<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT01699789</url>
  </required_header>
  <id_info>
    <org_study_id>CPIC-2012-KW</org_study_id>
    <secondary_id>R01MH078853</secondary_id>
    <secondary_id>P30MH082760</secondary_id>
    <secondary_id>P30MH068639</secondary_id>
    <secondary_id>PPRN-1501-26518</secondary_id>
    <secondary_id>R01MD007721</secondary_id>
    <secondary_id>G08LM011058</secondary_id>
    <secondary_id>UL1TR000124</secondary_id>
    <secondary_id>64244</secondary_id>
    <nct_id>NCT01699789</nct_id>
  </id_info>
  <brief_title>Community Partners in Care is a Research Project Funded by the National Institutes of Health</brief_title>
  <acronym>CPIC</acronym>
  <official_title>CPIC is a Community Partnered Participatory Research (CPPR) Project of Community and Academic Partners Working Together to Learn the Best Way to Reduce Depression in Our Communities.</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>RAND</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
    <collaborator>
      <agency>National Institute of Mental Health (NIMH)</agency>
      <agency_class>NIH</agency_class>
    </collaborator>
    <collaborator>
      <agency>Robert Wood Johnson Foundation</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>National Library of Medicine (NLM)</agency>
      <agency_class>NIH</agency_class>
    </collaborator>
    <collaborator>
      <agency>Patient-Centered Outcomes Research Institute</agency>
      <agency_class>Other</agency_class>
    </collaborator>
    <collaborator>
      <agency>National Institute on Minority Health and Health Disparities (NIMHD)</agency>
      <agency_class>NIH</agency_class>
    </collaborator>
  </sponsors>
  <source>RAND</source>
  <oversight_info>
    <has_dmc>No</has_dmc>
  </oversight_info>
  <brief_summary>
    <textblock>
      CPIC is a community initiative and research study funded by the NIH. CPIC was developed and&#xD;
      is being run by community and academic partners in Los Angeles underserved communities of&#xD;
      color. CPIC compares two ways of supporting diverse health and social programs in&#xD;
      under-resourced communities to improve their services to depressed clients. One approach is&#xD;
      time-limited expert technical assistance coupled with culturally-competent community outreach&#xD;
      to individual programs, on how to use quality improvement toolkits for depression that have&#xD;
      already been proven to be effective or helpful in primary care settings, but adapted for this&#xD;
      study for use in diverse community-based programs in underserved communities. The other&#xD;
      approach brings different types of agencies and members in a community together in a 4 to&#xD;
      6-month planning process, to fit the same depression quality improvement programs to the&#xD;
      needs and strengths of the community and to develop a network of programs serving the&#xD;
      community to support clients with depression together. The study is designed to determine the&#xD;
      added value of community engagement and planning over and above what might be offered through&#xD;
      a community-oriented, disease management company. Both intervention models are based on the&#xD;
      same quality improvement toolkits that support team leadership, care management, Cognitive&#xD;
      Behavioral Therapy, medication management, and patient education and activation.&#xD;
      Investigators hypothesized that the community engagement approach would increase agency and&#xD;
      clinician participation in evidence-based trainings and improve client mental health-related&#xD;
      quality of life. In addition, during the design phase, community participants prioritized&#xD;
      adding as outcomes indicators of social determinants of mental health, including physical&#xD;
      functioning, risk factors for homelessness and employment. Investigators hypothesized by&#xD;
      activating community agencies that can address health and social services needs to engage&#xD;
      depressed clients, these outcomes would also be improved more in the collaboration condition.&#xD;
      Investigators also hypothesized that the collaboration approach would increase use of&#xD;
      services.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Underserved communities of color in low income, largely ethnic-minority neighborhoods face an&#xD;
      excessive burden of illness from depression due to higher prevalence of depression and lower&#xD;
      access to quality care. Evidence-based quality improvement (QI) programs for depression in&#xD;
      primary care settings-where many low-income and minority patients receive their only mental&#xD;
      health care-can enhance quality of depression care and improve health outcomes. These&#xD;
      programs are under-utilized in community-based health care settings, and have not been&#xD;
      adapted for use across diverse agencies (social service, faith based, primary and specialty&#xD;
      care) that could partner to support disease management for depression. Partners in Care&#xD;
      (PIC)and WE Care are interventions designed to improve access to evidence-based depression&#xD;
