 <10), poor MHRQL (Short Form Health Survey, SF-12<40); Secondary: mental wellness, good physical health, behavioral health hospitalization, chronic homelessness risk, work/workloss days, services use at 6 and 12 months. End-point regressions were used to estimate intervention effects on outcomes for subgroups with ≥3 MCC, non-MCC, and intervention-by-MCC interactions (exploratory). Results Among MCC clients at 6 months, CEP vs RS lowered likelihoods of depression and poor MHRQL; increased likelihood of mental wellness; reduced work-loss days among employed and likelihoods of ≥4 behavioral-health hospitalization nights and chronic homelessness risk, while increasing faith-based and park community center depression services; and at 12 months, likelihood of good physical health and park community center depression services use (each P<.05). There were no significant interactions or primary outcome effects for non-MCC. Conclusions CEP was more effective than RS in improving 6-month primary outcomes among depressed MCC clients, without significant interactions.
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Affiliation(s)
- Benjamin Springgate
- Louisiana State University, Department of Medicine, School of Medicine, New Orleans, LA
| | - Lingqi Tang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Michael Ong
- David Geffen School of Medicine at UCLA, Los Angeles CA
| | - Wayne Aoki
- Los Angeles Christian Health Centers, Los Angeles CA
| | - Bowen Chung
- Los Angeles County Department of Mental Health Services, UCLA-Harbor General Hospital, David Geffen School of Medicine and Semel Institute at UCLA, RAND Health Program, Los Angeles CA
| | - Elizabeth Dixon
- School of Nursing, University of California, Los Angeles, Los Angeles CA
| | - Megan Dwight Johnson
- Greater Los Angeles Veteran Affairs Health Care System, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Craig Landry
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Elizabeth Lizaola
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | | | | | | | | | - Aziza Lucas Wright
- The RAND Corporation, Healthy African American Families II, New Vision Church of Jesus Christ, Los Angeles CA
| | | | - Pluscedia Williams
- Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles, CA
| | - Lily Zhang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute, Los Angeles CA
| | - Thomas Belin
- Department of Biostatistics, Fielding School of Public Health, South Los Angeles CA
| | | | - Loretta Jones
- Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles CA
| | - Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute, Department of Health Policy and Management, Fielding School of Public Health at UCLA; RAND Health Program, Los Angeles CA
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Figueroa C, Castillo EG, Norquist G, Wells KB, Griffith K, Kadkhoda F, Jones F, Shorter P, Bromley E. A Window of Opportunity: Visions and Strategies for Behavioral Health Policy Innovation. Ethn Dis 2018; 28:407-416. [PMID: 30202194 DOI: 10.18865/ed.28.s2.407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective The New York City's Thrive (ThriveNYC) and the Los Angeles County Health Neighborhood Initiative (HNI) are two local policies focused on addressing the social determinants of behavioral health as a preventive strategy for improving health service delivery. On January 29, 2016, leaders from both initiatives came together with a range of federal agencies in health care, public health, and policy research at the RAND Corporation in Arlington, Virginia. The goal of this advisory meeting was to share lessons learned, consider research and evaluation strategies, and create a dialogue between stakeholders and federal funders - all with the purpose to build momentum for policy innovation in behavioral health equity. Methods This article analyzes ethnographic notes taken during the meeting and in-depth interviews of 14 meeting participants through Kingdon's multiple streams theory of policy change. Results Results demonstrated that stakeholders shared a vision for behavioral health policy innovation focused on community engagement and social determinants of health. In addition, Kingdon's model highlighted that the problem, policy and politics streams needed to form a window of opportunity for policy change were coupled, enabling the possibility for behavioral health policy innovation. Conclusions The advisory meeting suggested that local policy makers, academics, and community members, together with federal agents, are working to implement behavioral health policy innovation.
