Community-Based Interventions for Mental Health
Recruiting in Palo Alto (17 mi)
+1 other location
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: City University of New York, School of Public Health
Disqualifiers: Severe mental illness, others
No Placebo Group
Trial Summary
What is the purpose of this trial?This trial studies a community program in Harlem that aims to improve mental health services by solving funding and access issues, training local health workers, and coordinating various health and social services. The program also uses common metrics to continuously improve care quality. The goal is to create a sustainable model for providing mental health care within a network of comprehensive services.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your healthcare provider.
What data supports the effectiveness of this treatment?
The Collaborative Care Model (CoCM), which is part of the treatment, has been shown to be effective for mental health conditions like depression, especially in primary care settings. Studies have demonstrated its potential to improve mental health care quality and address unmet needs, particularly in low-income and rural areas.
12345Is the Community-Based Interventions for Mental Health treatment generally safe for humans?
The Collaborative Care Model (CCM), a component of the Community-Based Interventions for Mental Health, has been widely studied and shown to be safe and effective in improving mental health outcomes, particularly for depression and anxiety, without significant safety concerns reported.
13678How does this community-based mental health treatment differ from other treatments?
This treatment is unique because it uses a community-based approach, involving university students and local health workers to identify and refer individuals with mental health issues, making it more accessible and cost-effective in low-resource settings compared to traditional clinical treatments.
59101112Eligibility Criteria
This trial is for Black and Latino adults aged 18-65 living in Harlem, specifically those from low-income housing or receiving primary care locally. Participants should have a moderate risk for depression, indicated by a PHQ-4 Total Score of 3 or higher.Inclusion Criteria
Harlem residents from low-income housing developments or receiving primary care services in Harlem
PHQ-4 Total Score ≥3, moderate risk for depression
I am a Black or Latino adult aged between 18 and 65.
Exclusion Criteria
Those with risk for depression or anxiety who screen positive for severe mental illness (e.g., psychosis, mania, substance abuse, and high suicide risk) using screening items from the Mini-International Neuropsychiatric Interview will be excluded from the study and referred to MH services at higher levels of care
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
0-6 months
Education and Resources
Participants receive online training on MH task-shifting skills, including screening, psychoeducation, and referral to MH care.
6-12 months
Online sessions
Multisector Collaborative Care
Participants engage in a community-engaged multisector collaborative care model, including additional training on multisectoral team skills and care navigation.
6-12 months
Follow-up
Participants are monitored for implementation and consumer outcomes, including mental health service linkage and program sustainment.
12-24 months
Participant Groups
The study tests the Harlem Strong Community Mental Health Collaborative's approach to mental health. It involves problem-solving care barriers, training community workers in mental health tasks, coordinating healthcare with social services, and improving data systems for quality care.
3Treatment groups
Experimental Treatment
Active Control
Group I: Multisector Collaborative Care and TechnologyExperimental Treatment4 Interventions
MCC sites will be randomized to receive an additional technology-based implementation tool to evaluate impact on implementation and consumer outcomes.
Group II: Multisector Collaborative CareExperimental Treatment3 Interventions
Multisector Collaborative Care (MCC) Model will consist of all resources offered in E\&R and additional trainings on skills related to working in a multisectoral team, care navigation, syndemic risks and coordination of services related to MH, social services, and health care.
Group III: Education and ResourcesActive Control1 Intervention
Education and Resources (E\&R) involves online training through the E-Hub on delivery of basic MH task-shifting skills, such as screening, psychoeducation, and referral to MH care. A community directory along with training on community resources will be made available to all participants. Specifically, we will recommend that those identified to have common MH problems (PHQ-4≥3) are offered a single two-hour zoom-based group psychoeducation session about depression and anxiety, COVID-19 impact on MH, wellness and self-care skills, and directory of Harlem-based MH services and other community resources. Participants exhibiting higher level needs are referred to MH specialists.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Harlem Congregation for Community ImprovementNew York, NY
CUNY Graduate School of Public Health and Health PolicyNew York, NY
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Who Is Running the Clinical Trial?
City University of New York, School of Public HealthLead Sponsor
Harlem Congregation for Community Improvement, Inc.Collaborator
HealthfirstCollaborator
HealthfirstCollaborator
References
Mental health consumers and providers dialogue in an institutional setting: a participatory approach to promoting recovery-oriented care. [2022]This brief report presents the preliminary findings of a participatory project, to answer a question raised by stakeholders in mental health services: How can providers and patients create a process for knowledge exchange to support recovery-oriented care?
Scaling Implementation of Collaborative Care for Depression: Adaptation of the Stages of Implementation Completion (SIC). [2023]Tools to monitor implementation progress could facilitate scale-up of effective treatments. Most treatment for depression, a common and disabling condition, is provided in primary care settings. Collaborative Care Management (CoCM) is an evidence-based model for treating common mental health conditions, including depression, in this setting; yet, it is not widely implemented. The Stages of Implementation Completion (SIC) was adapted for CoCM and piloted in eight rural primary care clinics serving adults challenged by low-income status. The CoCM-SIC accurately assessed implementation effectiveness and detected site variations in performance, suggesting key implementation activities to aid future scale-ups of CoCM for diverse populations.
