Randomized Trial of Reverse Colocated Integrated Care on Persons with Severe, Persistent Mental Illness in Southern Texas.

BACKGROUND: Persons with severe, persistent mental illness (SPMI) are at high risk for poor health and premature mortality. Integrating primary care in a mental health center may improve health outcomes in a population with SPMI in a socioeconomically distressed region of the USA. OBJECTIVE: To examine the effects of reverse colocated integrated care on persons with SPMI and co-morbid chronic disease receiving behavioral health services at a local mental health authority located at the US-Mexico border. DESIGN: Randomized trial evaluating the effect of a reverse colocated integrated care intervention among chronically ill adults. PARTICIPANTS: Participants were recruited at a clinic between November 24, 2015, and June 30, 2016. INTERVENTIONS: Receipt of at least two visits with a primary care provider and at least one visit with a chronic care nurse or dietician, compared with usual care (behavioral health only). MAIN MEASURES: The primary outcome was blood pressure. Secondary outcomes included HbA1c, BMI, total cholesterol, and depressive symptoms. Sociodemographic data were collected at baseline, and outcomes were measured at baseline and 6- and 12-month follow-ups. KEY RESULTS: A total of 416 participants were randomized to the intervention (n = 249) or usual care (n = 167). Groups were well balanced on almost all baseline characteristics. At 12 months, intent-to-treat analysis showed intervention participants improved their systolic blood pressure (ß = - 3.86, p = 0.04) and HbA1c (ß = - 0.36, p = 0.001) compared with usual care participants when controlling for age, sex, and other baseline characteristics. No participants withdrew from the study due to adverse effects. Per-protocol analyses yielded similar results to intent-to-treat analyses and found a significantly protective effect on diastolic blood pressure. Older and diabetic populations differentially benefited from this intervention. CONCLUSIONS: Colocation and integration of behavioral health and primary care improved blood pressure and HbA1c after 1-year follow-up for persons with SPMI and co-morbid chronic disease in a US-Mexico border community. TRIAL REGISTRATION: clinicaltrials.gov , Identifier: NCT03881657.

Use of a Smartphone Recovery Tool for Latinos with Co-Occurring Alcohol and Other Drug Disorders and Mental Disorders.

OBJECTIVE: Addressing alcohol and other drug disorders and other mental disorders among adult Hispanics/Latinos is of critical concern, as they are one of the fastest-growing ethnic groups with a disproportionate rate of disease, mental disorders, and poverty. Although improvement in outcomes is associated with sustained participation in ongoing treatment for co-occurring alcohol and other drug disorders/mental disorders, continuing care is rare for these chronic conditions, especially for Latinos with more limited access to culturally and linguistically competent services. METHODS: The evidence-based smartphone recovery application Addiction-Comprehensive Health Enhancement Support System (A-CHESS) was translated and adapted for Spanish-speaking Latinos with alcohol and other drug disorders/mental disorders, thus developing CASA-CHESS to address a high level of need for services, high rates of relapse, and lack of existing culturally competent services for Latinos. RESULTS: Of the 79 Latino clients who completed residential treatment and received a smartphone equipped with CASA-CHESS, 26.6% discontinued using CASA-CHESS and 73.4% remained active for four or more months. CASA-CHESS usage was sustained over the four months across all three tenets of self-determination theory (competence, relatedness, and autonomy), with the most commonly utilized services being relevant to relatedness (e.g., messaging, discussion boards). CASA-CHESS clients demonstrated a similar pattern of usage to A-CHESS clients. CONCLUSIONS: Findings illustrate that Spanish-speaking Latinos with alcohol and other drug disorders/mental disorders will use a smartphone application to assist with their recovery, continuing their access to resources, case management, and quality information after leaving residential treatment. Consistent with previous findings, our results also emphasize the importance of social support during the four months post-discharge. Such evidence-based, theory-driven digital interventions may extend access to culturally and linguistically competent services.

Enhanced Integrated Behavioral Health Model Improves Depressive Symptoms in a Low-Income, Uninsured, Primarily Hispanic Population Served by a Free and Charitable Clinic.

BACKGROUND: Residents living in US-Mexico border communities have some of the worst health outcomes nationally. This randomized trial evaluated whether patients receiving enhanced integrated behavioral health (IBH) care at a southern Texas free and charitable were more likely to improve health outcomes after 12 months compared to patients receiving standard care. THEORY & METHODS: The IBH intervention featured brief intervention by a behavioral health specialist and enhanced coordinated care. The primary outcome was systolic blood pressure. Secondary outcomes were diastolic blood pressure, HbA1c, BMI, and depressive symptoms. Linear regression models were utilized to assess the impact of IBH on participants; secondary analyses examined possible effect modification. RESULTS: After 12 months, intervention participants (n = 172) were more likely to have a lower PHQ-9 score than control participants (n = 198) (ß = -1.67, p = 0.01). There was significant modification of the intervention effect by age; there was a different effect on older participants (ß = -2.08, p = 0.01). There were no statistically significant findings for other outcomes. CONCLUSIONS: Collaborative, integrated behavioral health and primary care can improve depressive symptoms for low-income or uninsured individuals living in southern Texas border communities. These findings provide evidence that may help develop IBH programs to improve health of vulnerable populations experiencing health inequities.