University of Southern California
Depression screening along with support from a community health worker and social worker.
Latino community health workers screen patients for depression and other mental health challenges while they seek care in the emergency department. Those who screen positive for depression review depression-education materials with the community health worker and are scheduled to meet with a bilingual, bicultural social worker who provides services on-site.
Using depression care guidelines, the social worker offers patients a choice of treatment consisting of eight weeks of problem-solving therapy, antidepressant medication, or both and makes appropriate referrals. Patients also receive information about mental health resources in their community and a letter for their primary care physician to inform them that the patient screened positive for depression.
Low-income, minority patients disproportionately utilize the emergency department as a surrogate for primary care and are rarely screened or provided with depression treatment while there. Integrating a motivational, personalized, culturally and linguistically appropriate assessment of substance use and other mental health service needs with active treatment referrals into emergency medical services may significantly improve access to, and participation in, depression treatment.
The involvement of the departments of medicine, psychiatry and emergency medicine in this project provides cross-disciplinary collaboration and insights on how to screen for and improve the delivery of depression treatment in the
emergency department. It is hoped that subsequent reduction of the adverse consequences of depression will improve patient outcomes and decrease rates of emergency department overutilization.
Depression screening during emergency department visits, conducted by community health workers and social workers, successfully increased patient receipt of problem solving therapy, antidepressent medications or both (51% vs 26% in controls). For patients receiving problem solving therapy, those in the intervention group were more likely to have four or more sessions (33% vs 4% controls). However, the intervention did not improve depression outcomes. Implementation challenges may have hindered the overall success of the intervention.
- Sarita Mohanty, MD, MPH
- Isabel Laomasino, MD, MSHS