Underserved communities of color face an excess burden of illness from depression, due to the high prevalence of depression coupled with lower access to quality care among the poor. While evidence-based quality improvement programs for depression exist, these programs are under-utilized in underserved communities and have not been used across multiple agencies supporting safety-net clients. This is a revised proposal for Community Partners in Care (CPIC), a study designed to examine the effectiveness of a community-engagement, network-building intervention to implement evidence-based quality improvement interventions (PIC/WE Care) for depression within a multi-agency context, relative to a low-intensity dissemination control condition. Effectiveness is examined in terms of a) client access to care, health outcomes and quality of care;b) implementation process and costs;c) provider and administrator adoption of PIC/WE Care protocols and knowledge and attitudes concerning depression care and quality improvement toolkits. We propose a group level randomized control trial (RCT) in two Los Angeles Communities, South Los Angeles and Hollywood. The unit of randomization is the site or independent team of a participating agency. Agencies will include social service, primary care, and mental health specialty organizations. The study is longitudinal at the client, clinician, and organizational levels. Agencies and providers will be recruited and their sites randomized to the intervention or control condition. A community conference orients all sites to the study, provides the control condition and initiates planning under a community engagement model for the experimental sites. Clients will be recruited from intervention and control sites into a one-year outcomes study. Following the trial, the control sites receive delayed training in use of PIC/WE Care toolkits. We propose to evaluate uptake of these programs across four years as organizations have the intervention (either initially versus control condition;or in the wait-list delayed training for controls). We propose to use mixed methods to study the process of implementation of evidence-based interventions in underserved communities, under both the intervention and control conditions. The project investigators and community leaders represent diverse clinical and social science disciplines. The project is conducted, overall, under a community participatory partnered approach.
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