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Point of View

Archstone Foundation, in partnership with the University of Washington and University of California, Davis, has selected four primary care and community-based organization (CBO) partnerships to participate in a Learning Collaborative to Improve Depression Care for older adults and reduce mental health disparities.

Over the past seven years, Archstone Foundation has supported evidence-based partnerships to improve depression care for older persons through the Care Partners project. The four new clinic-CBO partnerships will learn from Care Partners as they advance new approaches to partnered depression care in their communities.

Each partnership will receive a one-year award of $30,000 to participate in a continuous quality improvement learning community. Partners will create innovative solutions to address patients’ medical, behavioral, and social needs to improve care.

The University of Washington conducted extensive outreach via their website, a webinar, mailing list, and individualized messages to more than 30 health care entities and CBOs to alert organizations about the opportunity to apply to be a part of the Leaning Collaborative. A total of just six applications were received, which underscores the extra burden currently faced by primary care clinics and CBOs in serving older adults since the start of the COVID-19 pandemic.

Although the team received fewer applications than anticipated due to competing priorities related to the COVID pandemic, we were able to provide awards to several strong partnerships creating a great learning community. With fewer sites, experts from the technical assistance team will be able to offer more robust and tailored support for each partnership, and the total size of the award was increased from $20,000 to $30,000.

The four partnership applications selected show tremendous promise to improve depression care through a coordinated approach. They are:

  1. Community Health Centers of the Central Coast (CHCCC) and the Food Bank of Santa Barbara County (FBSBC);
  2. Eisner Health and Special Service for Groups’ (SSG) SILVER program;
  3. San Bernardino County Department of Aging and Adult Services’ Age Wise program and Lifestyle Medical; and
  4. Grove by Sutter Health and Council on Aging, Santa Rosa, California.

New Partnerships Replicate Success and Test New Approaches

Each partnership will bring unique perspectives to the Learning Collaborative. In fact, these four new sites will add to the rich array of approaches to improving depression care that was highlighted by Dr. Jürgen Unützer, University of Washington, in a previous Point of View blog post.

“These four partnerships will advance the partnered approach to depression care first implemented in the Care Partners project,” says Dr. Theresa Hoeft, University of Washington. “Although true coordinated care across clinics and CBOs can be difficult to achieve, it is well worth the investment. Joining with other innovators who are implementing new models in the Learning Collaborative will create a community that can learn from one another to improve that partnership process and ultimately improve care.”

  • Community Health Centers of the Central Coast (CHCCC) and the Food Bank of Santa Barbara County (FBSBC) will design an innovative partnership project focused on integrated behavioral health care coordination and increased food access to improve depression in older adults. Their work will focus on older adults with behavioral health conditions who are experiencing food insecurity and social isolation. CHCCC and FBSBC will provide care coordination and case management services to ensure access to emergency food programs, clinical treatment, and community-based resources. FBSBC staff will also refer eligible older adults in their programs to CHCCC for integrated health services. Through their partnership, CHCCC and FBSBC aim to improve the depression care of older adults through whole-person and collaborative health practices.
  • Eisner Health and SSG SILVER plan to implement a collaboration focused on patients enrolled at Eisner Health’s clinic in the City of Lynwood, a Medically Underserved Area with Health Professional Shortage Area designations for primary care and mental health. Together, they envision a deeper relationship between the two organizations that would enhance outreach efforts, establish a continuum of care, and ensure methodical coordination and follow-up. A highlight of their proposed approach is a planned bi-directional referral mechanism to help clients find needed services and regular case consultation across the organizations to improve care for patients. SSG SILVER has experience offering case management to vulnerable populations, including persons with serious mental illness and those with a history of homelessness or law enforcement involvement.
  • San Bernardino County Department of Aging and Adult Services’ Age Wise program and Lifestyle Medical plan to expand their efforts toward the holistic treatment of older adults throughout the county, especially those who are suffering with symptoms of depression or have a clinical diagnosis of depression. Age Wise is a community-based, mental health program for older adults, with services including in-home and telehealth consulting services, case management, peer and family advocacy, and support and education groups. The goal of the partnership is to provide comprehensive wraparound services to ensure the highest quality of care. Like the Eisner Health and SSG SILVER program partnership, the Age Wise-Lifestyle Medical partnership plans to utilize bi-directional referrals to improve mental and physical wellbeing.
  • Grove by Sutter Health and Council on Aging, Santa Rosa, California will expand their connection to community resources and partnerships in order to more readily help their patients with their mental health needs. Grove integrates high-touch primary care with the connection to social services and home care to support older adults living with multiple chronic conditions. An interesting aspect of this partnership is that they will employ the Peer Support Program through the Council on Aging to enhance care through the Grove Project by Sutter Health.

Together, these partners will meet regularly to participate in webinars on evidence-based depression care and partnership building. They will also join monthly learning calls to support ongoing quality improvement work to implement partnered, high-quality depression care.

Sites will work in collaboration with their partners to find and engage patients in depression care; develop and implement a treatment plan to address patient care domains; monitor, adjust, adapt, and sustain quality improvement to depression care; and adapt evidence-based practices for diverse and underserved populations to reduce mental health disparities. The partners will share lessons, challenges, and outcomes with each other as part of the Learning Collaborative, and with others interested in improving depression care.

Special thanks to the University of Washington, UC Davis, and the Care Partners Learning Collaborative project sites for their contributions to this post.

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