Working toward Wellness
Early Results from a Telephone Care Management Program for Medicaid Recipients with Depression
Although many public assistance recipients suffer from depression, few receive consistent treatment. This report presents results through six months of a one-year telephonic care management program in Rhode Island that tried to encourage depressed parents who were receiving Medicaid to seek treatment from a mental health professional. The program, called “Working toward Wellness,” represents one of four strategies being studied in the Enhanced Services for the Hard-to-Employ Demonstration and Evaluation to improve employment for low-income parents who face serious barriers to employment. The project is 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, with additional funding from the Department of Labor.
In Working toward Wellness, master’s-level clinicians (“care managers”) called the study participants in the program group to encourage them to seek treatment, to make sure that they were complying with treatment, and to provide telephonic counseling. The effects of the program are being studied by examining 499 depressed Medicaid recipients with children, who were randomly assigned to the program group or the control group from November 2004 to October 2006. Participants were given a list of mental health professionals in the community from whom they could receive treatment.
- Care managers effectively engaged people with depression via telephone. Overall, 94 percent of those assigned to the program group had at least one discussion with a care manager, and care managers called program group members once a month, on average.
- The program increased the use of mental health services. The program group was more likely than the control group to see psychiatrists, psychologists, and clinical social workers, and program group members made twice as many visits to mental health professionals. They were also more likely to fill prescriptions for antianxiety medications, but these effects are fairly modest in size.
- Early effects on depression severity are mixed. The program did not significantly reduce the average depression level, but it did significantly change the distribution of depression severity, particularly reducing the number of people who were very severely or mildly depressed while increasing the number who were moderately depressed.
- Impacts are concentrated among Hispanic sample members. The program increased visits to mental health professionals, increased the filling of antidepressant medications, and reduced depression more for Hispanic sample members than for others. Although this result is consistent with prior studies, it should be interpreted with caution because the Hispanic sample is small and Spanish-speaking participants were served by one Spanish-speaking care manager and a small number of health care providers.
The program was designed to last a year, and a second follow-up study will examine its effects at 18 months on depression severity and on employment, earnings, and work productivity.