Harlem Strong Mental Health Coalition

Official title

Harlem Strong Mental Health Coalition: A Multi-sector Community-Engaged Collaborative for System Transformation

Overview

Addressing health disparities, especially in the face of coronavirus pandemic, requires an integrated multi-sector equity-focused, community-based approach. This study will examine the impact of Harlem Strong Community Mental Health Collaborative, a community-wide multi-sectoral coalition in which a health insurer works with a network of community-based organizations, medical providers, and behavioral health providers to engage in a network-wide implementation planning process to: (1) problem-solve financing, access, and quality of care barriers, (2) support capacity building for mental health (MH) task-sharing for community health workers, (3) facilitate coordination and collaboration across MH/behavioral health, primary care, and a range of social services, including case management, housing supports, financial education, employment support, and other community resources to improve linkages to services, and (4) identify a set of common MH, social risk, and health metrics and strategies to integrate these metrics into data systems across the network for continuous quality improvement of the system. The long-term goal of our study is to develop sustainable model for task-sharing MH care that will be embedded in a coordinated comprehensive network of services, including primary care, behavioral/MH, social services, and other community resources.

Detailed description

This study examines the impact of Harlem Strong Community Mental Health Collaborative, a community-wide multi-sectoral coalition in which a health insurer works with community-based organizations and medical and behavioral health providers to (1) problem-solve financing, access, and quality of care barriers, (2) support capacity building for MH task-sharing for community health workers, (3) facilitate coordination and collaboration across MH/behavioral health, primary care, and social services, and (4) identify a set of common metrics and strategies for continuous system quality improvement. The research study will evaluate the impact using a Hybrid Implementation-Effectiveness design to assess the effects of the Harlem Strong Collaborative on implementation and consumer outcomes. The investigators will also describe implementation outcomes and key informant interviews to explore impact of community engagement, organization variables, and provider factors on model impact. The long-term goal of this study is to develop a sustainable model for task-sharing MH care that will be embedded in a coordinated comprehensive network of services.

The investigators will conduct a stepped-wedge clustered randomized control study evaluating the effectiveness of a MH task-sharing intervention, that involves randomization and sequenced exposure to three implementation conditions: (1) online education and resources (E\&R) about MH task-sharing (screening, education, and referral), (2) community-engaged multisector collaborative care model (MCC), where a neighborhood-based coalition will support implementation of MH task-sharing, and (3) community crowdsourced technology solution to support implementation (MCC+Tech).

Interventions

• Behavioral MH task-sharing training
  Providers will be trained to screen for MH, provide education, refer, and coordinate to range of social services. MH training typically consists of education and resources, such as one-time workshops and toolkits, provided with limited technical assistance.
• Behavioral Supervision
  Additionally, Community Health Workers (CHWs) will receive bi-weekly group supervision for the first 6-months, and monthly supervision for the remaining year on Zoom from a supervisor at Center for Innovation in Mental Health.
• Behavioral Learning Collaborative
  A learning collaborative with multidisciplinary teams from various healthcare organizations will support continuous quality improvement and develop develop structured approach to improve provision of care.
• Other Technology Intervention
  To be determined by community crowdsourcing after the first phase of implementation of the multisector collaborative care for MH task-sharing.

Primary outcome measures

• Depression - PHQ-9 [Time frame: 6-12 months]
• Anxiety - GAD-7 [Time frame: 6-12 months]
• Reach of Screening [Time frame: 0-24 months]
• Mental Health Service Linkage [Time frame: 0-24 months]

Secondary outcome measures (8)

• Program Adoption [Time frame: 0-12 months]
• Program Sustainment [Time frame: 24 months]
• Implementation Barriers and Facilitators [Time frame: 12, 24 months]
• Provider Attitude towards Adopting Evidence-Based Practices (EBPAS) [Time frame: 0, 6, 12, 24 months]
• Partnerships with Coalition Members [Time frame: 0, 6, 12, 24 months]
• Housing Security [Time frame: 6-12 months]
• Employment Security [Time frame: 6-12 months]
• Food Insecurity [Time frame: 6-12 months]

Eligibility criteria

Inclusion criteria

• Black and Latino adults between 18 and 65 years
• Harlem residents from low-income housing developments or receiving primary care services in Harlem
• PHQ-4 Total Score ≥3, moderate risk for depression

Exclusion criteria

• Those with risk for depression or anxiety who screen positive for severe mental illness (e.g., psychosis, mania, substance abuse, and high suicide risk) using screening items from the Mini-International Neuropsychiatric Interview will be excluded from the study and referred to MH services at higher levels of care

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Crossover

Masking

Single blind

Primary purpose

Health services research

Study locations

United States · 2 centers

• CUNY Graduate School of Public Health and Health Policy — New York
• Harlem Congregation for Community Improvement — New York

Publications

• Ngo VK, Vu TT, Levine D, Punter MA, Beane SJ, Weiss MR, Wyka K, Florez-Arango JF, Zhou X. A multisector community-engaged collaborative for mental health integration in primary care and housing developments: Protocol for a stepped-wedge randomized controlled trial (the Harlem Strong Program). BMC Public Health. 2024 Sep 19;24(1):2554. doi: 10.1186/s12889-024-20026-6. PMID 39300414

Identifiers

NCT: NCT05833555 · U01OD033245

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