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An Uplifting Partnership

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The seeds of a groundbreaking partnership to improve depression care in under-resourced parts of Los Angeles were sown more than a decade ago.

The seeds of a groundbreaking partnership to improve depression care in under-resourced parts of Los Angeles were sown more than a decade ago. 

As the leader of a non-profit advocacy organization aiming to improve the health of African American, Latino, and Korean communities of Los Angeles, Loretta Jones was deeply concerned about the mental wellbeing of the communities she represented – and the stigma that kept many from seeking help for clinical depression. “Depression wasn’t a word that people were even using in our communities,” says Jones, founder and CEO of Healthy African American Families II. “We needed to get the word out that this is an illness that can be treated, that the treatment people needed could be found in the community, and that the community would be there for them.”

As a psychiatrist and health services researcher interested in improving mental health services in under-resourced communities, Dr. Kenneth Wells (MPH ’80), a professor in the Fielding School’s Department of Health Policy and Management and David Geffen School of Medicine at UCLA, as well as a staff member at RAND, had completed a major national study, Partners in Care, finding that African Americans, Latinos and other ethnic minority groups were significantly less likely than more affluent whites to receive the care they needed for depression. But the Wells-led study also showed that expanding access to appropriate depression care led to 4-5 times greater mental-health outcome improvements for ethnic minorities than for whites. “It was clear there was a tremendous opportunity because there had been so little prior exposure to evidence-based treatment in these under-resourced communities,” Wells says.

The question was how to translate the promise of high-quality depression care into a public health reality in communities of color. To help find answers, Wells approached Jones, and for the next several years “I became Loretta’s apprentice,” Wells says, as they engaged in discussions about the best ways to establish a dialogue in the community about depression; to improve the quality and accessibility of depression care; and to build on existing community strengths in doing so. The result is the ongoing Community Partners in Care (CPIC), which “has made it safe to talk about depression in my community,” says Jones, one of the leaders in the effort, which involves nearly 100 community organizations in South Los Angeles and Hollywood-Metro Los Angeles.

CPIC has used rigorous study methods to determine whether agencies and communities working together through a community engagement process is a better way of improving depression services and quality of life outcomes for people who need the services than agencies working alone. Most notably, CPIC employs a model that draws on the strengths of the university and the community in an equal partnership. “This is a truly level playing field that allows communities to give input to universities on what needs to be done, and the university to respond with evidence-based but community-involved research,” says Jones. “There is no decision made by the university that is not vetted in the community first. No publications are submitted without the community’s input into them.”

 

 

More than any collaboration she has seen, Jones says, CPIC values the expertise residing in the community – including individuals who possess what she refers to as “the PhD of the sidewalk.” Because of community input, for example, CPIC expanded on the Partners in Care concept, which was based in primary care clinics, to also bring depression education and services to homeless and social service agencies, prison re-entry populations, substance-use treatment clinics, faith-based institutions, and other community programs and settings.

The work of Dr. Thomas Belin, professor in the Fielding School’s Department of Biostatistics and co-chair of the methods committee that designed the CPIC study, exemplifies the value of the project’s close partnership. Belin has given talks on integrating traditional statistical ideas into community-partnered research, underscoring the importance of cultivating trust given the legacy of research abuses that have historically occurred in minority communities. In his role of helping to ensure that CPIC remains on a secure scientific foundation, Belin has benefited greatly from community input. “This project illustrates how much we have to gain by bridging strong science with the needs of the community in a way that is based on mutual respect,” Belin says. “When we combine academic strength in rigorous science with community partners’ credibility and knowledge of the local environment, the result can be amazingly powerful.”

The results of the study have fulfilled the hopes of its architects. In a randomized trial involving more than 1,000 depressed, primarily low-income African American and Latino clients drawn from 93 community settings, the community engagement approach led to improved mental health-related quality of life, a lower risk for homelessness, and a reduction by approximately 50 percent in hospitalizations for behavioral health conditions. As the randomized phase has drawn to a close, CPIC has entered a dissemination phase in which the results are shared with the community and workshops are held to discuss strategies for sustainable efforts to apply the findings to improving depression services.

CPIC’s success hasn’t gone unnoticed. The project has earned national acclaim, including the Team Science Award of the Association of Clinical and Translational Science in 2014, Community-Campus Partnerships for Health’s annual award for 2015, as well as the Landmark Award as the UCLA Community Program of the Year. In 2014, based on early results from the study, the L.A. County Board of Supervisors approved a proposal led by the county’s Department of Mental Health Services to adopt the Health Neighborhood Initiative, which uses the CPIC engagement model to respond to community behavior health needs under expanded Medicaid services. The Veterans Health Administration, based on CPIC’s findings on reducing homelessness risk, is working with CPIC leadership on research and training initiatives to improve services for homeless veterans.

Wells and Jones are teaching current and future professionals in public health and related fields about the CPIC partnership model, applying it to a wide variety of health concerns. Wells directs the Community Based Participatory Health Research course at the Fielding School with staff from Healthy African American Families II, the L.A. County Department of Health Services and the L.A. County Department of Mental Health Services.

Jones, honored in 2014 by the UCLA Fielding School of Public Health Alumni Association with the Ruth Roemer Social Justice Leadership Award, has dedicated more than 40 years to eliminating health disparities and improving health outcomes in Los Angeles. “The work we’re doing with CPIC has allowed communities to feel like they’re being heard in a way they haven’t before,” she says. “We’ve been working a long time to try to reduce health disparities, and with this model we are finally starting to see that we can make a difference.”