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Affiliation(s)
| | - Enrico G Castillo
- University of California, Los Angeles, David Geffen School of Medicine, Los Angeles County Department of Mental Health, Los Angeles, CA
| | - Grayson Norquist
- Emory University Department of Psychiatry and Behavioral Sciences Chief of Psychiatry Service, Grady Health System, Atlanta, GA
| | - Kenneth B Wells
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine at UCLA, Department of Psychiatry & Biobehavioral Sciences; RAND Corporation; University of California, Los Angeles School of Public Health, Los Angeles, CA
| | - Krystal Griffith
- Center for Health Services and Society, University of California, Los Angeles, CA
| | - Farbod Kadkhoda
- Center for Health Services and Society, University of California, Los Angeles, CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Priscilla Shorter
- IDEAS Center, The Child Study Center of NYU at NYU Langone Medical Center, Department of Child and Adolescent Psychiatry, NYC, NY
| | - Elizabeth Bromley
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; Desert Pacific MIRECC Health Services Unit, VA Greater Los Angeles Healthcare System, Los Angeles, CA
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Izquierdo A, Ong M, Jones F, Jones L, Ganz D, Rubenstein L. Engaging African American Veterans with Health Care Access Challenges in a Community Partnered Care Coordination Initiative: A Qualitative Needs Assessment. Ethn Dis 2018; 28:475-484. [PMID: 30202201 DOI: 10.18865/ed.28.s2.475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Little has been written about engaging potentially eligible members of a health care system who are not accessing the care to which they are entitled. Knowing more about the experiences of African American Veterans who regularly experience health care access challenges may be an important step toward equitable, coordinated Veterans Health Administration (VHA) care. This article explores the experiences of African American Veterans who are at risk of experiencing poor care coordination. Design We partnered with a community organization to recruit and engage Veterans in three exploratory engagement workshops between October 2015 and February 2016. Participants and Setting Veterans living in South Los Angeles, California. Main Outcome Measures Veterans were asked to describe their experiences with community care and the VHA, a division of the US Department of Veterans Affairs (VA). Field notes taken during the workshops were analyzed by community and academic partners using grounded theory methodology to identify emergent themes. Results 12 Veterans and 3 family members of Veterans participated in one or more engagement workshops. Their trust in the VA was generally low. Positive themes included: Veterans have knowledge to share and want to help other Veterans; and connecting to VA services can result in positive experiences. Negative themes included: functional barriers to accessing VA health care services; insensitive VA health care environment; lack of trust in the VA health care system; and Veteran status as disadvantageous for accessing non-VA community services. Conclusions Veterans living in underserved areas who have had difficulty accessing VA care have unique perspectives on VA services. Partnering with trusted local community organizations to engage Veterans in their home communities is a promising strategy to inform efforts to improve care access and coordination for vulnerable Veterans.
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Affiliation(s)
- Adriana Izquierdo
- Department of Medicine, University of California, Los Angeles, CA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA.,Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, CA
| | - Michael Ong
- Department of Medicine, University of California, Los Angeles, CA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA.,Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Loretta Jones
- Healthy African American Families II, Los Angeles, CA.,Charles R. Drew University of Medicine & Science, Los Angeles, CA
| | - David Ganz
- VA Greater Los Angeles Healthcare System, Los Angeles, CA.,Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, CA.,Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA.,Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.,RAND Corporation, Santa Monica, CA
| | - Lisa Rubenstein
- Department of Medicine, University of California, Los Angeles, CA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA.,Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, CA.,RAND Corporation, Santa Monica, CA
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Thames AD, Hammond A, Nunez RA, Mahmood Z, Jones F, Carter SL, Bilder RM, Fisher S, Bivens-Davis T, Jones L. Sexual Health Behavior and Mental Health Among Older African American Women: The Sistahs, Sexuality, and Mental Health Well-Being Project. J Womens Health (Larchmt) 2018; 27:1177-1185. [PMID: 30070959 DOI: 10.1089/jwh.2017.6777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In Los Angeles County, the rates of sexually transmitted infections and diseases among African Americans represent a significant public health disparity. Older African American women are at particular risk as they are more likely to engage in high-risk sexual behaviors and report social isolation and loneliness than their younger counterparts. However, the literature on the relationship between sexual health and mental health in this group is limited. The purpose of this study was to use a community-based participatory research (CBPR) approach to better understand sexual health behaviors and mental health among African American women over 50 years of age who reside in South Los Angeles. MATERIALS AND METHODS This project was divided into two phases. Phase I (January-March 2017) of the project consisted of four dialog/focus groups (N = 45) (ages: 50-80; Mage = 67). The purpose of Phase II (April 2017) was to present study results from Phase I to the community via a community-based conference, as well as gather feedback and generate discussion about the next steps for community prevention/intervention. RESULTS Women reported that they did not feel comfortable discussing sexual practices with their physician, partners, and friends. Most women identified depression, loneliness, and self-esteem issues as reasons for engaging in high-risk sexual behaviors. During Phase II, potential intervention avenues emerged to address issues such as lack of physician-patient communication, lack of community support, and dialogs about sex. CONCLUSIONS The use of CBPR greatly enhanced our knowledge of the core issues surrounding sexual health and mental health among older African American women.
