This application addresses NCMHD Competitive Revision Application (NOT-MD-10-002). It provides the opportunity to fill the knowledge gap of Comparative Effectiveness Research (CER) for mental health care for Latinos by comparing two public health approaches. One is offered by telephone and one face-to face, consisting of a brief evidence-based depression treatment (6 to 8 sessions), with care coordination, aggressive outreach and systematic monitoring and supervision. The proposed application is made by the University of Puerto Rico (UPR) in collaboration with Cambridge Health Alliance (CHA) through its Center for Multicultural Mental Health Research (CMMHR). It seeks to expand the Comprehensive Research Center of Excellence (UPR-CHA RCE) to: 1) conduct CER focusing on evidence based depression care given """"""""outside the clinic walls"""""""" for Latinos;(2) incorporate training of junior investigators on comparative effectiveness into current P60 activities;(3) establish CER data infrastructure in two large public health systems;and 4) develop tools (i.e. manuals) and methods (training materials like DVDs) to disseminate CER findings and methodologies. The ongoing UPR-CHA RCE focuses on the multiple and complex factors contributing to health disparities among mainland and island Latino populations. Depression is a highly prevalent, chronic condition among ethnic and racial minorities with significant consequences for health care costs. There are enduring disparities in depression treatment for Latinos, as evidenced by problems In access, engagement and retention. Latinos with depression are less likely to access specialty mental health services than non- Latino whites and for those that do access care, early dropout and high rates of missed follow-up appointments persist. Our proposed research design responds to depression disparities in entry, engagement and retention into depression treatment for Latinos. We propose a two site randomized control trial to test the comparative effectiveness of a combined care manager and brief Cognitive Behavioral Therapy (CBT) intervention called Engagement and Counseling for Latinos, administered by telephone (ECLA-T), compared against the same intervention administered face to face (ECLA-F), and mental health treatment in usual primary care for 300 Latino depressed patients attending primary care clinics.
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