Depression Treatment Uptake in Integrated Primary Care: How a "Warm Handoff" and Other Factors Affect Decision Making by Latinos.

OBJECTIVE: Integrated behavioral health care has the potential to reduce barriers to mental health treatment among low-income and minority populations. This study aimed to identify predictors of Latino patients' decision to follow through with referrals to depression treatment in an integrated primary care setting, including type of referral (a "warm handoff" from a primary care provider [PCP] to a behavioral health care provider or a prescribed referral). METHODS: The authors conducted a sequential medical record review of 431 patients referred for depression treatment in integrated behavioral health services followed by qualitative semistructured interviews with a subsample of 16 patients. RESULTS: English-speaking Latinos were four times less likely to attend an initial visit within two months of a referral if they received a warm handoff rather than a prescribed referral. The strength of the patient-provider relationship and the quality of the referral experience, including whether the PCP addressed patients' health literacy and expectations for depression care, affected patients' decision to engage in depression treatment. CONCLUSIONS: Engaging Latinos in needed mental health treatment is a challenge, even when treatment is provided in primary care settings. Warm handoffs are considered effective components of engagement, but this study suggests that the effectiveness of warm handoffs may vary depending on the patient's primary language. The following factors seem important to engaging Latinos into care: patient-provider relationship, quality of the referral process, addressing expectations about depression care, and reducing communication barriers, including health literacy and linguistic barriers. Future studies of engagement strategies should explore these factors.

Professional competencies and training needs of professional social workers in integrated behavioral health in primary care.

The Affordable Care Act has led to a widespread movement to integrate behavioral health services into primary care settings. Integrated behavioral health (IBH) holds promise for treating mild to moderate psychiatric disorders in a manner that more fully addresses the biopsychosocial spectrum of needs of individuals and families in primary care, and for reducing disparities in accessing behavioral health care. For behavioral health practitioners, IBH requires a shift to a brief, outcome-driven, and team-based model of care. Despite the fact that social workers comprise the majority of behavioral health providers in IBH settings, little research has been done to assess the extent to which social workers are prepared for effective practice in fast-paced primary care. We conducted a survey of social workers (N = 84) in IBH settings to assess the following: (1) Key competency areas for social work practice in IBH settings and (2) Self-rated preparedness for effective practice in IBH settings. Online snowball sampling methods were used over a period of 1 month. Results indicate that social workers feel prepared for general practice in IBH settings, but would benefit from additional training in IBH-specific competency areas identified in the survey. Findings can help guide social work training to improve workforce preparedness for practice in IBH settings in the wake of health care reform.

Examining cultural competence in health care: implications for social workers.

This article examines and unpacks the "black box" of cultural competence in health interventions with racial and ethnic minority populations. The analysis builds on several recent reviews of evidence-based efforts to reduce health disparities, with a focus on how cultural competence is defined and operationalized. It finds that the use of multiple similar and indistinct terms related to cultural competence, as well as the lack of a mutually agreeable definition for cultural competence itself, has resulted in an imprecise concept that is often invoked but rarely defined and only marginally empirically validated as an effective health intervention. This article affirms the centrality of cultural competence as an essential values-based component of optimal social work practice, while also suggesting future directions for operationalizing, measuring, and testing cultural competence to build an evidence base on whether and how it works to reduce health disparities.