Participation in Training for Depression Care Quality Improvement: A Randomized Trial of Community Engagement or Technical Support.
OBJECTIVE
Community engagement and planning (CEP) could improve dissemination of depression care quality improvement in underresourced communities, but whether its effects on provider training participation differ from those of standard technical assistance, or resources for services (RS), is unknown. This study compared program- and staff-level participation in depression care quality improvement training among programs enrolled in CEP, which trained networks of health care and social-community agencies jointly, and RS, which provided technical support to individual programs.


METHODS
Matched programs from health care and social-community service sectors in two communities were randomly assigned to RS or CEP. Data were from 1,622 eligible staff members from 95 enrolled programs. Primary outcomes were any staff trained (for programs) and total hours of training (for staff). Secondary staff-level outcomes were hours of training in specific depression collaborative care components.


RESULTS
CEP programs were more likely than RS programs to participate in any training (p=.006). Within health care sectors, CEP programs were more likely than RS programs to participate in training (p=.016), but within social-community sectors, there was no difference in training by intervention. Among staff who participated in training, mean training hours were greater among CEP programs versus RS programs for any type of training (p<.001) and for training related to each component of depression care (p<.001) except medication management.


CONCLUSIONS
CEP may be an effective strategy to promote staff participation in depression care improvement efforts in underresourced communities.
Dr. Chung is with the Department of Psychiatry, Harbor-University of California, Los Angeles (UCLA), Medical Center, and he is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Ngo, Dr. Wells, Dr. Sherbourne, and Dr. Miranda are also affiliated (e-mail: bchung@mednet.ucla.edu ). Dr. Wells and Dr. Miranda are also with the Center for Health Services and Society, Department of Psychiatry, UCLA, where Mrs. Pulido, Dr. Johnson, and Dr. Tang are also affiliated. Dr. Johnson is also with the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, where Dr. Ong is affiliated. Dr. Ong is also with the Department of Medicine, UCLA. Ms. Jones is with Healthy African American Families II, Los Angeles. Mr. Gilmore is with Behavioral Health Services, Inc. Ms. Stoker-Mtume is with Shields for Families, Los Angeles.
Bowen
B
Chung
Dr. Chung is with the Department of Psychiatry, Harbor-University of California, Los Angeles (UCLA), Medical Center, and he is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Ngo, Dr. Wells, Dr. Sherbourne, and Dr. Miranda are also affiliated (e-mail: bchung@mednet.ucla.edu ). Dr. Wells and Dr. Miranda are also with the Center for Health Services and Society, Department of Psychiatry, UCLA, where Mrs. Pulido, Dr. Johnson, and Dr. Tang are also affiliated. Dr. Johnson is also with the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, where Dr. Ong is affiliated. Dr. Ong is also with the Department of Medicine, UCLA. Ms. Jones is with Healthy African American Families II, Los Angeles. Mr. Gilmore is with Behavioral Health Services, Inc. Ms. Stoker-Mtume is with Shields for Families, Los Angeles.
Victoria K
VK
Ngo
Dr. Chung is with the Department of Psychiatry, Harbor-University of California, Los Angeles (UCLA), Medical Center, and he is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Ngo, Dr. Wells, Dr. Sherbourne, and Dr. Miranda are also affiliated (e-mail: bchung@mednet.ucla.edu ). Dr. Wells and Dr. Miranda are also with the Center for Health Services and Society, Department of Psychiatry, UCLA, where Mrs. Pulido, Dr. Johnson, and Dr. Tang are also affiliated. Dr. Johnson is also with the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, where Dr. Ong is affiliated. Dr. Ong is also with the Department of Medicine, UCLA. Ms. Jones is with Healthy African American Families II, Los Angeles. Mr. Gilmore is with Behavioral Health Services, Inc. Ms. Stoker-Mtume is with Shields for Families, Los Angeles.
