3 - (SYM 142) Training Community Health Workers to Increase the Mental Health Workforce for Underserved Groups: Preliminary Outcomes for Latinx Adults

Introduction: Efforts to increase access to mental health care to underserved populations have necessitated expanding the work force of those trained to provide evidence-based interventions designed to treat highly prevalent conditions like depression and anxiety. Community health workers (CHWs) have been an essential part of medical health service for decades; as members of the communities they serve, they can help overcome barriers that restrict access to care (e.g., language). The use of CHWs in mental health care is a relatively recent development that has mostly been studied outside of the U.S. but has shown encouraging results. Studies on health worker- or peer- led interventions in the U.S. generally have involved low intensity services such as parent training or screening and referral. Delivery of empirically-based mental health interventions requires more extensive training and ongoing supervision. In this paper we describe the Strong Minds program, a CBT skills-based intervention for adults with depression and anxiety delivered by CHWs in several languages (including English and Spanish), and discuss effectiveness in a subsample of Latinx participants.

Method:  Participants were recruited from two data collection sites, one in North Carolina and one in Boston.  Teams of Strong Minds CHWs and supervisors were trained at both sites. Based on phone screening, eligible participants reported moderate to severe symptoms of depression and/or anxiety and were not already engaged in ongoing mental health services. A subset of 211 Latinx participants (87% female; mean age 43) participated in the Strong Minds intervention and completed a follow up assessment at 3 months.

Results: From baseline to three month follow up, 86% of participants showed a reduction in symptoms of depression, and 82% showed a reduction in anxiety. Using a more stringent measure of change (the reliable change index), 44% showed reliable and clinically significant improvement in depression and 30% in anxiety. We will also present data on treatment fidelity, which is a concern that has been raised about

Conclusions: To meet the overwhelming community need for affordable mental health services for people seeking services in a language other than English and from a culturally matched provider, a CHW training model may provide a viable alternative. We discuss our findings in relation to the strengths of this model, the current status of CHW roles and training in the U.S., and some of the challenges in dissemination.