Although an extensive literature exists on the efficacy of psychotherapy treatments for major depressive disorder (MDD), there is limited data on the effectiveness of such treatments in diverse, community-based real-world practice settings. MDD is of public health concern because it is a common psychiatric disorder that is associated with significant levels of functional impairment, increased health care utilization, and suicide attempts. The purpose of this proposal is to develop an infrastructure within a community mental health center in Philadelphia to support the conduct of effectiveness research on manual-based psychotherapies that have proven efficacious in previous studies. The collaborative venture described in this application will bring together academic intervention and services researchers with administrators, clinicians, and staff working at two clinics that are part of Northwestern Human Services of Philadelphia (NHSP). NHSP is the largest publicly funded provider of mental health services in Philadelphia. Nearly all of the target consumers at NHSP are low-income individuals receiving some form of public assistance or other support and Medicaid for medical and behavioral health services. MDD is the second most common disorder found at these clinics, and the most common of the non-chronic population. Preliminary studies have indicated that while psychotherapy is delivered to many consumers with major depressive disorder in these settings, clinicians at NHSP have not been trained in empirically-supported psychotherapies for MDD. Thus, there is a great need to export empirically-supported psychotherapies for MDD to such settings and to evaluate their effectiveness in the community. Initial work, however, must focus on engaging and retaining consumers because staff at NHSP, as well as our preliminary studies, have identified lack of engagement/attrition as a major problem at these clinics. Specifically, the infrastructure will support (1) collaborative research planning/review meetings between academics and clinical service providers/ administrators, (2) implementation of a systems-wide outcomes assessment program at NHSP, (3) computer/ data analysis expertise within NHSP that will integrate outcomes assessment with clinical information databases, (4) pilot studies focusing initially upon engagement/attrition, and subsequently on the effectiveness of empirically supported psychotherapies for major depressive disorder. The infrastructure support created will work synergistically with existing programs at Penn that focuses on psychotherapy research (Center for the Study of Psychotherapy) and mental health services research (Center for Mental Health Policy and Services Research)
