The 130th Annual Meeting of APHA

Abstract #43983

Joseph C. Horton, MSW, LCSW¹, Wilson Compton, MD², Linda B. Cottler, PhD², and Michael Dennis, PhD³. (1) School of Medicine, Department of Psychiatry, Washington University, 40 North Kingshighway, Suite 4, St Louis, MO 63108, 314-362-2265, jch1@gwbmail.wustl.edu, (2) Department of Psychiatry, Washington University School of Medicine, 40 N. Kingshighway, Suite 4, St. Louis, MO 63108, (3) Chestnut Health Systems, 720 West Chestnut, Bloomington, IL 61701

Two major studies have demonstrated that mental health professionals working with primary care physicians can improve the quality and outcomes of care for patients beginning a new episode of treatment for major depression. Building on the concept that depression is an under-recognized and under-treated illness, our goal is to demonstrate an innovative way to improve the recognition and treatment of depression in a substance abuse treatment setting. We adapted a primary care case management intervention for substance abuse treatment by using a substance abuse counselor as the case manager instead of a nurse. We are conducting in-person psychiatric assessments on 500 consecutive adult admissions to the Chestnut Health Systems (CHS) substance abuse treatment programs in Madison County, IL. Subjects with current DSM-IV major depression (n=120) are then randomized to the enhanced psychiatric case management (CM) group (n=60) or to a no case management, treatment as usual (TAU) group (n=60). Each patient in the CM group is assigned to a clinical case manager who educates him/her about depression and provides individualized case management services that facilitate referral to and compliance with psychiatric care. All subjects are followed at 6 and 12 months to assess short and long term outcomes using CHS records, State database records, in person interviews, and urine drug testing. Because the research design and outcomes study is imposed on a community based outpatient substance treatment program, implementation has both enriched the study and made it more complex. These issues and preliminary results of the baseline will be discussed.

Learning Objectives: At the conclusion of this session, the participant will be able to

• Articulate the advantages of involving mental health professionals with primary care physicians in the treatment of those with major depression
• Describe the application of this concept to substance abuse settings in the form of case management provided by a substance abuse counselor
• Discuss the study in process, its initial findings, and its potential application in other substance abuse treatment settings

Keywords: Mental Illness, Substance Abuse Treatment

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.