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Comparative Effectiveness of Coalitions Versus Technical Assistance for Depression Quality Improvement in Persons with Multiple Chronic Conditions.

ABSTRACT: Significance:Prior research suggests that Community Engagement and Planning (CEP) for coalition support compared with Resources for Services (RS) for program technical assistance to implement depression quality improvement programs improves 6- and 12-month client mental-health related quality of life (MHRQL); however, effects for clients with multiple chronic medical conditions (MCC) are unknown. Objective:To explore effectiveness of CEP vs RS in MCC and non-MCC subgroups. Design:Secondary analyses of a cluster-randomized trial. Setting:93 health care and community-based programs in two neighborhoods. Participants:Of 4,440 clients screened, 1,322 depressed (Patient Health Questionnaire, PHQ8) provided contact information, 1,246 enrolled and 1,018 (548 with ?3 MCC) completed baseline, 6- or 12-month surveys. Intervention:CEP or RS for implementing depression quality improvement programs. Outcomes and Analyses:Primary: depression (PHQ9 <10), poor MHRQL (Short Form Health Survey, SF-12<40); Secondary: mental wellness, good physical health, behavioral health hospitalization, chronic homelessness risk, work/workloss days, services use at 6 and 12 months. End-point regressions were used to estimate intervention effects on outcomes for subgroups with ?3 MCC, non-MCC, and intervention-by-MCC interactions (exploratory). Results:Among MCC clients at 6 months, CEP vs RS lowered likelihoods of depression and poor MHRQL; increased likelihood of mental wellness; reduced work-loss days among employed and likelihoods of ?4 behavioral-health hospitalization nights and chronic homelessness risk, while increasing faith-based and park community center depression services; and at 12 months, likelihood of good physical health and park community center depression services use (each P<.05). There were no significant interactions or primary outcome effects for non-MCC. Conclusions:CEP was more effective than RS in improving 6-month primary outcomes among depressed MCC clients, without significant interactions.

SUBMITTER: Springgate B

PROVIDER: S-EPMC6128327 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Comparative Effectiveness of Coalitions Versus Technical Assistance for Depression Quality Improvement in Persons with Multiple Chronic Conditions.

Springgate Benjamin B Tang Lingqi L Ong Michael M Aoki Wayne W Chung Bowen B Dixon Elizabeth E Johnson Megan Dwight MD Jones Felica F Landry Craig C Lizaola Elizabeth E Mtume Norma N Ngo Victoria K VK Pulido Esmeralda E Sherbourne Cathy C Wright Aziza Lucas AL Whittington Yolanda Y Williams Pluscedia P Zhang Lily L Miranda Jeanne J Belin Thomas T Gilmore James J Jones Loretta L Wells Kenneth B KB

Ethnicity & disease 20180906 Suppl 2

<h4>Significance</h4>Prior research suggests that Community Engagement and Planning (CEP) for coalition support compared with Resources for Services (RS) for program technical assistance to implement depression quality improvement programs improves 6- and 12-month client mental-health related quality of life (MHRQL); however, effects for clients with multiple chronic medical conditions (MCC) are unknown.<h4>Objective</h4>To explore effectiveness of CEP vs RS in MCC and non-MCC subgroups.<h4>Desi ...[more]

PMID: 30202185

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Project description:Depression collaborative care implementation using community engagement and planning (CEP) across programs improves 6-month client outcomes in minority communities, compared with technical assistance to individual programs (resources for services [RS]). However, 12-month outcomes are unknown.To compare effects of CEP and RS on mental health-related quality of life (MHRQL) and use of services among depressed clients at 12 months.Matched health and community programs (n = 93) in 2 communities randomly assigned to receive CEP or RS. (ClinicalTrials.gov: NCT01699789).Self-reported MHRQL and services use at baseline, 6 months, and 12 months.Los Angeles, California.1018 adults with depressive symptoms (8-item Patient Health Questionnaire score ?10), 88% of whom were an ethnic minority.CEP and RS to implement depression collaborative care.The primary outcome was poor MHRQL (12-item mental health composite score ?40) at baseline, 6 months, and 12 months; the secondary outcome was use of services at 12 months.At 6 months, the finding that CEP outperformed RS to reduce poor MHRQL was significant but sensitive to underlying statistical assumptions. At 12 months, some analyses suggested that CEP was advantageous to MHRQL, whereas others did not confirm a significant difference favoring CEP. The finding that CEP reduced behavioral health hospitalizations at 6 months was less evident at 12 months and was sensitive to underlying statistical assumptions. Other services use did not significantly differ between interventions at 12 months.Data are self-reported, and findings are sensitive to modeling assumptions.In contrast to 6-month results, no consistent effects of CEP on reducing the likelihood of poor MHRQL and behavioral health hospitalizations were found at 12 months. Still, given the needs of underresourced communities, the favorable profile of CEP, and the lack of evidence-based alternatives, CEP remains a viable strategy for policymakers and communities to consider.National Institute of Mental Health, Robert Wood Johnson Foundation, California Community Foundation, National Library of Medicine, and National Institutes of Health/National Center for Advancing Translational Science for the UCLA Clinical and Translational Science Institute.

