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Cheung EH, Petersen E, Zhang L, Wilkerson C, Barceló NE, Soderlund PD, Yerstein M, Wells K. Drivers of shared decision making in inpatient psychiatry: An exploratory survey of patients' and multi-disciplinary team members' perspectives. Gen Hosp Psychiatry 2022; 79:7-14. [PMID: 36152457 DOI: 10.1016/j.genhosppsych.2022.08.004] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/20/2022] [Accepted: 08/25/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the prevalence and predictors of Shared Decision Making (SDM) in an adult, inpatient psychiatric setting. METHOD Multi-disciplinary clinician focus groups and patient pre-testing informed the development of a survey on 4 SDM and 11 factors hypothesized to interfere with SDM. The survey was administered to 89 adult inpatients (80% response rate) and their treatment team psychiatrists, nurses, and social workers (n = 338 ratings, 95% response rate). Group differences and predictors were estimated using t and F-tests. RESULTS Patients' mean SDM score (n = 64, standardized Cronbach alpha = 0.858) was 3.35 ± 1.13 (5 = highest agreement), and correlated with overall satisfaction with care (n = 61, r = 0.399, p = 0.001). Patients' disagreement with clinician's diagnosis (44% of patients) correlated with lower SDM ratings by patients (t = 2.55, df = 62, p = 0.013) and by clinicians (t = 2.99, df = 69, p = 0.004). Psychotic diagnoses were not a significant determining factor for SDM. Overall, clinicians rated SDM more favorably than patients (t = -5.43, df = 63, p < 0.001), with nurses and social workers rating SDM higher than physicians (p < 0.001). CONCLUSIONS Diagnostic agreement / disagreement is a key predictor of SDM for patients and clinicians, while presence of psychosis is not. SDM was rated higher by clinicians than patients. SDM ratings vary significantly between clinical disciplines.
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Affiliation(s)
- Erick H Cheung
- University of California Los Angeles, David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, and Resnick Neuropsychiatric Hospital, 757 Westwood Plaza, Los Angeles, CA 90095, United States of America.
| | - Emily Petersen
- University of California Los Angeles, David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, and Resnick Neuropsychiatric Hospital, 757 Westwood Plaza, Los Angeles, CA 90095, United States of America
| | - Lily Zhang
- Research Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA 90024, United States of America; National Clinician Scholars Program, Division of General Internal Medicine, David Geffen School of Medicine, 1100 Glendon Ave., Suite 900, Los Angeles, CA 90024, United States of America
| | - Catherine Wilkerson
- Research Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA 90024, United States of America; National Clinician Scholars Program, Division of General Internal Medicine, David Geffen School of Medicine, 1100 Glendon Ave., Suite 900, Los Angeles, CA 90024, United States of America
| | - Nicolás E Barceló
- University of California Los Angeles, David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, and Resnick Neuropsychiatric Hospital, 757 Westwood Plaza, Los Angeles, CA 90095, United States of America; Research Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA 90024, United States of America; National Clinician Scholars Program, Division of General Internal Medicine, David Geffen School of Medicine, 1100 Glendon Ave., Suite 900, Los Angeles, CA 90024, United States of America
| | - Patricia D Soderlund
- National Clinician Scholars Program, Division of General Internal Medicine, David Geffen School of Medicine, 1100 Glendon Ave., Suite 900, Los Angeles, CA 90024, United States of America; Memory Keepers Medical Discovery Team - Health Equity, University of Minnesota Medical School, Duluth Campus, 624 East 1st St, #201, Duluth, MN 55805, United States of America
| | - Maria Yerstein
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, United States of America
| | - Kenneth Wells
- University of California Los Angeles, David Geffen School of Medicine, Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, and Resnick Neuropsychiatric Hospital, 757 Westwood Plaza, Los Angeles, CA 90095, United States of America; Research Center for Health Services and Society, UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA 90024, United States of America; National Clinician Scholars Program, Division of General Internal Medicine, David Geffen School of Medicine, 1100 Glendon Ave., Suite 900, Los Angeles, CA 90024, United States of America; Department of Mental Health, Veterans Affairs Greater Los Angeles HealthCare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073-1003, United States of America
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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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Barceló NE, Shadravan S, Wells CR, Goodsmith N, Tarrant B, Shaddox T, Yang Y, Bath E, DeBonis K. Reimagining Merit and Representation: Promoting Equity and Reducing Bias in GME Through Holistic Review. Acad Psychiatry 2021; 45:34-42. [PMID: 33111187 DOI: 10.1007/s40596-020-01327-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [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: 12/08/2019] [Accepted: 09/30/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE This study aims to evaluate the capacity of a holistic review process in comparison with non-holistic approaches to facilitate mission-driven recruitment in residency interview screening and selection, with particular attention to the promotion of race equity for applicants underrepresented in medicine (URM). METHODS Five hundred forty-seven applicants to a psychiatry residency program from US allopathic medical schools were evaluated for interview selection via three distinct screening rubrics-one holistic approach (Holistic Review; HR) and two non-holistic processes: Traditional (TR) and Traditional Modified (TM). Each applicant was assigned a composite score corresponding to each rubric, and the top 100 applicants in each rubric were identified as selected for interview. Odds ratios (OR) of selection for interview according to URM status and secondary outcomes, including clinical performance and lived experience, were measured by analysis of group composition via univariate logistic regression. RESULTS Relative to Traditional, Holistic Review significantly increased the odds of URM applicant selection for interview (TR-OR: 0.35 vs HR-OR: 0.84, p < 0.01). Assigning value to lived experience and de-emphasizing USMLE STEP1 scores contributed to the significant changes in odds ratio of interview selection for URM applicants. CONCLUSIONS Traditional interview selection methods systematically exclude URM applicants from consideration without due attention to applicant strengths or potential contribution to clinical care. Conversely, holistic screening represents a structural intervention capable of critically examining measures of merit, reducing bias, and increasing URM representation in residency recruitment, screening, and selection.