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Affiliation(s)
- April D Thames
- 1 Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles , Los Angeles, California
| | - Andrea Hammond
- 1 Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles , Los Angeles, California
| | - Rodolfo A Nunez
- 1 Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles , Los Angeles, California.,2 Department of Psychology, University of California Los Angeles , Los Angeles, California
| | - Zanjbeel Mahmood
- 1 Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles , Los Angeles, California
| | - Felica Jones
- 3 Healthy African American Families II , Los Angeles, California
| | | | - Robert M Bilder
- 1 Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles , Los Angeles, California
| | - Steven Fisher
- 5 Fox Hills Ladera Healthy Families Association , Los Angeles, California
| | | | - Loretta Jones
- 3 Healthy African American Families II , Los Angeles, California
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Ramdharry G, Jones F, Holmes S, James N, Booth S, Reilly M, Hanna M. Neuro-muscular bridges: development of an evidence based selfmanagement resource for people with neuro-muscular diseases. Neuromuscul Disord 2018. [DOI: 10.1016/s0960-8966(18)30412-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Castillo EG, Shaner R, Tang L, Chung B, Jones F, Whittington Y, Miranda J, Wells KB. Improving Depression Care for Adults With Serious Mental Illness in Underresourced Areas: Community Coalitions Versus Technical Support. Psychiatr Serv 2018; 69:195-203. [PMID: 29032700 PMCID: PMC5794612 DOI: 10.1176/appi.ps.201600514] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Community Partners in Care (CPIC) was a group-randomized study of two approaches to implementing expanded collaborative depression care: Community Engagement and Planning (CEP), a coalition approach, and Resources for Services (RS), a technical assistance approach. Collaborative care networks in both arms involved health care and other agencies in five service sectors. This study examined six- and 12-month outcomes for CPIC participants with serious mental illness. METHODS This secondary analysis focused on low-income CPIC participants from racial-ethnic minority groups with serious mental illness in underresourced Los Angeles communities (N=504). Serious mental illness was defined as self-reported severe depression (≥20 on the Patient Health Questionnaire-8) at baseline or a lifetime history of bipolar disorder or psychosis. Logistic and Poisson regression with multiple imputation and response weights, controlling for covariates, was used to model intervention effects. RESULTS Among CPIC participants, 50% had serious mental illness. Among those with serious mental illness, CEP relative to RS reduced the likelihood of poor mental health-related quality of life (OR=.62, 95% CI=.41-.95) but not depression (primary outcomes); reduced the likelihood of having homelessness risk factors and behavioral health hospitalizations; increased the likelihood of mental wellness; reduced specialty mental health medication and counseling visits; and increased faith-based depression visits (each p<.05) at six months. There were no statistically significant 12-month effects. CONCLUSIONS Findings suggest that a coalition approach to implementing expanded collaborative depression care, compared with technical assistance to individual programs, may reduce short-term behavioral health hospitalizations and improve mental health-related quality of life and some social outcomes for adults with serious mental illness, although no evidence was found for long-term effects in this subsample.
