UNM Health Sciences Center faculty members have received two of only six major Robert Wood Johnson Foundation grants awarded nationally to study innovative methods of combating depression at the community level. Howard Waitzkin, M.D., Ph.D., professor, School of Medicine Department of Family and Community Medicine, received a grant of $298,508 to assess the effectiveness of community health workers, known as promotoras, in treating depression at community centers. Steven Adelsheim, M.D., associate professor, School of Medicine Department of Psychiatry, and Jane McGrath, M.D., associate professor, School of Medicine Department of Pediatrics, received $300,000 for a 24-month program that will provide depression screening and treatment for adolescents in rural New Mexico schools.
The research grants were awarded under the $21-million, national program, entitled, "Depression in Primary Care: Linking Clinical and System Strategies." The program's goals foster innovation and the increased use of effective treatment models for depression in primary care settings. Some 192 letters of intent to apply were received when the call for proposals went out. Of that that number, 35 applicants were invited to submit full applications in September 2002. The UNM researchers received two of the six major grant awards.
Community health workers, known as promotoras in Latin America and U.S. Hispanic communities, have emerged as widely used practitioners in underserved settings. Waitzkin's study will seek to evaluate if promotoras can contribute effectively to depression care in primary care settings. The UNM research team will work in collaboration with First Choice Community Healthcare, a network of 10 community health centers committed to providing accessible services in underserved communities. UNM colleagues in the Departments of Family and Community Medicine, Psychiatry, Economics, and Communication and Journalism will participate in the project.
"Our project will become, to our knowledge, the first evaluation of promotoras as mental health practitioners focusing on depression and will provide important information for stakeholders including community leaders, primary care practitioners, health service administrators, and policy makers," said Waitzkin. "An innovation that succeeds in reducing economic, cultural, and linguistic barriers in New Mexico's daunting context - of poverty, adverse mental health outcomes, and ethnic/ racial minorities' comprising the majority of the population - could become an influential model for change, both regionally and nationally."
Adelsheim's grant is the only one focused on addressing the special needs of rural teenagers with depression. In 1999, New Mexico had the greatest proportion of children living in poverty, the highest teen death rate from homicide/suicide/accidents and the fifth highest percentage of teens not in school or working. Yet, with only 12 child psychiatrists in the entire state outside Albuquerque, there are only limited psychiatric services available in rural areas to meet this need. Adelsheim's proposed project, "Evaluation of Depression Screening and Treatment in Rural New Mexico School-Based Health Centers," will implement and evaluate what promises to be a cost-effective program to address the needs of rural teenagers in the state.
His study will train primary care providers in four rural school-based centers to provide depression screening and treatment. Screening will be provided for at least 720 teenagers and depression treatment will be provided over three school semesters for roughly 180 students. Telemedicine consultations will be used to cost-effectively support mental health treatment activities.
"We've been involved with this for some time and we developed a depression protocol with our work as a Medicaid managed care pilot project," said Adelsheim of the grant to screen teenagers for depression. "This current grant will allow us to effectively evaluate the early identification and treatment protocol as well as give us information as to the cost effectiveness of school-based health center as sites for treatment for mental health conditions compared to the existing the community and inpatient services."
The UNM Center for Telehealth; UNM Pediatrics Department; New Mexico Department of Health, Office of School Health; Columbia University Division of Child and Adolescent Psychiatry; the Child and Adolescent Services Research Center at San Diego Children's Hospital and Health Center; and the Anderson School and Graduate School at UNM are also participating in the grant, Adelsheim said.
The Robert Wood Johnson Foundation, based in Princeton, N.J., is the nation's largest philanthropy devoted exclusively to health and health care. It concentrates its grantmaking in four goal areas: to assure that all Americans have access to quality health care at reasonable cost; to improve the quality of care and support for people with chronic health conditions; to promote healthy communities and lifestyles; and to reduce the personal, social and economic harm caused by substance abuse - tobacco, alcohol and illicit drugs. More information on RWJF can be found at www.rwjf.org.
Contact: Cindy Foster, 272-3322