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Affiliation(s)
| | | | | | - Nichole Goodsmith
- Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA, USA
| | | | - Trevor Shaddox
- University of California, Los Angeles, Los Angeles, CA, USA
| | - Yvonne Yang
- University of California, Los Angeles, Los Angeles, CA, USA
| | - Eraka Bath
- University of California, Los Angeles, Los Angeles, CA, USA
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Abstract
OBJECTIVE To determine the household and community characteristics most closely associated with variation in COVID-19 incidence on American Indian reservations in the lower 48 states. DESIGN Multivariate analysis with population weights. SETTING Two hundred eighty-seven American Indian Reservations and tribal homelands (in Oklahoma) and, as of April 10, 2020, 861 COVID-19 cases on these reservation lands. MAIN OUTCOME MEASURES The relationship between rate per 1000 individuals of publicly reported COVID-19 cases at the tribal reservation and/or community level and average household characteristics from the 2018 5-Year American Community Survey records. RESULTS By April 10, 2020, in regression analysis, COVID-19 cases were more likely by the proportion of homes lacking indoor plumbing (10.83, P = .001) and were less likely according to the percentage of reservation households that were English-only (-2.43, P = .03). Household overcrowding measures were not statistically significant in this analysis (-6.40, P = .326). CONCLUSIONS Failure to account for the lack of complete indoor plumbing and access to potable water in a pandemic may be an important determinant of the increased incidence of COVID-19 cases. Access to relevant information that is communicated in the language spoken by many reservation residents may play a key role in the spread of COVID-19 in some tribal communities. Household overcrowding does not appear to be associated with COVID-19 infections in our data at the current time. Previous studies have identified household plumbing and overcrowding, and language, as potential pandemic and disease infection risk factors. These risk factors persist. Funding investments in tribal public health and household infrastructure, as delineated in treaties and other agreements, are necessary to protect American Indian communities.
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Affiliation(s)
- Desi Rodriguez-Lonebear
- University of Arizona School of Sociology, Tucson, Arizona (Dr Rodriguez-Lonebear); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Semel Institute, Los Angeles, California (Dr Barceló); Public Policy and American Indian Studies Departments, Luskin School of Public Affairs, UCLA, Los Angeles, California (Dr Akee); Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health and Native Nations Institute at the Udall Center for Studies in Public Policy, University of Arizona, Tucson, Arizona (Dr Carroll)
| | - Nicolás E. Barceló
- University of Arizona School of Sociology, Tucson, Arizona (Dr Rodriguez-Lonebear); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Semel Institute, Los Angeles, California (Dr Barceló); Public Policy and American Indian Studies Departments, Luskin School of Public Affairs, UCLA, Los Angeles, California (Dr Akee); Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health and Native Nations Institute at the Udall Center for Studies in Public Policy, University of Arizona, Tucson, Arizona (Dr Carroll)
| | - Randall Akee
- University of Arizona School of Sociology, Tucson, Arizona (Dr Rodriguez-Lonebear); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Semel Institute, Los Angeles, California (Dr Barceló); Public Policy and American Indian Studies Departments, Luskin School of Public Affairs, UCLA, Los Angeles, California (Dr Akee); Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health and Native Nations Institute at the Udall Center for Studies in Public Policy, University of Arizona, Tucson, Arizona (Dr Carroll)
| | - Stephanie Russo Carroll
- University of Arizona School of Sociology, Tucson, Arizona (Dr Rodriguez-Lonebear); Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and the Semel Institute, Los Angeles, California (Dr Barceló); Public Policy and American Indian Studies Departments, Luskin School of Public Affairs, UCLA, Los Angeles, California (Dr Akee); Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health and Native Nations Institute at the Udall Center for Studies in Public Policy, University of Arizona, Tucson, Arizona (Dr Carroll)
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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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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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