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Affiliation(s)
- Enrico G Castillo
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Roderick Shaner
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Lingqi Tang
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Bowen Chung
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Felica Jones
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Yolanda Whittington
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Jeanne Miranda
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
| | - Kenneth B Wells
- Dr. Castillo, Dr. Tang, Dr. Chung, Dr. Miranda, and Dr. Wells are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles. Dr. Shaner and Ms. Whittington are with the Los Angeles County Department of Mental Health. Ms. Jones is with Healthy African American Families II, Los Angeles
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Grasselli J, Elez E, Caratù G, Matito J, Santos C, Macarulla T, Vidal J, Garcia M, Viéitez JM, Paéz D, Falcó E, Lopez Lopez C, Aranda E, Jones F, Sikri V, Nuciforo P, Fasani R, Tabernero J, Montagut C, Azuara D, Dienstmann R, Salazar R, Vivancos A. Concordance of blood- and tumor-based detection of RAS mutations to guide anti-EGFR therapy in metastatic colorectal cancer. Ann Oncol 2018; 28:1294-1301. [PMID: 28368441 PMCID: PMC5834108 DOI: 10.1093/annonc/mdx112] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Circulating tumor DNA (ctDNA) is a potential source for tumor genome analysis. We explored the concordance between the mutational status of RAS in tumor tissue and ctDNA in metastatic colorectal cancer (mCRC) patients to establish eligibility for anti-epidermal growth factor receptor (EGFR) therapy. Patients and methods A prospective-retrospective cohort study was carried out. Tumor tissue from 146 mCRC patients was tested for RAS status with standard of care (SoC) PCR techniques, and Digital PCR (BEAMing) was used both in plasma and tumor tissue. Results ctDNA BEAMing RAS testing showed 89.7% agreement with SoC (Kappa index 0.80; 95% CI 0.71 − 0.90) and BEAMing in tissue showed 90.9% agreement with SoC (Kappa index 0.83; 95% CI 0.74 − 0.92). Fifteen cases (10.3%) showed discordant tissue-plasma results. ctDNA analysis identified nine cases of low frequency RAS mutations that were not detected in tissue, possibly due to technical sensitivity or heterogeneity. In six cases, RAS mutations were not detected in plasma, potentially explained by low tumor burden or ctDNA shedding. Prediction of treatment benefit in patients receiving anti-EGFR plus irinotecan in second- or third-line was equivalent if tested with SoC PCR and ctDNA. Forty-eight percent of the patients showed mutant allele fractions in plasma below 1%. Conclusions Plasma RAS determination showed high overall agreement and captured a mCRC population responsive to anti-EGFR therapy with the same predictive level as SoC tissue testing. The feasibility and practicality of ctDNA analysis may translate into an alternative tool for anti-EGFR treatment selection.
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Affiliation(s)
- J Grasselli
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Barcelona.,Department of Medical Oncology, Catalan Institute of Oncology, Universitat de Barcelona, L'Hospitalet, Barcelona
| | - E Elez
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Barcelona.,Department of Medical Oncology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona
| | - G Caratù
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona
| | - J Matito
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona
| | - C Santos
- Department of Medical Oncology, Catalan Institute of Oncology, Universitat de Barcelona, L'Hospitalet, Barcelona
| | - T Macarulla
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Barcelona.,Department of Medical Oncology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona
| | - J Vidal
- Department of Medical Oncology, Del Mar University Hospital, Barcelona
| | - M Garcia
- Department of Medical Oncology, Catalan Institute of Oncology, Universitat de Barcelona, L'Hospitalet, Barcelona
| | - J M Viéitez
- Department of Medical Oncology, Asturias University Hospital, Oviedo
| | - D Paéz
- Department of Medical Oncology, Santa Creu i Sant Pau University Hospital, Barcelona
| | - E Falcó
- Department of Medical Oncology, Son Llatzer University Hospital, Palma de Mallorca
| | - C Lopez Lopez
- Department of Medical Oncology, Marques de Valdecilla University Hospital, Santander
| | - E Aranda
- Department of Medical Oncology, Reina Sofía University Hospital, Córdoba, Spain
| | - F Jones
- Sysmex Inostics, Mundelein, USA
| | - V Sikri
- Sysmex Inostics, Mundelein, USA
| | - P Nuciforo
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology, Barcelona
| | - R Fasani
- Molecular Oncology Group, Vall d'Hebron Institute of Oncology, Barcelona
| | - J Tabernero
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Barcelona.,Department of Medical Oncology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona
| | - C Montagut
- Department of Medical Oncology, Del Mar University Hospital, Barcelona
| | - D Azuara
- Traslational Research Laboratory, Catalan Institute of Oncology, L'Hospitalet, Barcelona
