Despite the success of several controlled trials of multifaceted interventions to improve primary care depression treatment, translation of these interventions into everyday community practice has proven extraordinarily difficult. The reasons for this translational failure are not yet clear, but there is growing evidence that patients """"""""muddle through"""""""" mental health care, lacking a clear idea of how to access and effectively use the resources available for treatment, even when organized systems of care and prepared practice teams are in place. The collective experience of our study team highlights the need to involve community stakeholders (patients, providers, and payors) as full collaborators in understanding the complex dynamics of primary care mental health treatment in order to develop effective and sustainable interventions that meet local community needs. The long-term goal of our developing Greater Flint Depression in Primary Care Partnership is to explore the effectiveness of specific features of the Chronic Care Model in creating sustainable improvement in the quality of depression care in a challenging real-world community setting. Our partnership links the research expertise contained in the multidisciplinary University of Michigan Depression Center to the collective community vision contained in the Greater Flint Health Coalition and Michigan Prevention Research Center, and will follow the principles of the evidence-based community/partnership model recently described by Wells et al. The overarching question we want to answer is how to tailor the Chronic Care Model to meet the needs of a heterogeneous patient population that does not conform to the rational """"""""activated patient"""""""" expectation embedded in the CCM. This proposal requests funding to carry out the following specific aims: 1. to create and refine the structure and relationships of the community-academic partnership 2. to create a sustainable infrastructure to support the research activities of the partnership 3. to explore the suitability of this infrastructure for research through a series of small pilot studies focused on patient access and engagement in care and treatment adherence We will evaluate the success of this approach in creating a viable partnership using mixed-methods analysis. By the end of this project, we will have gained valuable insights into the strengths and weaknesses of this approach, its feasibility for use in other settings, and the research potential of our partnership. If successful, we will have created a community-based laboratory to support a comprehensive research program that can explore specific aspects of the Chronic Care Model as applied to mental health care and as implemented in this heterogeneous real- world community. ? ? ?
