201. Promotoras as Mental Health Practitioners in Primary Care: A Multi-Method Study of an Intervention to Address Contextual Sources of Depression
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Richard Santos, Joel Yager, Christina M. Getrich, Howard Waitzkin, Cathleen E. Willging, Anita Parmar, Laura Zúñiga Rodríguez, and Shirley Heying
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Adult ,Employment ,Male ,Gerontology ,Health (social science) ,Interprofessional Relations ,New Mexico ,MEDLINE ,Medically Underserved Area ,Violence ,Food Supply ,law.invention ,Health(social science) ,Professional Role ,Randomized controlled trial ,law ,Intervention (counseling) ,Humans ,Medicine ,Poverty ,Depression (differential diagnoses) ,Primary health care ,Community Health Workers ,Original Paper ,Community health aides ,Depression ,business.industry ,Health services accessibility ,Public Health, Environmental and Occupational Health ,Community health centers ,Odds ratio ,Middle Aged ,Mental health ,Community Mental Health Services ,Intake interview ,Treatment Outcome ,Community health ,Housing ,Female ,business - Abstract
We assessed the role of promotoras—briefly trained community health workers—in depression care at community health centers. The intervention focused on four contextual sources of depression in underserved, low-income communities: underemployment, inadequate housing, food insecurity, and violence. A multi-method design included quantitative and ethnographic techniques to study predictors of depression and the intervention’s impact. After a structured training program, primary care practitioners (PCPs) and promotoras collaboratively followed a clinical algorithm in which PCPs prescribed medications and/or arranged consultations by mental health professionals and promotoras addressed the contextual sources of depression. Based on an intake interview with 464 randomly recruited patients, 120 patients with depression were randomized to enhanced care plus the promotora contextual intervention, or to enhanced care alone. All four contextual problems emerged as strong predictors of depression (chi square, p
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