Michael K
MK
Ong
Dr. Chung is with the Department of Psychiatry, Harbor-University of California, Los Angeles (UCLA), Medical Center, and he is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Ngo, Dr. Wells, Dr. Sherbourne, and Dr. Miranda are also affiliated (e-mail: bchung@mednet.ucla.edu ). Dr. Wells and Dr. Miranda are also with the Center for Health Services and Society, Department of Psychiatry, UCLA, where Mrs. Pulido, Dr. Johnson, and Dr. Tang are also affiliated. Dr. Johnson is also with the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, where Dr. Ong is affiliated. Dr. Ong is also with the Department of Medicine, UCLA. Ms. Jones is with Healthy African American Families II, Los Angeles. Mr. Gilmore is with Behavioral Health Services, Inc. Ms. Stoker-Mtume is with Shields for Families, Los Angeles.
Esmeralda
E
Pulido
Dr. Chung is with the Department of Psychiatry, Harbor-University of California, Los Angeles (UCLA), Medical Center, and he is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Ngo, Dr. Wells, Dr. Sherbourne, and Dr. Miranda are also affiliated (e-mail: bchung@mednet.ucla.edu ). Dr. Wells and Dr. Miranda are also with the Center for Health Services and Society, Department of Psychiatry, UCLA, where Mrs. Pulido, Dr. Johnson, and Dr. Tang are also affiliated. Dr. Johnson is also with the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, where Dr. Ong is affiliated. Dr. Ong is also with the Department of Medicine, UCLA. Ms. Jones is with Healthy African American Families II, Los Angeles. Mr. Gilmore is with Behavioral Health Services, Inc. Ms. Stoker-Mtume is with Shields for Families, Los Angeles.
Felica
F
Jones
Dr. Chung is with the Department of Psychiatry, Harbor-University of California, Los Angeles (UCLA), Medical Center, and he is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Ngo, Dr. Wells, Dr. Sherbourne, and Dr. Miranda are also affiliated (e-mail: bchung@mednet.ucla.edu ). Dr. Wells and Dr. Miranda are also with the Center for Health Services and Society, Department of Psychiatry, UCLA, where Mrs. Pulido, Dr. Johnson, and Dr. Tang are also affiliated. Dr. Johnson is also with the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, where Dr. Ong is affiliated. Dr. Ong is also with the Department of Medicine, UCLA. Ms. Jones is with Healthy African American Families II, Los Angeles. Mr. Gilmore is with Behavioral Health Services, Inc. Ms. Stoker-Mtume is with Shields for Families, Los Angeles.
James
J
Gilmore
Dr. Chung is with the Department of Psychiatry, Harbor-University of California, Los Angeles (UCLA), Medical Center, and he is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Ngo, Dr. Wells, Dr. Sherbourne, and Dr. Miranda are also affiliated (e-mail: bchung@mednet.ucla.edu ). Dr. Wells and Dr. Miranda are also with the Center for Health Services and Society, Department of Psychiatry, UCLA, where Mrs. Pulido, Dr. Johnson, and Dr. Tang are also affiliated. Dr. Johnson is also with the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, where Dr. Ong is affiliated. Dr. Ong is also with the Department of Medicine, UCLA. Ms. Jones is with Healthy African American Families II, Los Angeles. Mr. Gilmore is with Behavioral Health Services, Inc. Ms. Stoker-Mtume is with Shields for Families, Los Angeles.
Norma
N
Stoker-Mtume
Dr. Chung is with the Department of Psychiatry, Harbor-University of California, Los Angeles (UCLA), Medical Center, and he is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Ngo, Dr. Wells, Dr. Sherbourne, and Dr. Miranda are also affiliated (e-mail: bchung@mednet.ucla.edu ). Dr. Wells and Dr. Miranda are also with the Center for Health Services and Society, Department of Psychiatry, UCLA, where Mrs. Pulido, Dr. Johnson, and Dr. Tang are also affiliated. Dr. Johnson is also with the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, where Dr. Ong is affiliated. Dr. Ong is also with the Department of Medicine, UCLA. Ms. Jones is with Healthy African American Families II, Los Angeles. Mr. Gilmore is with Behavioral Health Services, Inc. Ms. Stoker-Mtume is with Shields for Families, Los Angeles.