      treatments (medication management or psychotherapy) for primary care patients and, in WE&#xD;
      Care, social service clients. PIC evaluated a services delivery intervention while WE Care&#xD;
      was an effectiveness trial with study-provided treatments. Both studies promoted use of the&#xD;
      same evidence-based treatments. Both PIC and WE Care programs improved use of evidence-based&#xD;
      treatments for depression and health outcomes for African Americans and Latinos. The PIC&#xD;
      interventions reduced health outcome disparities evident in usual care in the first follow-up&#xD;
      year and at five-year follow-up. While these findings offer hope to underserved communities,&#xD;
      such communities have poor resources to support implementation of these programs, and may&#xD;
      have historical distrust in research and health care settings. There is no evidence-based&#xD;
      approach to support agency networks in underserved communities in implementing QI programs&#xD;
      for depression. To address this information gap, investigators created Community Partners in&#xD;
      Care (CPIC), a group-level randomized, controlled trial, with randomization at the level of&#xD;
      an agency site or &quot;unit.&quot; The trial is being fielded in two underserved communities,&#xD;
      Hollywood and South Los Angeles, and conducted through a community- participatory, partnered&#xD;
      research (CPPR) approach.&#xD;
&#xD;
      The specific aims of the study are:&#xD;
&#xD;
        1. To engage two underserved communities in improving safety-net care for depression.&#xD;
&#xD;
        2. To examine the effects of a community-engagement approach to implementing evidence-based&#xD;
           depression quality improvement toolkits (PIC/WE Care) through a community collaborative&#xD;
           network across services sectors, compared to technical assistance to individual programs&#xD;
           from the same services sectors coupled with culturally-competent outreach to implement&#xD;
           the same toolkits. The outcomes are: a) client access to care, quality of care and&#xD;
           health outcomes, with the primary outcome being mental-health related quality of life&#xD;
           and additional outcomes reflecting social determinants of mental health of interest to&#xD;
           the community (physical health, homelessness risk factors, employment); b) services&#xD;
           utilization and costs; c) agency adoption of PIC/WE Care; d) and provider attitudes,&#xD;
           knowledge and practice.&#xD;
&#xD;
        3. To describe the process of implementation of the community engagement intervention.&#xD;
&#xD;
      CPIC was awarded funds from the Patient Centered Outcomes Research Institute (PCORI) in 2013&#xD;
      to accomplish the following 3 aims:&#xD;
&#xD;
        1. To compare the long-term (3-year) effectiveness of community engagement and planning&#xD;
           versus agency technical assistance to implement depression QI and improve depressed&#xD;
           clients' health status and risk for homelessness&#xD;
&#xD;
        2. To determine how depressed clients in under-resourced communities prioritize diverse&#xD;
           health and social outcomes and identify their preferences for services to address&#xD;
           priority outcomes&#xD;
&#xD;
        3. To identify capacities of providers to respond to depressed clients' priorities and to&#xD;
           generate recommendations for building capacity to better address clients'priorities.&#xD;
&#xD;
      We hypothesize that community engagement and planning will be more effective than technical&#xD;
      assistance in improving 3-year outcomes and that clients will prioritize quality of life. We&#xD;
      expect to find gaps in provider capacities to address client priorities that network&#xD;
      strategies could address.&#xD;
&#xD;
      Our primary outcome for the long-term follow-up is mental health related quality of life and&#xD;
      secondary outcomes are use of healthcare and community services for depression and physical&#xD;
      functioning and homeless risk factors.&#xD;
&#xD;
      In 2014, CPIC was awarded funds from the National Institute on Minority Health and Health&#xD;
      Disparities (NIMHD) to use existing quantitative CPIC data and collect new qualitative data&#xD;
      to describe pathways to reducing disparities. The funding allows us to longitudinally track&#xD;
      the implementation of the CEP model in a new county-wide initiative to develop community&#xD;
      networks to promote healthy neighborhoods. The aims under this additional funding are:&#xD;
&#xD;
        1. To determine pathways to reducing mental health and social disparities by conducting&#xD;
           community-academic partnered analyses of CPIC data by 1) examining intervention effects&#xD;
           for disparity subgroups (African Americans, Latinos, gender groups, insurance and&#xD;
           housing status groups); 2) identifying predictors and mediators of barriers to&#xD;
           access/services and client outcomes; 3) analyzing intervention effects on provider&#xD;
           workforce diversity; and 4) generating explanatory models for intervention effects and&#xD;
