Working toward Wellness
Telephone Care Management for Medicaid Recipients with Depression, Thirty-Six Months After Random Assignment
Although many public assistance recipients suffer from depression, few receive consistent treatment. This report presents 36-month results from a random assignment evaluation of a one-year program that provided telephonic care management to encourage depressed parents, who were Medicaid recipients in Rhode Island, to seek treatment from mental health professionals. Called "Working toward Wellness" (WtW), the program represents one of four strategies being studied in the Enhanced Services for the Hard-to-Employ Demonstration and Evaluation Project 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.
This report focuses on assessing the success of the program’s efforts to improve depression symptoms and work-related outcomes, two years after the end of the intervention. In WtW, master’s-level clinicians ("care managers") telephoned 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; these parents were randomly assigned to either the program group or the control group from November 2004 to October 2006.
- WtW care managers used the telephone effectively to initiate engagement with people with depression to consider treatment. They contacted 91 percent of those assigned to the program group, and they averaged about nine contacts per client over the yearlong intervention.
- 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. Although the program group members were more likely to receive mental health treatment and to fill prescription medications for depression in the early phase of WtW, this effect disappeared after the one-year 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 clinicians regarding WtW clients as they progressed in treatment. Such a collaborative approach was difficult to orchestrate in the case of WtW because the care managers worked for UBH while the community clinicians worked in a variety of settings outside UBH.
- WtW did not have an effect on depression or employment outcomes at 36 months after the end of the intervention. At that point, despite some modest impacts on depression for subgroups in earlier follow-up periods, the overall distributions of depression levels between the program and the control groups are not significantly different. Since the 36-month impact on depression was minimal, it is not surprising that there were no differences in employment outcomes for the two groups.