Optimal patient-provider communication and a collaborative relationship may improve mental health care and health outcomes. Minority patients'involvement in their own mental health treatment may be an important component for improving patient-provider interaction and retention in care, particularly for Latino patients, many of whom hold traditional role expectations against active involvement in the clinical encounter but may drop out of care when services do not match their needs. Given the relationship of patient involvement and health outcomes, increasing Latino patients'activation and self-management as a mechanism to eliminate service disparities is the goal of the proposed study. The project, """"""""Interventions to Increase Engagement and Retention in Mental Health Care,"""""""" evaluates a patient activation and selfmanagement (PASM) intervention in mental health care, and identifies whether its effects can be enhanced by incorporating a provider training (PT) intervention.
The first aim i s to conduct a randomized controlled trial to test the PASM intervention for Latino and non-Latino white mental health outpatients, and assess its impact on perceived self-management, perceived activation, and engagement and retention in mental health care.
The second aim i s to investigate the relative effectiveness of adding a provider training component using a quasi-experimental design.
The third aim i s to explore the racial/ethnic differences in the effect of the patient activation/self-management intervention for Latinos as compared to non-Latino whites, as little is known about the impact of patient race/ethnicity on the effectiveness of patient interventions.
The fourth aim i s to explore the role of patient-provider communication and therapeutic alliance as mediators of the relationship between patient activation/self-management and their engagement and retention in care. It is expected that increased patient-provider communication and a stronger therapeutic alliance will result from patients participating in the decision-making process. These potential changes in the process of care are expected to consequently increase patient engagement (keeping scheduled appointments) and retention (reduction of premature unilateral termination) in mental health care. The fifth aim is to evaluate the organizational sustainability of the two interventions (PASM and PT) by assessing their acceptability, planned adoption and costs. Expanding the traditional evaluation of evidence to incorporate the sustainability of the interventions is needed for policy makers and practitioners to implement effective public health programs. We expect that teaching patients and providers a set of skills needed to facilitate a more patient active role in the mental health encounter, emphasizing the importance of the patient's decision-making process about their own mental health treatment, and enhancing the collaborative provider-patient relationship will increase engagement and retention and consequently, reduce service disparities.

National Institute of Health (NIH)
National Institute on Minority Health and Health Disparities (NIMHD)
Comprehensive Center (P60)
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Special Emphasis Panel (ZMD1)
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University of Puerto Rico Med Sciences
San Juan
United States
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