           their sustainability by interviewing CPIC administrators and providers, as well as prior&#xD;
           and current clients.&#xD;
&#xD;
        2. To explore the generalizability and replicability of the CPIC partnered model and, more&#xD;
           broadly, to inform the process of incorporating science into policy by conducting a&#xD;
           longitudinal case study of the CEP model implementation in a county-wide &quot;neighborhood&#xD;
           health&quot; initiative in Los Angeles to reduce mental health and social disparities.&#xD;
&#xD;
      As a result of this study, we will be able to explain how community-engaged and participatory&#xD;
      models of intervention implementation can reduce health and social disparities and ultimately&#xD;
      achieve public health impact. Study findings will be disseminated widely using traditional&#xD;
      academic, community-valued, and policy-relevant dissemination channels.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Completed</overall_status>
  <start_date>January 2009</start_date>
  <completion_date type="Actual">May 31, 2016</completion_date>
  <primary_completion_date type="Actual">May 31, 2016</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Health Services Research</primary_purpose>
    <masking>Single (Outcomes Assessor)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>Percent of Participants With Poor Mental Health Quality of Life, MCS12≤ 40</measure>
    <time_frame>6 months follow-up</time_frame>
    <description>From the Short Form, 12-item quality of life measure, mental health-related quality of life is the primary client outcome. Poor mental health related quality of life is defined as MCS12≤ 40 (one standard deviation below population mean).</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Percent of Participants With PHQ-9 Score ≥ 10</measure>
    <time_frame>6 months follow-up</time_frame>
    <description>Patient Health Questionnaire 9-item version (PHQ-9) at least mild depression (score ≥ 10)</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Percent of Participants With Poor Mental Health Quality of Life, MCS12≤ 40</measure>
    <time_frame>12 months follow-up</time_frame>
    <description>From the Short Form, 12-item quality of life measure, mental health-related quality of life is the primary client outcome. Poor mental health related quality of life is defined as MCS12≤ 40 (one standard deviation below population mean).</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Percent of Participants With Poor Mental Health Quality of Life, MCS12≤ 40</measure>
    <time_frame>36 months follow-up</time_frame>
    <description>From the Short Form, 12-item quality of life measure, mental health-related quality of life is the primary client outcome. Poor mental health related quality of life is defined as MCS12≤ 40 (one standard deviation below population mean).</description>
  </primary_outcome>
  <primary_outcome>
    <measure>Percent of Participants With PHQ-8 Score ≥ 10</measure>
    <time_frame>36 months follow-up</time_frame>
    <description>Patient Health Questionnaire 8-item version (PHQ-8) at least mild depression (score ≥ 10)</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Mental Wellness</measure>
    <time_frame>6 months follow-up</time_frame>
    <description>Mental wellness is defined as at least a good bit of time in the prior 4 weeks on any of three items: feeling peaceful or calm, being a happy person, having energy</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants Reported Organized Life</measure>
    <time_frame>6 months follow-up</time_frame>
    <description>A response of somewhat or definitely true to &quot;my life is organized&quot; versus unsure or somewhat false or definitely false</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Physically Active</measure>
    <time_frame>6 months follow-up</time_frame>
    <description>Physically Active is defined as at least active to &quot;How physically active you are?&quot;</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Homeless or ≥ 2 Risk Factors for Homelessness</measure>
    <time_frame>6 months follow-up</time_frame>
    <description>Defined as current homelessness or living in a shelter or having at least 2 risk factors (e.g., no place to stay for at least 2 nights or eviction from a primary residence, financial crisis, or food insecurity in the past 6 months)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Working for Pay</measure>
    <time_frame>6 months follow-up</time_frame>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Any Missed Work Day in Last 30 Days, if Working</measure>
    <time_frame>6 months follow-up</time_frame>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Hospitalization for Behavioral Health in the Past 6 Months</measure>
    <time_frame>6 months follow-up</time_frame>
    <description>self-reported services use in the past 6 months for overnight hospital stays for mental health or substance abuse</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With &gt;=4 Hospital Nights for Behavioral Health in the Past 6 Months</measure>
    <time_frame>6 months follow-up</time_frame>