| | - R Dienstmann
- Department of Medical Oncology, Vall d'Hebron Institute of Oncology, Barcelona.,Oncology Data Science Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - R Salazar
- Department of Medical Oncology, Catalan Institute of Oncology, Universitat de Barcelona, L'Hospitalet, Barcelona
| | - A Vivancos
- Cancer Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona
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Vidal J, Muinelo L, Dalmases A, Jones F, Edelstein D, Iglesias M, Orrillo M, Abalo A, Rodríguez C, Brozos E, Vidal Y, Candamio S, Vázquez F, Ruiz J, Guix M, Visa L, Sikri V, Albanell J, Bellosillo B, López R, Montagut C. Plasma ctDNA RAS mutation analysis for the diagnosis and treatment monitoring of metastatic colorectal cancer patients. Ann Oncol 2018; 28:1325-1332. [PMID: 28419195 PMCID: PMC5834035 DOI: 10.1093/annonc/mdx125] [Citation(s) in RCA: 247] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background RAS assessment is mandatory for therapy decision in metastatic colorectal cancer (mCRC) patients. This determination is based on tumor tissue, however, genotyping of circulating tumor (ct)DNA offers clear advantages as a minimally invasive method that represents tumor heterogeneity. Our study aims to evaluate the use of ctDNA as an alternative for determining baseline RAS status and subsequent monitoring of RAS mutations during therapy as a component of routine clinical practice. Patients and methods RAS mutational status in plasma was evaluated in mCRC patients by OncoBEAM™ RAS CRC assay. Concordance of results in plasma and tissue was retrospectively evaluated. RAS mutations were also prospectively monitored in longitudinal plasma samples from selected patients. Results Analysis of RAS in tissue and plasma samples from 115 mCRC patients showed a 93% overall agreement. Plasma/tissue RAS discrepancies were mainly explained by spatial and temporal tumor heterogeneity. Analysis of clinico-pathological features showed that the site of metastasis (i.e. peritoneal, lung), the histology of the tumor (i.e. mucinous) and administration of treatment previous to blood collection negatively impacted the detection of RAS in ctDNA. In patients with baseline mutant RAS tumors treated with chemotherapy/antiangiogenic, longitudinal analysis of RAS ctDNA mirrored response to treatment, being an early predictor of response. In patients RAS wt, longitudinal monitoring of RAS ctDNA revealed that OncoBEAM was useful to detect emergence of RAS mutations during anti-EGFR treatment. Conclusion The high overall agreement in RAS mutational assessment between plasma and tissue supports blood-based testing with OncoBEAM™ as a viable alternative for genotyping RAS of mCRC patients in routine clinical practice. Our study describes practical clinico-pathological specifications to optimize RAS ctDNA determination. Moreover, OncoBEAM™ is useful to monitor RAS in patients undergoing systemic therapy to detect resistance and evaluate the efficacy of particular treatments.
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Affiliation(s)
- J Vidal
- Cancer Research Program, FIMIM Hospital del Mar, Barcelona, Spain.,Medical Oncology Department, Hospital del Mar, Barcelona
| | - L Muinelo
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - A Dalmases
- Pathology Department, Hospital del Mar, Barcelona
| | - F Jones
- Sysmex Inostics Inc., Mundelein, USA
| | | | - M Iglesias
- Cancer Research Program, FIMIM Hospital del Mar, Barcelona, Spain.,Pathology Department, Hospital del Mar, Barcelona
| | - M Orrillo
- Medical Oncology Department, Hospital del Mar, Barcelona
| | - A Abalo
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - C Rodríguez
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - E Brozos
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - Y Vidal
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - S Candamio
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - F Vázquez
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - J Ruiz
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - M Guix
- Medical Oncology Department, Hospital del Mar, Barcelona
| | - L Visa
- Medical Oncology Department, Hospital del Mar, Barcelona
| | - V Sikri
- Sysmex Inostics Inc., Mundelein, USA
| | - J Albanell
- Cancer Research Program, FIMIM Hospital del Mar, Barcelona, Spain.,Medical Oncology Department, Hospital del Mar, Barcelona.,Universitat Pompeu Fabra, Barcelona, Spain
| | - B Bellosillo
- Medical Oncology Department, Hospital del Mar, Barcelona.,Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - R López
- Traslational Medical Oncology Group (Oncomet)/Liquid Biopsy Analysis Unit, Health Research Institute of Santiago (IDIS), Complexo Hospitalario Universitario de Santiago de Compostela (SERGAS) CIBERONC, Santiago de Compostela
| | - C Montagut
- Cancer Research Program, FIMIM Hospital del Mar, Barcelona, Spain.,Medical Oncology Department, Hospital del Mar, Barcelona
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Springgate B, Tang L, Ong M, Aoki W, Chung B, Dixon E, Johnson MD, Jones F, Landry C, Lizaola E, Mtume N, Ngo VK, Pulido E, Sherbourne C, Wright AL, Whittington Y, Williams P, Zhang L, Miranda J, Belin T, Gilmore J, Jones L, Wells KB. Comparative Effectiveness of Coalitions Versus Technical Assistance for Depression Quality Improvement in Persons with Multiple Chronic Conditions. Ethn Dis 2018. [PMID: 30202185 DOI: 10.18865/ed.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