Treatment recommendations made by a consultant psychiatrist to improve the quality of care in a collaborative mental health intervention in rural Nepal. [2020]The Collaborative Care Model (CoCM) for mental healthcare, where a consulting psychiatrist supports primary care and behavioral health workers, has the potential to address the large unmet burden of mental illness worldwide. A core component of this model is that the psychiatrist reviews treatment plans for a panel of patients and provides specific clinical recommendations to improve the quality of care. Very few studies have reported data on such recommendations. This study reviews and classifies the recommendations made by consulting psychiatrists in a rural primary care clinic in Nepal.
A novel collaborative practice model for treatment of mental illness in indigent and uninsured patients. [2019]The implementation and evaluation of a collaborative practice model (CPM) of mental health care at a free clinic are described.
Collaborative Care for Mental Health in Low- and Middle-Income Countries: A WHO Health Systems Framework Assessment of Three Programs. [2018]The collaborative care model is an evidence-based intervention for behavioral and other chronic conditions that has the potential to address the large burden of mental illness globally. Using the World Health Organization Health Systems Framework, the authors present challenges in implementing this model in low- and middle-income countries (LMICs) and discuss strategies to address these challenges based on experiences with three large-scale programs: an implementation research study in a district-level government hospital in rural Nepal, one clinical trial in 50 primary health centers in rural India, and one study in four diabetes clinics in India. Several strategies can be utilized to address implementation challenges and enhance scalability in LMICs, including mobilizing community resources, engaging in advocacy, and strengthening the overall health care delivery system.
Enhancing the scalability of the collaborative care model for depression using mobile technology. [2021]The collaborative care model (CoCM) has substantial support for improving behavioral health care in primary care. However, large-scale CoCM adoption relies on addressing operational and financial implementation challenges across health care settings with varying resources. An academic medical center serving socioeconomically and racially diverse patients implemented the CoCM in seven practices. A smartphone application was introduced to facilitate CoCM care management during depression treatment (app-augmented CoCM). App features included secure texting, goal/appointment reminders, symptom monitoring, and health education material. A nonrandomized convenience patient sample (N = 807) was enrolled in app-augmented CoCM and compared with patients in standard CoCM (N = 3,975). Data were collected on clinical contact frequency, engagement, and clinical outcomes. App-augmented CoCM patients received more health care team contacts (7.9 vs. 4.9, p
Closing the False Divide: Sustainable Approaches to Integrating Mental Health Services into Primary Care. [2022]Mental disorders account for 25% of all health-related disability worldwide. More patients receive treatment for mental disorders in the primary care sector than in the mental health specialty setting. However, brief visits, inadequate reimbursement, deficits in primary care provider (PCP) training, and competing demands often limit the capacity of the PCP to produce optimal outcomes in patients with common mental disorders. More than 80 randomized trials have shown the benefits of collaborative care (CC) models for improving outcomes of patients with depression and anxiety. Six key components of CC include a population-based approach, measurement-based care, treatment to target strategy, care management, supervision by a mental health professional (MHP), and brief psychological therapies. Multiple trials have also shown that CC for depression is equally or more cost-effective than many of the current treatments for medical disorders. Factors that may facilitate the implementation of CC include a more favorable alignment of medical and mental health services in accountable care organizations and patient-centered medical homes; greater use of telecare as well as automated outcome monitoring; identification of patients who might benefit most from CC; and systematic training of both PCPs and MHPs in integrated team-based care.
Assessing Collaborative Care in Mental Health Teams: Qualitative Analysis to Guide Future Implementation. [2020]The Collaborative Care Model (CCM) is an evidence-based approach for structuring care for chronic health conditions. Attempts to implement CCM-based care in a given setting depend, however, on the extent to which care in that setting is already aligned with the specific elements of CCM-based care. We therefore interviewed staff from ten outpatient mental health teams in the US Department of Veterans Affairs to determine whether care delivery was consistent or inconsistent with CCM-based care in those settings. We discuss implications of our findings for future attempts to implement CCM-based outpatient mental health care.
Task sharing and stepped referral model for community mental health promotion in low- and middle-income countries (LMIC): insights from a feasibility study in India. [2022]This study is a low-cost community mental health task-sharing model driven by university students to strengthen the mental health workforce in poor resource settings. This article presents the feasibility of a stepped referral model using the community health workforce and university students. The primary feasibility objective is to detect and refer people with mental illness from the community using a task-sharing approach.
[Intervention technics in the community: community diagnosis]. [2006]The practice of community mental health care demands the introduction of suitable models of intervention. Community medicine, which has preceded the development of community mental health, offers operative models based on epidemiologic concepts and techniques. This paper analyses the different components of community diagnosis, a necessary step in the process of community intervention. A practical example illustrates the use of the latter by the mental health worker.
Community Interventions to Promote Mental Health and Social Equity. [2023]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.
Global mental health in high-income countries. [2018]Over the past decade there have been significant efforts to scale-up mental health services in resource-poor countries. A number of cost-effective innovations have emerged as a result. At the same time, there is increasing concern in resource-rich countries about efficacy, efficiency and acceptability of mental health services. We consider two specific innovations used widely in low- and middle-income countries, task-sharing and a development model of mental healthcare, that we believe have the potential to address some of the current challenges facing mental health services in high-income countries.