Project description:OBJECTIVE:Community Partners in Care (CPIC) was a group-randomized study of two approaches to implementing expanded collaborative depression care: Community Engagement and Planning (CEP), a coalition approach, and Resources for Services (RS), a technical assistance approach. Collaborative care networks in both arms involved health care and other agencies in five service sectors. This study examined six- and 12-month outcomes for CPIC participants with serious mental illness. METHODS:This secondary analysis focused on low-income CPIC participants from racial-ethnic minority groups with serious mental illness in underresourced Los Angeles communities (N=504). Serious mental illness was defined as self-reported severe depression (≥20 on the Patient Health Questionnaire-8) at baseline or a lifetime history of bipolar disorder or psychosis. Logistic and Poisson regression with multiple imputation and response weights, controlling for covariates, was used to model intervention effects. RESULTS:Among CPIC participants, 50% had serious mental illness. Among those with serious mental illness, CEP relative to RS reduced the likelihood of poor mental health-related quality of life (OR=.62, 95% CI=.41-.95) but not depression (primary outcomes); reduced the likelihood of having homelessness risk factors and behavioral health hospitalizations; increased the likelihood of mental wellness; reduced specialty mental health medication and counseling visits; and increased faith-based depression visits (each p<.05) at six months. There were no statistically significant 12-month effects. CONCLUSIONS:Findings suggest that a coalition approach to implementing expanded collaborative depression care, compared with technical assistance to individual programs, may reduce short-term behavioral health hospitalizations and improve mental health-related quality of life and some social outcomes for adults with serious mental illness, although no evidence was found for long-term effects in this subsample.

Project description:BackgroundAlthough the benefits of evidence-based practices (EBPs) for advancing community outcomes are well-recognized, challenges with the uptake of EBPs are considerable. Technical assistance (TA) is a core capacity building strategy that has been widely used to support EBP implementation and other community development and improvement efforts. Yet despite growing reliance on TA, no reviews have systematically examined the evaluation of TA across varying implementation contexts and capacity building aims. This study draws on two decades of peer-reviewed publications to summarize the evidence on the evaluation and effectiveness of TA.MethodsGuided by Arksey and O'Malley's six-stage methodological framework, we used a scoping review methodology to map research on TA evaluation. We included peer-reviewed articles published in English between 2000 and 2020. Our search involved five databases: Business Source Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), PsycInfo, and PubMed.ResultsA total of 125 evaluation research studies met the study criteria. Findings indicate that publications have increased over the last two decades, signaling a growth in the recognition and reporting of TA. Technical assistance is being implemented across diverse settings, often serving socially vulnerable and under-resourced populations. Most evaluation research studies involved summative evaluations, with TA outcomes mostly reported at the organizational level. Only 5% of the studies examined sustainability of TA outcomes. This review also demonstrates that there is a lack of consistent standards regarding the definition of TA and the level of reporting across relevant TA evaluation categories (e.g., cadence of contact, and directionality).ConclusionsAdvances in the science and practice of TA hinge on understanding what aspects of TA are effective and when, how, and for whom these aspects of TA are effective. Addressing these core questions requires (i) a standard definition for TA; (ii) more robust and rigorous evaluation research designs that involve comparison groups and assessment of direct, indirect, and longitudinal outcomes; (iii) increased use of reliable and objective TA measures; and (iv) development of reporting standards. We view this scoping review as a foundation for improving the state of the science and practice of evaluating TA.