SIGNIFICANCE Prior research suggests that Community Engagement and Planning (CEP) for coalition support compared with Resources for Services (RS) for program technical assistance to implement depression quality improvement programs improves 6- and 12-month client mental-health related quality of life (MHRQL); however, effects for clients with multiple chronic medical conditions (MCC) are unknown. OBJECTIVE To explore effectiveness of CEP vs RS in MCC and non-MCC subgroups. DESIGN Secondary analyses of a cluster-randomized trial. SETTING 93 health care and community-based programs in two neighborhoods. PARTICIPANTS Of 4,440 clients screened, 1,322 depressed (Patient Health Questionnaire, PHQ8) provided contact information, 1,246 enrolled and 1,018 (548 with ≥3 MCC) completed baseline, 6- or 12-month surveys. INTERVENTION CEP or RS for implementing depression quality improvement programs. OUTCOMES AND ANALYSES Primary: depression (PHQ9 <10), poor MHRQL (Short Form Health Survey, SF-12<40); Secondary: mental wellness, good physical health, behavioral health hospitalization, chronic homelessness risk, work/workloss days, services use at 6 and 12 months. End-point regressions were used to estimate intervention effects on outcomes for subgroups with ≥3 MCC, non-MCC, and intervention-by-MCC interactions (exploratory). RESULTS Among MCC clients at 6 months, CEP vs RS lowered likelihoods of depression and poor MHRQL; increased likelihood of mental wellness; reduced work-loss days among employed and likelihoods of ≥4 behavioral-health hospitalization nights and chronic homelessness risk, while increasing faith-based and park community center depression services; and at 12 months, likelihood of good physical health and park community center depression services use (each P<.05). There were no significant interactions or primary outcome effects for non-MCC. CONCLUSIONS CEP was more effective than RS in improving 6-month primary outcomes among depressed MCC clients, without significant interactions.
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Affiliation(s)
- Benjamin Springgate
- Louisiana State University, Department of Medicine, School of Medicine, New Orleans, LA
| | - Lingqi Tang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Michael Ong
- David Geffen School of Medicine at UCLA, Los Angeles CA
| | - Wayne Aoki
- Los Angeles Christian Health Centers, Los Angeles CA
| | - Bowen Chung
- Los Angeles County Department of Mental Health Services, UCLA-Harbor General Hospital, David Geffen School of Medicine and Semel Institute at UCLA, RAND Health Program, Los Angeles CA
| | - Elizabeth Dixon
- School of Nursing, University of California, Los Angeles, Los Angeles CA
| | - Megan Dwight Johnson
- Greater Los Angeles Veteran Affairs Health Care System, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Craig Landry
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Elizabeth Lizaola
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | | | | | | | | | - Aziza Lucas Wright
- The RAND Corporation, Healthy African American Families II, New Vision Church of Jesus Christ, Los Angeles CA
| | | | - Pluscedia Williams
- Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles, CA
| | - Lily Zhang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute, Los Angeles CA
| | - Thomas Belin
- Department of Biostatistics, Fielding School of Public Health, South Los Angeles CA
| | | | - Loretta Jones
- Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles CA
| | - Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute, Department of Health Policy and Management, Fielding School of Public Health at UCLA; RAND Health Program, Los Angeles CA
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48
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Berman BA, Jones L, Jones F, Jones A, Pacheco BA, McCarthy WJ. How can we help African American substance users stop smoking? client and agency perspectives. J Ethn Subst Abuse 2017; 18:428-444. [PMID: 29257942 DOI: 10.1080/15332640.2017.1404955] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Research is needed to better understand barriers to smoking cessation and sustained abstinence among racial/ethnic minority polydrug users. We conducted community dialogue groups involving 49 clients in substance use treatment programs with predominantly ethnic minority clientele and individual dialogues/interviews with seven program providers (stakeholders). Most clients were African American, under 40 years old, women, current smokers, and high school graduates. Smoking cessation services in these programs were considered inadequate and community programs insufficiently culturally tailored and economically and geographically inaccessible. Participants discussed individual "willpower" and choice; agency tobacco-related programs and policies; the relationships between smoking, smoking cessation, and treatment goals; and steps needed to reshape agency services and policies to provide greater support for smoking cessation in this at-risk population.
