Working Toward Wellness : Telephone Care Management for Medicaid Recipients with Depression, Thirty-Six Months after Random Assignment

Although low-income individuals are disproportionately likely to suffer from depression, few receive treatment, and even fewer persist with their treatment. Randomized controlled trials have demonstrated that telephone care management interventions can successfully encourage primary care patients and employed workers to talk with mental health specialists, increase their use of antidepressants, reduce their depression, and even improve their work performance and job retention. This report presents the 36-month results from a program called “Working toward Wellness” (WtW) that provided telephone care management to a low-income population — depressed parents receiving Medicaid in Rhode Island — to encourage them to seek treatment from a mental health professional. The project was conducted as one of four studies in the Enhanced Services for the Hard-to-Employ Demonstration and Evaluation Project, which was sponsored by the Administration for Children and Families and the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services (HHS), with additional funding from the Department of Labor. WtW is being evaluated by MDRC in partnership with United Behavioral Health (UBH) and Group Health Cooperative (GHC). UBH delivered the care management services, and GHC designed the intervention and provided technical assistance and training to UBH staff. This report presents the following key findings: - WtW care managers used the telephone effectively to initiate engagement with people with depression to consider treatment. - WtW increased the use of mental health services while the intervention was running, but it did not help individuals sustain treatment after the intervention ended. - Authorization procedures limited the capacity of WtW care managers to function as liaisons between clients and clinicians; care managers could not provide direct feedback to the clinicians regarding WtW clients as they progressed in treatment. - WtW did not have an effect on depression or employment outcomes at 36 months after the end of the intervention