Megan
M
Johnson
Dr. Chung is with the Department of Psychiatry, Harbor-University of California, Los Angeles (UCLA), Medical Center, and he is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Ngo, Dr. Wells, Dr. Sherbourne, and Dr. Miranda are also affiliated (e-mail: bchung@mednet.ucla.edu ). Dr. Wells and Dr. Miranda are also with the Center for Health Services and Society, Department of Psychiatry, UCLA, where Mrs. Pulido, Dr. Johnson, and Dr. Tang are also affiliated. Dr. Johnson is also with the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, where Dr. Ong is affiliated. Dr. Ong is also with the Department of Medicine, UCLA. Ms. Jones is with Healthy African American Families II, Los Angeles. Mr. Gilmore is with Behavioral Health Services, Inc. Ms. Stoker-Mtume is with Shields for Families, Los Angeles.
Lingqi
L
Tang
Dr. Chung is with the Department of Psychiatry, Harbor-University of California, Los Angeles (UCLA), Medical Center, and he is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Ngo, Dr. Wells, Dr. Sherbourne, and Dr. Miranda are also affiliated (e-mail: bchung@mednet.ucla.edu ). Dr. Wells and Dr. Miranda are also with the Center for Health Services and Society, Department of Psychiatry, UCLA, where Mrs. Pulido, Dr. Johnson, and Dr. Tang are also affiliated. Dr. Johnson is also with the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, where Dr. Ong is affiliated. Dr. Ong is also with the Department of Medicine, UCLA. Ms. Jones is with Healthy African American Families II, Los Angeles. Mr. Gilmore is with Behavioral Health Services, Inc. Ms. Stoker-Mtume is with Shields for Families, Los Angeles.
Kenneth Brooks
KB
Wells
Dr. Chung is with the Department of Psychiatry, Harbor-University of California, Los Angeles (UCLA), Medical Center, and he is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Ngo, Dr. Wells, Dr. Sherbourne, and Dr. Miranda are also affiliated (e-mail: bchung@mednet.ucla.edu ). Dr. Wells and Dr. Miranda are also with the Center for Health Services and Society, Department of Psychiatry, UCLA, where Mrs. Pulido, Dr. Johnson, and Dr. Tang are also affiliated. Dr. Johnson is also with the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, where Dr. Ong is affiliated. Dr. Ong is also with the Department of Medicine, UCLA. Ms. Jones is with Healthy African American Families II, Los Angeles. Mr. Gilmore is with Behavioral Health Services, Inc. Ms. Stoker-Mtume is with Shields for Families, Los Angeles.
Cathy
C
Sherbourne
Dr. Chung is with the Department of Psychiatry, Harbor-University of California, Los Angeles (UCLA), Medical Center, and he is also with RAND Health, RAND Corporation, Santa Monica, California, where Dr. Ngo, Dr. Wells, Dr. Sherbourne, and Dr. Miranda are also affiliated (e-mail: bchung@mednet.ucla.edu ). Dr. Wells and Dr. Miranda are also with the Center for Health Services and Society, Department of Psychiatry, UCLA, where Mrs. Pulido, Dr. Johnson, and Dr. Tang are also affiliated. Dr. Johnson is also with the U.S. Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, where Dr. Ong is affiliated. Dr. Ong is also with the Department of Medicine, UCLA. Ms. Jones is with Healthy African American Families II, Los Angeles. Mr. Gilmore is with Behavioral Health Services, Inc. Ms. Stoker-Mtume is with Shields for Families, Los Angeles.
Jeanne
J
Miranda
D000328:Adult; D003156:Community Mental Health Services / Q000592:standards* / Q000706:statistics & numerical data; D055812:Community-Based Participatory Research; D003866:Depressive Disorder / Q000628:therapy*; D055317:Evidence-Based Practice; D006282:Health Personnel / Q000193:education* / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D015397:Program Evaluation; D058996:Quality Improvement / Q000592:standards* / Q000706:statistics & numerical data