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Affiliation(s)
- Barbara A Berman
- a Department of Health Policy and Management , UCLA Fielding School of Public Health , Los Angeles , California
| | - Loretta Jones
- b Division of Community Engagement Healthy African American Families , Los Angeles , California.,c Department of Preventive and Social Medicine, Community Faculty , Charles R. Drew University of Medicine and Science , Los Angeles , California
| | - Felica Jones
- b Division of Community Engagement Healthy African American Families , Los Angeles , California
| | - Andrea Jones
- b Division of Community Engagement Healthy African American Families , Los Angeles , California.,d Charles R. Drew University of Medicine and Science , Los Angeles , California
| | | | - William J McCarthy
- a Department of Health Policy and Management , UCLA Fielding School of Public Health , Los Angeles , California
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49
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Ong MK, Jones L, Aoki W, Belin TR, Bromley E, Chung B, Dixon E, Johnson MD, Jones F, Koegel P, Khodyakov D, Landry CM, Lizaola E, Mtume N, Ngo VK, Perlman J, Pulido E, Sauer V, Sherbourne CD, Tang L, Vidaurri E, Whittington Y, Williams P, Lucas-Wright A, Zhang L, Southard M, Miranda J, Wells K. A Community-Partnered, Participatory, Cluster-Randomized Study of Depression Care Quality Improvement: Three-Year Outcomes. Psychiatr Serv 2017; 68:1262-1270. [PMID: 28712349 PMCID: PMC5711579 DOI: 10.1176/appi.ps.201600488] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Community Partners in Care, a community-partnered, cluster-randomized trial with depressed clients from 93 Los Angeles health and community programs, examined the added value of a community coalition approach (Community Engagement and Planning [CEP]) versus individual program technical assistance (Resources for Services [RS]) for implementing depression quality improvement in underserved communities. CEP was more effective than RS in improving mental health-related quality of life, reducing behavioral health hospitalizations, and shifting services toward community-based programs at six months. At 12 months, continued evidence of improvement was found. This study examined three-year outcomes. METHODS Among 1,004 participants with depression who were eligible for three-year follow-up, 600 participants from 89 programs completed surveys. Multiple regression analyses estimated intervention effects on poor mental health-related quality of life and depression, physical health-related quality of life, behavioral health hospital nights, and use of services. RESULTS At three years, no differences were found in the effects of CEP versus RS on depression or mental health-related quality of life, but CEP had modest effects in improving physical health-related quality of life and reducing behavioral health hospital nights, and CEP participants had more social- and community-sector depression visits and greater use of mood stabilizers. Sensitivity analyses with longitudinal modeling reproduced these findings but found no significant differences between groups in change from baseline to three years. CONCLUSIONS At three years, CEP and RS did not have differential effects on primary mental health outcomes, but CEP participants had modest improvements in physical health and fewer behavioral health hospital nights.
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Affiliation(s)
- Michael K Ong
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Loretta Jones
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Wayne Aoki
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Thomas R Belin
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Elizabeth Bromley
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Bowen Chung
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Elizabeth Dixon
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Megan Dwight Johnson
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Felica Jones
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Paul Koegel
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Dmitry Khodyakov
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Craig M Landry
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Elizabeth Lizaola
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Norma Mtume
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Victoria K Ngo
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Judith Perlman
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Esmeralda Pulido
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Vivian Sauer
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Cathy D Sherbourne
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Lingqi Tang
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Ed Vidaurri
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Yolanda Whittington
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Pluscedia Williams
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Aziza Lucas-Wright
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Lily Zhang
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Marvin Southard
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Jeanne Miranda
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
| | - Kenneth Wells
