219929 Telephone Care Management of Medicaid recipients with depression: A Randomized Control Trial

Tuesday, November 9, 2010 : 5:00 PM - 5:15 PM

Sue Kim, PhD, MPH , Health and Bariers to Employment, MDRC, Oakland, CA
Allen LeBlanc, PhD , Health Equity Institute for Research, Practice & Policy, San Francisco State University, San Francisco, CA
Charles Michalopoulos, PhD , Health and Bariers to Employment, MDRC, Oakland, CA
Francisca Azocar, PhD , United Behavioral Health, San Francisco, CA
Evette Ludman, PhD , Center for Health Studies, Group Health Cooperative, Seattle, WA
Greg Simon, MD , Center for Health Studies, Group Health Cooperative, Seattle, WA
David Butler , Health and Barriers to Employment, MDRC, New York, NY
Telephone care management(TCM) has been shown to improve outcomes for depressed patients. However, there is a lack of studies on its effectiveness for Medicaid recipients. This study examines a one-year TCM intervention designed to help low-income individuals experiencing major depression to enter and remain in in-person treatment. This study included 499 Medicaid participants who screened positive for depression in Rhode Island at baseline (average age of 35(18-64yo) and 90% were women). After random assignment, the intervention group received intensive monitoring from care managers to facilitate clinical treatment. The control group received usual care, which included referrals to mental health treatment providers. Depression severity was measured at baseline, six and 18 months. Administrative and survey data provided information on utilization of mental health services. Qualitative data were drawn from care managers' case notes. At 18 months follow-up, the mean depression scores between the program and control groups were not significantly different. Although care managers were able to contact 91 percent of those assigned to the program group and averaged about 9 contacts per client over a year, less than a third of the participants received in-person professional treatment specifically for depression. The participants typically faced a proliferation of ongoing stressors in multiple life domains. The cumulative impact of these life stressors greatly limited or overwhelmed clients' efforts to seek or maintain in-person care. The lack of success among Medicaid recipients highlights the need for a more intensive intervention that may require more than a telephonic care management.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Other professions or practice related to public health
Public health or related research
Social and behavioral sciences

Learning Objectives:
1.Evaluate the effectiveness of a telephonic care management program to engage parents, who are depressed and receiving Medicaid, in depression treatment. 2.Describe the circumstances of many of the participants that influence their well-being and ability to seek treatment.

Keywords: Depression, Medicaid

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am trained as a health economist and health services researcher and have been conducting several evaluations of programs that study care coordination or care management for Medicaid recipients.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.