    <description>self-reported services use in the past 6 months with &gt;=4 overnight hospital stays for any emotional, mental, alcohol, or drug problem, median cut point for baseline variable</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With &gt;=2 Emergency Room Visits in the Past 6 Months</measure>
    <time_frame>6 months follow-up</time_frame>
    <description>self-reported services use in the past 6 months with &gt;=2 emergency room visits in past 6 months, median cut point for baseline variable</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Any MHS Outpatient Visit in the Past 6 Months</measure>
    <time_frame>6 months follow-up</time_frame>
    <description>self-reported mental health outpatient visit from mental health provider, including psychiatrists, psychologists, social workers, psychiatric nurses, or counselors in the past 6 months</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Any PCP Visit With Depression Service in the Past 6 Months</measure>
    <time_frame>6 months follow-up</time_frame>
    <description>self-reported services use in the past 6 months with any primary care visit for depression</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With &gt;= 2 PCP Visits With Depression Services, if Any</measure>
    <time_frame>6 months follow-up</time_frame>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Faith-based Program Participation in the Past 6 Months</measure>
    <time_frame>6 months follow-up</time_frame>
    <description>Went to any religious or spiritual places such as a church, mosque, temple, or synagogue in the past 6 months</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Any Use of Park and Recreation or Community Centers in the Past 6 Months</measure>
    <time_frame>6 months follow-up</time_frame>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Use of an Antidepressant Medication for 2 Months or More in the Past 6 Months</measure>
    <time_frame>6 months follow-up</time_frame>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Medication Visits Among MHS Users in the Past 6 Months</measure>
    <time_frame>6 months follow-up</time_frame>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Faith-based Visits With Depression Service if Faith Participation in the Past 6 Months</measure>
    <time_frame>6 months follow-up</time_frame>
    <description>For this sector, depression/mental health service is defined by client report of having assessment, counseling, education, medication discussion or referral for depression or emotional or mental health problems.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Park or Community Center Visits With Depression Service if Went to Park or Community Center in Past 6 Months</measure>
    <time_frame>6 months follow-up</time_frame>
    <description>For this sector, depression/mental health service is defined by client report of having assessment, counseling, education, medication discussion or referral for depression or emotional or mental health problems.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Total Mental Health Related Outpatient Visits in the Past 6 Months</measure>
    <time_frame>6 months follow-up</time_frame>
    <description>Total outpatient visits for depression, mental health or substance abuse from emergency rooms, primary care or public health, mental health, substance abuse, or social-community services sectors in the past 6 months</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Hospitalization for Behavioral Health in the Past 6 Months</measure>
    <time_frame>12 months follow-up</time_frame>
    <description>self-reported services use in the past 6 months for overnight hospital stays for mental health or substance abuse</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Any MHS Outpatient Visit in the Past 6 Months</measure>
    <time_frame>12 months follow-up</time_frame>
    <description>self-reported mental health outpatient visit from mental health provider, including psychiatrists, psychologists, social workers, psychiatric nurses, or counselors in the past 6 months</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Any PCP Visit With Depression Service in the Past 6 Months</measure>
    <time_frame>12 months follow-up</time_frame>
    <description>self-reported services use in the past 6 months with any primary care visit for depression</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Faith-based Program Participation in the Past 6 Months</measure>
    <time_frame>12 months follow-up</time_frame>
    <description>Went to any religious or spiritual places such as a church, mosque, temple, or synagogue in the past 6 months</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Any Use of Park and Recreation or Community Centers in the Past 6 Months</measure>
    <time_frame>12 months follow-up</time_frame>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Use of an Antidepressant Medication for 2 Months or More in the Past 6 Months</measure>
    <time_frame>12 months follow-up</time_frame>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Total Mental Health Related Outpatient Visits in the Past 6 Months</measure>
    <time_frame>12 months follow-up</time_frame>