- Dr. Ong is with the Department of Medicine; Dr. Belin is with the Department of Biostatistics; Dr. Bromley, Dr. Landry, Ms. Lizaola, Ms. Williams, Ms. Zhang, Dr. Miranda, and Dr. Wells are with the Center for Health Services and Society, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; Dr. Chung and Dr. Tang are with the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine; and Dr. Dixon is with the School of Nursing, all at the University of California, Los Angeles (UCLA), Los Angeles. Dr. Ong is also with the Department of Medicine, Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, West Los Angeles VA Healthcare System, Los Angeles. Ms. Williams is also with Healthy African American Families II, Los Angeles, where Dr. Jones and Ms. Jones are affiliated. Dr. Wells is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, and Dr. Sherbourne are affiliated. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanente of Southern California, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer is with Jewish Family Services of Los Angeles, Los Angeles. Mr. Vidaurri and Ms. Whittington are with the Los Angeles County Department of Mental Health, Los Angeles. Ms. Lucas-Wright is with the UCLA Clinical and Translational Science Institute and the Charles R. Drew University of Medicine and Science, both in Los Angeles. Dr. Southard is with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
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Sherbourne CD, Aoki W, Belin TR, Bromley E, Chung B, Dixon E, Gilmore JM, Johnson MD, Jones F, Koegel P, Khodyakov D, Landry CM, Lizaola E, Mtume N, Ngo VK, Ong MK, Perlman J, Pulido E, Sauer V, Tang L, Whittington Y, Vidaurri E, Williams P, Lucas-Wright A, Zhang L, Miranda J, Jones L, Wells K. Comparative Effectiveness of Two Models of Depression Services Quality Improvement in Health and Community Sectors. Psychiatr Serv 2017; 68:1315-1320. [PMID: 29089009 PMCID: PMC5872839 DOI: 10.1176/appi.ps.201700170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The effectiveness of community coalition building and program technical assistance was compared in implementation of collaborative care for depression among health care and community sector clients. METHODS In under-resourced communities, within 93 programs randomly assigned to coalition building (Community Engagement and Planning) or program technical assistance (Resources for Services) models, 1,018 clients completed surveys at baseline and at six, 12, or 36 months. Regression analysis was used to estimate intervention effects and intervention-by-sector interaction effects on depression, mental health-related quality of life, and community-prioritized outcomes and on services use. RESULTS For outcomes, there were few significant intervention-by-sector interactions, and stratified findings suggested benefits of coalition building in both sectors. For services use, at 36 months, increases were found for coalition building in primary care visits, self-help visits, and appropriate treatment for community clients and in community-based services use for health care clients. CONCLUSIONS Relative to program technical assistance, community coalition building benefited clients across sectors and shifted long-term utilization across sectors.
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Affiliation(s)
- Cathy D Sherbourne
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Wayne Aoki
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Thomas R Belin
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Elizabeth Bromley
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Bowen Chung
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Elizabeth Dixon
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - James M Gilmore
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Megan Dwight Johnson
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Felica Jones
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Paul Koegel
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Dmitry Khodyakov
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Craig M Landry
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Elizabeth Lizaola
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Norma Mtume
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Victoria K Ngo
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Michael K Ong
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Judith Perlman
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Esmeralda Pulido
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Vivian Sauer
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Lingqi Tang
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Yolanda Whittington
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Ed Vidaurri
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Pluscedia Williams
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Aziza Lucas-Wright
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Lily Zhang
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Jeanne Miranda
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Loretta Jones
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
| | - Kenneth Wells
- Dr. Sherbourne, Dr. Koegel, Dr. Khodyakov, Dr. Ngo, Ms. Perlman, Ms. Lucas-Wright, and Dr. Wells are with RAND Health, RAND Corporation, Santa Monica, California. Dr. Wells, along with Dr. Bromley, Dr. Chung, Dr. Landry, and Dr. Miranda, is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA). Dr. Bromley is also with the Desert Pacific Mental Illness Research, Education and Clinical Center, U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles. Dr. Aoki is with Los Angeles Christian Health Centers, Los Angeles. Dr. Belin is with the Department of Biostatistics, UCLA Fielding School of Public Health, Los Angeles. Dr. Dixon is with the School of Nursing, UCLA. Mr. Gilmore is with Behavioral Health Services, Los Angeles. Dr. Johnson is with the Department of Psychiatry, Kaiser Permanent of Southern California, Los Angeles. Ms. Jones, Ms. Williams, and Dr. Jones are with Healthy African American Families II, Los Angeles. Ms. Lizaola, Dr. Tang, and Ms. Zhang are with the Semel Institute Center for Health Services and Society, UCLA, Los Angeles. Ms. Mtume is with Shields for Families, Los Angeles. Dr. Ong is with the Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles. Ms. Pulido is with L.A. Care Health Plan, Los Angeles. Ms. Sauer, now retired, was with Jewish Family Services of Los Angeles at the time of this study. Ms. Whittington is with the Los Angeles County Department of Mental Health, Los Angeles, where Mr. Vidaurri was affiliated before his retirement
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