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| IMPLEMENTATION STORIES
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RESPECT-Depression in Miami
At the Jefferson Reaves Senior Health Center in Overtown, Florida, staff members work hard to treat depression. With resources and support from the MacArthur Initiative on Depression and Primary Care at Dartmouth and Duke, our care team was able to develop a treatment program that fit our patients’ needs.
Mental health problems, particularly depression, are very common in primary care. Jefferson Reaves is a primary care clinic for residents in the Overtown community. The clinic is also a teaching clinic for University of Miami’s family medicine residents. The clinic care team, including Dr. David Brown; psychologist, Dr. Nicole Eull; mental health counselor, Erika M. Arias; and psychiatrist, Dr. Raymond Ownby, conducted some preliminary research in 2004-20051 in which the team discovered a lack of services for mentally ill patients attending the clinic. The team then decided to implement a collaborative model of depression care adapted for our local resources and needs at Jefferson Reaves. This project considers depression a chronic disease. It provides primary care physicians and patients, with the help of mental health professionals and a depression care manager, with the tools they need to better manage the disease.
The MacArthur Initiative was one of the major resources we were able to use for information gathering. They had patient education materials on depression and a diagnostic tool for depression, the PHQ 9, available for our use. These materials were a great starting point for improving the mental health care of our patients at the clinic. The training materials allowed the team to get started with a pre-defined protocol and pre-existing teaching materials. The patient education materials were a great way to give our patients information about depression and how to manage it. The materials also gave staff members a better understanding of what patients were experiencing.
The MacArthur Initiative materials were particularly helpful because the care team was able to tailor educational materials and treatment processes to the needs of our patients. We translated the educational materials into Spanish and Creole since the clinic is located in Florida . This allowed us to treat anyone who walked in the door with depressive symptoms no matter what language they spoke. The team also needed to adapt the approach to depression care to fit our patients’ limited resources and insurance, if they have any at all. Due to the lack of insurance for most of our patients and the lack of affordable counseling options, mental health counseling outside of our clinic was not a viable option for most patients.
We were able to offer free services to patients dealing with depression who otherwise would not be able to receive care due to their financial standing. The Three Component Model formed the basis of a grant application to a local health foundation. During the two years of our grant, we screened more than a thousand patients for depression, conducted hundreds of psychological consultations, and we were able to offer ongoing counseling, medication management, and additional services to over 150 depressed patients who would not have had easy access to mental health care. Patients in care management demonstrated progressive improvements in symptoms over time.
Overall, our treatment team was very privileged and thankful to have the opportunity to work with the MacArthur Initiative. The depression care model will be a great benefit to our patients.
David Brown, MD
Chief of Family Medicine, Florida International University College of Medicine
Erika Arias, MS
Depression Care Manager, Jefferson Reaves Sr. Health Center
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Brown DR, Hernández A, Saint-Jean G, Evans S, Tafari I, Brewster LG, Celestin MJ, Gómez-Estefan C, Regalado F, Akal S, Nierenberg B, Kauschinger ED, Schwartz R, and Page JB. A participatory action research pilot study of urban health disparities using rapid assessment response and evaluation. Am J Public Health. 2008;98(1):28-38 |
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