Bridging Disciplinary Boundaries (January 11 - 14, 2007)

This study presents findings from a community-based participatory research pilot to improve screening and treatment for rural women of reproductive age experiencing depression. A generalist social work intervention model was used to provide community outreach, education, screening and supportive home visiting to identify and overcome tangible and intangible barriers to mental health service utilization. The aims of this study are 1) to assess to what degree supportive social work services were utilized when offered 2) to assess factors related to utilization of social work services, and 3) to explore factors associated with additional help-seeking behavior for those participating in the intervention.

Active consumer and provider participation occurred during all stages of the pilot program design and implementation. Community depression screening was conducted using the PRIME-MD. All referred participants (N=206) had elevated depressive symptoms and participated in baseline psychosocial assessment. Participants choosing to receive the home visiting intervention (N=96) received supportive counseling and case management to overcome both tangible access issues and intangible barriers to care (e.g. stigma, family concerns, self-esteem). Social workers tracked use of care in the specialty mental health, primary care and/or informal self-help sector. Those who did not elect social work intervention (N=110) received psychoeducational materials and usual care. Statistical analysis of factors influencing service use was conducted using chi-square cross-tabulation and logistic regression in SPSS 12.5.

Supportive social work services were utilized by 47% of women initially referred. There were significant associations between receipt of social work services for those receiving TANF (χ²=12.51, p<.0005), Medicaid (χ²=9.56, p=.002), having children (χ²=7.31, p=.007), as well as for women of color (χ²=3.95, p=.047). There were no significant differences between groups for overall symptom level or meeting criteria for major depression, minor depression, or subthreshold depressive symptoms. The self-selected intervention group had significantly higher co-morbidities including smoking (χ²=12.34, p<.0005), substance abuse (χ²=8.80, p=.001), domestic violence (χ²=17.89, p<.0005) and other mental health issues and concerns (χ²=25.22, p<.0005) than comparison. For intervention participants, multi-sector service use was quite high: 83.2% specialty mental health; 88.4% primary care; and 32.6% informal self-help. High rates of utilization across multiple sectors by participants resulted in little demographic or symptomatic variance by sector; the only factors significantly associated with multi-sector service use were a co-morbidity of domestic violence combined with elevated depressive symptoms.

In this pilot study, the use of a transitional social work intervention to enhance access to community treatment proved to be a highly successful way of linking women with treatment across multiple sectors of care. Once women engaged with the social worker, use of additional community services was also high. The presence of co-morbidities proved to be influential in decisions to initiate social work and multi-sector help-seeking, reinforcing the value of multisystemic assessment. Study findings also suggest that generalist social work interventions to identify and overcome barriers to treatment may be an effective way to enhance mental health service utilization. Further research efforts are needed in order to test the applicability of findings to other settings and populations.