Project description:BackgroundOver 5000 community anti-drug coalitions operating in the USA serve as a cornerstone of federal drug prevention. These coalitions, however, have demonstrated effectiveness in preventing substance use only when they use technical assistance (TA) and implement evidence-based programs (EBPs). The absence of TA and EBP implementation by coalitions is a key research-to-practice gap. The Coalition Check-Up TA system is designed to fill this gap by supporting community coalition implementation of EBPs. Existing TA models for evidence-based coalition approaches are resource intensive and coalition model specific. The Coalition Check-Up is a lower cost strategy that works with a variety of types of coalitions to support sustainable implementation of EBPs. This study protocol describes a hybrid type 3 effectiveness-implementation trial applying Wandersman's Interactive Systems Framework to test the effects of the Coalition Check-Up on coalition EBP implementation capacity and outcomes. The Interactive Systems Framework outlines how the prevention support system-especially TA-bolsters EBP dissemination and implementation.MethodsUsing a cluster randomized controlled design, this trial will test the overall effectiveness of the Coalition Check-Up, including how it contributes to EBP implementation and prevention of youth substance use. The first aim is to estimate the impact of the Coalition Check-Up on coalitions' capacity to do their work. We will recruit 68 anti-drug coalitions for random assignment to the Coalition Check-Up or "TA as usual" condition. We will evaluate whether the Coalition Check-Up improves coalition capacity using measures of coalition member responses about team processes, coalition network composition, and collaborative structure. Our second aim is to estimate the impact of the Coalition Check-Up on implementation of EBPs, and our third aim is to estimate the impact of the Coalition Check-Up on youth substance use.DiscussionThis project will clarify how the Coalition Check-Up, a scalable approach to TA due to its low cost, affects coalition capacity to support EBP implementation. Analyses also provide insight into causal pathways from the prevention support system to the prevention delivery system outlined by the Interactive Systems Framework. Results will build the evidence-base for how to support community coalitions' sustainable implementation of evidence-based prevention programs and policies.Trial registrationClinicaltrials.gov registration number NCT04592120 . Registered on October 19, 2020.

Project description:Broad-based species comparisons across mammalian orders suggest a number of factors that might influence the evolution of large brains. However, the relationship between these factors and total and regional brain size remains unclear. This study investigated the relationship between relative brain size and regional brain volumes and sociality in 13 felid species in hopes of revealing relationships that are not detected in more inclusive comparative studies. In addition, a more detailed analysis was conducted of four focal species: lions (Panthera leo), leopards (Panthera pardus), cougars (Puma concolor), and cheetahs (Acinonyx jubatus). These species differ markedly in sociality and behavioral flexibility, factors hypothesized to contribute to increased relative brain size and/or frontal cortex size. Lions are the only truly social species, living in prides. Although cheetahs are largely solitary, males often form small groups. Both leopards and cougars are solitary. Of the four species, leopards exhibit the most behavioral flexibility, readily adapting to changing circumstances. Regional brain volumes were analyzed using computed tomography. Skulls (n = 75) were scanned to create three-dimensional virtual endocasts, and regional brain volumes were measured using either sulcal or bony landmarks obtained from the endocasts or skulls. Phylogenetic least squares regression analyses found that sociality does not correspond with larger relative brain size in these species. However, the sociality/solitary variable significantly predicted anterior cerebrum (AC) volume, a region that includes frontal cortex. This latter finding is despite the fact that the two social species in our sample, lions and cheetahs, possess the largest and smallest relative AC volumes, respectively. Additionally, an ANOVA comparing regional brain volumes in four focal species revealed that lions and leopards, while not significantly different from one another, have relatively larger AC volumes than are found in cheetahs or cougars. Further, female lions possess a significantly larger AC volume than conspecific males; female lion values were also larger than those of the other three species (regardless of sex). These results may reflect greater complexity in a female lion's social world, but additional studies are necessary. These data suggest that within family comparisons may reveal variations not easily detected by broad comparative analyses.

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Comparative Effectiveness of Coalitions Versus Technical Assistance for Depression Quality Improvement in Persons with Multiple Chronic Conditions.

Publications

Comparative Effectiveness of Coalitions Versus Technical Assistance for Depression Quality Improvement in Persons with Multiple Chronic Conditions.

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