This study's goal is to better understand primary care clinicians' approaches to providing mental health care for socially and economically disadvantaged adult patients with chronic disease in community health centers (CHCs). Observation in six CHCs and interviews with at least 25 CHC clinicians will accomplish two specific aims focused on recognition, interpretation and responses to patient psychosocial issues in the context of chronic disease management.
These aims are: (1) To describe how CHC clinicians frame the psychosocial concerns of and structure the provision of mental health care to patients with chronic disease, by (a) exploring CHC clinicians' attitudes and beliefs about and approaches to psychosocial aspects of chronic disease management, (b) identifying criteria CHC clinicians use to distinguish treatable mental disorders from other psychosocial issues affecting patients with chronic disease, and (c) discovering the cues that prompt recognition and diagnosis of mental disorders in chronically ill, disadvantaged patients; and (2) To identify factors that influence CHC clinicians' beliefs, attitudes and clinical decisions in providing mental health care to these patients. Systematic analysis of interview transcripts and field notes will extract themes and patterns. The study addresses two important areas for improving health care for patients with chronic illness: identification and management of mental illness, and attention to the unique needs of disadvantaged patients.
