title: Depression Treatment Uptake in Integrated Primary Care: How a "Warm Handoff" and Other Factors Affect Decision Making by Latinos.
abstract: OBJECTIVE
  Integrated behavioral health care has the potential to reduce barriers to mental health treatment among low-income and minority populations. This study aimed to identify predictors of Latino patients' decision to follow through with referrals to depression treatment in an integrated primary care setting, including type of referral (a "warm handoff" from a primary care provider [PCP] to a behavioral health care provider or a prescribed referral).
  
  
  METHODS
  The authors conducted a sequential medical record review of 431 patients referred for depression treatment in integrated behavioral health services followed by qualitative semistructured interviews with a subsample of 16 patients.
  
  
  RESULTS
  English-speaking Latinos were four times less likely to attend an initial visit within two months of a referral if they received a warm handoff rather than a prescribed referral. The strength of the patient-provider relationship and the quality of the referral experience, including whether the PCP addressed patients' health literacy and expectations for depression care, affected patients' decision to engage in depression treatment.
  
  
  CONCLUSIONS
  Engaging Latinos in needed mental health treatment is a challenge, even when treatment is provided in primary care settings. Warm handoffs are considered effective components of engagement, but this study suggests that the effectiveness of warm handoffs may vary depending on the patient's primary language. The following factors seem important to engaging Latinos into care: patient-provider relationship, quality of the referral process, addressing expectations about depression care, and reducing communication barriers, including health literacy and linguistic barriers. Future studies of engagement strategies should explore these factors.
authors: Dr. Horevitz and Dr. Arean are with the Department of Psychiatry, University of California, San Francisco (e-mail: elizabeth.horevitz@gmail.com ). Dr. Organista is with the Department of Social Welfare, University of California, Berkeley.
authors: Elizabeth
authors: E
authors: Horevitz
authors: Dr. Horevitz and Dr. Arean are with the Department of Psychiatry, University of California, San Francisco (e-mail: elizabeth.horevitz@gmail.com ). Dr. Organista is with the Department of Social Welfare, University of California, Berkeley.
authors: Kurt C
authors: KC
authors: Organista
authors: Dr. Horevitz and Dr. Arean are with the Department of Psychiatry, University of California, San Francisco (e-mail: elizabeth.horevitz@gmail.com ). Dr. Organista is with the Department of Social Welfare, University of California, Berkeley.
authors: Patricia A
authors: PA
authors: Arean
mesh_terms: D000328:Adult; D002140:California / Q000208:ethnology; D003144:Communication Barriers; D003657:Decision Making; D019033:Delivery of Health Care, Integrated / Q000592:standards / Q000706:statistics & numerical data*; D003863:Depression / Q000208:ethnology / Q000628:therapy*; D005260:Female; D057220:Health Literacy; D006630:Hispanic or Latino / Q000208:ethnology / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D011203:Poverty; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data; D011369:Professional-Patient Relations; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data*; D012189:Retrospective Studies