Special thanks to the University of Washington, UC Davis, and the Care Partners Cohort 2 program sites for their contributions to this post.
On May 19, 2021, the University of Washington and UC Davis, with support from Archstone Foundation, hosted the final grantee meeting of the Care Partners Project.
Annual meetings have been a hallmark of the process since we originally launched the project in 2014 under our Depression in Late-Life Initiative. From the beginning, the meetings have promoted peer learning, shared successes and challenges, and supported a continuous quality improvement approach to the work of partnering health care clinics with community-based organizations (CBOs) and/or family members to improve depression outcomes for older adults.
Since 2017, across all seven sites in cohorts 1 and 2, 920 older adults with depression were enrolled in care. Most were women (three-quarters), and approximately one-quarter were men. Preliminary outcomes suggest that more than 50% of patients experienced a 5-point or more improvement in their PHQ-9 depression score. That represents a significant improvement in depressive symptoms and corresponds to care that is roughly two times better than usual depression care in the United States.
Although all the sites were working to improve depression care in late life, “Everybody had their own recipe about how to approach this work,” noted Dr. Jürgen Unützer, University of Washington. That created a rich array of approaches to improving partnered depression care.
The second and final cohort of program sites has been meeting yearly since it started in 2018. However, halfway through the three-year cohort, the COVID-19 global pandemic hit, which radically changed the way we deliver care and also proved to be a universal stressor – for patients, practitioners, and clinicians alike.
The onset of the pandemic was not something we could have imagined even a year and half ago, and yet it has changed the way the sites delivered care in profound and permanent ways. For example, all of the sites quickly moved to implement telemedicine and increased telephone-based outreach and care to depressed older adults.
Older adults were disproportionately impacted by COVID-19 due to medical risk factors, and sites had to quickly find ways to address issues of staying connected with their older patients during the pandemic. Outreach began with phone calls, and then they worked to add some structure to the calls so the work of depression care could continue in a clinically meaningful way, providing more than just a check-in. This prompted the creation of the Stay Connected program, which includes a list of resources contributed by the sites to make certain clients and patients are receiving the support they need during the pandemic.
Site by Site Reflections
At the final annual meeting, each site had an opportunity to reflect on one or two key things that they learned and will take away from the program moving forward. They also discussed the areas in depression care partnership work that could benefit from further developments to keep growing and improving.
Dr. Karen Rentas, Facey Medical Group, noted that they have now integrated behavioral health within OB/GYN for maternal mental health, and have plans for integration within oncology, pain management and pediatrics, extending the reach of depression care. Partnering the health care team with the Depression and Bipolar Support Alliance (DBSA) and the DBSA Peer Support Specialists allowed them to tap into each other’s expertise. Dr. Rentas and Douglas Hulst, DBSA, noted that the partnership provided two perspectives – from the Peer Support Specialist and the primary care physician or behavioral health specialist clinicians – to better understand what the patient is going through and to help provide a complete picture of what the patient/client is experiencing, allowing more complete treatment to be offered.
Wendi Vierra, Neighborhood HealthCare, made an important observation regarding their partnered work with Interfaith Community Services: namely, that providing secure homes and food as a first step makes a big difference in improving the well-being of older adults. Addressing tangible needs upfront allows clinicians to then work on improving other aspects of well-being. Eva Navarrete, Neighborhood HealthCare, learned that providing services in a familiar environment is key to engaging patients, and that partnership requires flexibility and adaptability to work together. Beth Brainerd Hallock, Interfaith Community Services, discussed the importance of beginning by building trust among team members and with clients. Addressing social determinants of health is very complex and it takes hard work to bring it all together.
Lorin Scher, UC Davis Health, mentioned that at the beginning, it seemed like a no-brainer to include family members in depression care, especially for partnership around symptom monitoring, transportation to appointments, and supporting therapy goals. The site offered family-partnered care to more than 430 patients; however only about 13% accepted, demonstrating that involving family members was more challenging than initially envisioned. Dr. Scher observed that patients who often come to a health care appointment with a family member (in particular patients with mobility limitations or a neurological condition) tended to be easier to recruit and to be more receptive to involving a family partner in care.
Claudia Nau, Kaiser Permanente Southern California, noted that their partnership with Healthy African American Families (HAAF II) provided the opportunity for deeper human connections that otherwise might be lost in a busy medical setting. They noticed that working as a team improved over time by scheduling regular check-in times to engage with the providers. The resiliency classes led by HAAF II offered an opportunity for older adults to engage with others. Felica Jones of HAAF II noted how hard the pandemic hit older adults in the South Los Angeles community and that those who live in the community and their providers will be going through a process of healing after more than a year dealing with the pandemic.
Emerging Lessons Learned
Dr. Ladson Hinton, UC Davis, reflected on the key themes of the Care Partners evaluation and qualitative findings. Three main themes have emerged: complexity of partnering; importance of CBO involvement; and the important intersection of social needs and depression care. For example, taking extra time at the beginning to build buy-in, identify a champion, and establish communication channels across organizations can be crucial to quality partnered care when the intervention is rolled out. CBO involvement has led to a great appreciation of social needs. And having a CBO partner that can then allow and encourage access to resources, education, and social connections can provide more holistic and effective depression care.
Sharing these insights at the annual meetings has strengthened the intervention, allowing sites to learn from one another’s experiences and solve problems. The groups concluded by brainstorming common opportunities to advocate for policy changes and with the suggestion for future opportunities to reunite and discuss how they are working to improve depression care in their communities.
