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Rhode Island Medicaid recipients who were 18 to 64 years old, had children, and were eligible for United Behavioral Health services (19,120 individuals) were sent a letter with an initial depression screening. The program contacted, by telephone, those who returned the screener (4,053 people) and those who were identified as at-risk for depression based on the screener (1,613 people). After a telephone screening, those found to have depressive symptoms and who agreed to participate (507) were randomly assigned to either the Working Toward Wellness intervention condition (253) or a comparison group (254); eight people later dropped out of the intervention condition. Random assignment occurred between November 17, 2004, and October 20, 2006.
Participants were randomly assigned between November 2004 and October 2006 to receive one year of treatment. This study looks at the impacts 6 months, 18 months, and 36 months after random assignment.
ACF and the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services funded this study, with additional funding from the U.S. Department of Labor. The study is part of the Enhanced Services for the Hard-to-Employ Demonstration and Evaluation Project.
Most participants (90 percent) were female; the average age of participants was between 35 and 36 years old; and 44 percent of participants were employed at the time of random assignment. Participants had, on average, between one and two children ages 18 or younger. The majority (54 percent) held a high school diploma or GED but no other education; 22 percent had a technical or four-year college degree, and 24 percent lacked a high school diploma or GED. The sample was 45 percent White, 33 percent Hispanic, 12 percent Black, and 6 percent of another racial or ethnic group. Finally, 35 percent had severe depression, and 12 percent had very severe depression.
United Behavioral Health
The Working Toward Wellness program was developed by Group Health Cooperative and delivered by United Behavioral Health for the evaluation.
Individuals in the Working Toward Wellness group received intensive outreach from case managers (to enter and remain in treatment). Master's-level care managers placed telephone calls to Working Toward Wellness participants to encourage them to seek treatment for their depression. The care managers also helped coordinate health appointments, encouraged and monitored follow-through on appointments and treatment plans, and provided supplemental information and counseling. Ninety-four percent of participants received a call from a care manager, and the average participant received nearly monthly contact. During the calls, care managers also asked participants about their employment status, goals, and barriers to employment, such as child care. Participants who resisted seeking professional treatment were offered a structured psychoeducational program that the care manager administered over the phone. The goal of the phone program was to establish a positive relationship between care managers and participants and maintain participant engagement.
Participants in the comparison group received referrals to mental health care providers but received no intervention beyond this standard practice.
None.
Care managers placed telephone calls to participants periodically over the course of a year. The average participant received nine calls from his or her care manager.
ACF, U.S. Department of Health and Human Services; Office of the Assistant Secretary for Planning and Evaluation; U.S. Department of Labor.
The Working Toward Wellness program was implemented in Rhode Island by United Behavioral Health, a Medicaid provider.
Physical health, Mental health, Parenting and co-parenting, Child well-being, Financial assets