Study protocol for comparing Screening, Brief Intervention, and Referral to Treatment (SBIRT) to referral as usual for depression in African American churches.

BACKGROUND: Depression is a leading cause of disability worldwide. African American adults, compared to White adults, are half as likely to be screened for depression in primary care settings. Disparities in depression screening contribute to poor clinical outcomes, as African Americans with depression are more disabled and sicker longer compared to Whites. African American churches are trusted settings that provide access to supports for depression. Indeed, in the first study of its kind, the investigators found that 20% of adults in African American churches screened positive for depression using the Patient Health Questionnaire-9 (PHQ-9). However, no subjects with a positive screen (PHQ-9 ≥ 10) accepted a treatment referral when offered by research personnel. Community Health Workers, who are trusted paraprofessionals from the target community, may bridge the gap between depression screening and treatment. The investigators have trained and certified 112 Community Health Workers from 45 African American churches in New York City to deliver an evidence-based intervention called Screening, Brief Intervention, and Referral to Treatment (SBIRT). Thus, the aim of the current study is to test the impact of Community Health Worker-delivered depression screening in Black churches on engagement with clinical services. METHODS: Using a hybrid type 1 effectiveness-implementation design, we propose a 2-arm, mixed-methods cluster randomized controlled trial. Church study sites will be randomized to either SBIRT (intervention arm) or referral as usual (usual care arm). This trial will be conducted with 600 church members across 30 churches (300 intervention; 300 usual care). Our primary outcome is treatment engagement, defined as attending a depression-related clinical visit. Secondary outcomes will be changes in Mental Health-Related Quality of Life and depressive symptoms at 3 and 6 months post-screening. Lastly, we will conduct a concurrent, mixed-methods (qualitative-quantitative) process evaluation to assess contextual facilitators and barriers of screening and referral. DISCUSSION: This is the first randomized trial of a church-placed, community health worker-delivered intervention for depression in African American populations. This study may provide a novel and effective approach to increasing depression identification and treatment linkage in economically disadvantaged populations with high depression rates. TRIAL REGISTRATION: ClinicalTrials.gov NCT04524767 . Registered on 21 August 2020.

Mental Health Perspectives Among Black Americans Receiving Services From a Church-Affiliated Mental Health Clinic.

Black Americans face substantial barriers to mental health services that are due, in part, to historical and contemporary issues of anti-Black racism. Identifying novel models of care that increase access and engagement in mental health services is important. One such model was developed by a predominantly Black church in Harlem, New York City, which built a free mental health clinic to serve the surrounding community. However, treatment barriers and facilitators of this care model have not been reported. Therefore, the authors conducted a qualitative study to identify Black Americans' (N=15) perspectives of their experiences seeking and receiving care from this church-affiliated mental health clinic and the role of the church in promoting mental health service utilization. Treatment facilitators included health care that was free of charge, services affiliated with a trusted institution, and access to culturally competent care that integrated their faith perspectives. Participants perceived the churches as having the potential to provide psychoeducation, destigmatization, and connection to mental health services. The perspectives shared suggest that this novel model of care may address several barriers to mental health care faced by some Black American populations.