    <description>Total outpatient visits for depression, mental health or substance abuse from emergency rooms, primary care or public health, mental health, substance abuse, or social-community services sectors in the past 6 months</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>PCS-12 Scores on 12-Item Physical Health Summary Measure, Comparison Between CEP and RS Groups</measure>
    <time_frame>36 months follow-up</time_frame>
    <description>12-item physical composite score (PCS-12). Possible scores on range from 0 to 100, with higher scores indicating better physical health</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Nights Hospitalized for Behavioral Health Reason in the Past 6 Months</measure>
    <time_frame>36 months follow-up</time_frame>
    <description>self-reported number of overnight hospital stays for any emotional, mental, alcohol, or drug problem in past 6 months</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>N of Emergency Room or Urgent Care Visits in the Past 6 Months</measure>
    <time_frame>36 months follow-up</time_frame>
  </secondary_outcome>
  <secondary_outcome>
    <measure>N of Visits to Primary Care in Past 6 Months</measure>
    <time_frame>36 months follow-up</time_frame>
  </secondary_outcome>
  <secondary_outcome>
    <measure>N of Outpatient Visits to Primary Care for Depression Services in the Past 6 Months</measure>
    <time_frame>36 months follow-up</time_frame>
  </secondary_outcome>
  <secondary_outcome>
    <measure>N of Outpatient Mental Health Visits in Past 6 Months</measure>
    <time_frame>36 months follow-up</time_frame>
  </secondary_outcome>
  <secondary_outcome>
    <measure>N of Outpatient Visits to a Substance Abuse Treatment Agency or Self Help Group in the Past 6 Months</measure>
    <time_frame>36 months follow-up</time_frame>
  </secondary_outcome>
  <secondary_outcome>
    <measure>N of Social Services for Depression Visits in the Past 6 Months</measure>
    <time_frame>36 months follow-up</time_frame>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Number of Calls to Hotline for Substance Use or Mental Health Problem in the Past 6 Months</measure>
    <time_frame>36 months follow-up</time_frame>
  </secondary_outcome>
  <secondary_outcome>
    <measure>N of Days on Which a Self-help Visit for Mental Health Was Made in the Past 6 Months</measure>
    <time_frame>36 months follow-up</time_frame>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Any Faith-based Services for Depression in the Past 6 Months</measure>
    <time_frame>36 months follow-up</time_frame>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Use of Any Antidepressant in the Past 6 Months</measure>
    <time_frame>36 months follow-up</time_frame>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Use of Any Mood Stabilizer in the Past 6 Months</measure>
    <time_frame>36 months follow-up</time_frame>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Use of Any Antipsychotic in the Past 6 Months</measure>
    <time_frame>36 months follow-up</time_frame>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Any Visit in Health Care Sector in the Past 6 Months</measure>
    <time_frame>36 months follow-up</time_frame>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Any Community-sector Visit for Depression in the Past 6 Months</measure>
    <time_frame>36 months follow-up</time_frame>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Any Depression Treatment in the Past 6 Months</measure>
    <time_frame>36 months follow-up</time_frame>
    <description>Antidepressant use for at least two months or at least four outpatient visits to mental health or primary care setting for depression services</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Survival Analysis for Time to the First Clinical Remission</measure>
    <time_frame>from baseline to 3 years</time_frame>
    <description>clinical remission: Patient Health Questionnaire, PHQ-8 score &lt;10. Cox Proportional Hazard model was used to examine the impact of the intervention on speed of clinical remission over the 3 years follow-up period, defined as the first assessment with clinical remission (PHQ-8&lt;10).</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Survival Analysis for Time to the First Community-Defined Remission</measure>
    <time_frame>from baseline to 3 years</time_frame>
    <description>Community-Defined Remission: PHQ-8&lt;10 or MCS-12&gt;40 or any mental wellness. Cox Proportional Hazard model was used to examine the impact of the intervention on speed of community-defined remission over the 3 years follow-up period, defined as the first assessment with community-defined (PHQ-8&lt;10 or MCS-12&gt;40 or any mental wellness)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Clinical Remission</measure>
    <time_frame>4 years follow-up</time_frame>
    <description>Clinical remission defined as Patient Health Questionnaire-2 (PHQ-2) score &lt; 3.</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Percent of Participants With Community-Defined Remission</measure>
    <time_frame>4 years follow-up</time_frame>
    <description>Community-Defined Remission defined as PHQ-2&lt;3, MCS-12&gt;40, or mental wellness</description>
  </secondary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Actual">1246</enrollment>
  <condition>Depression</condition>
  <condition>Information Dissemination</condition>
  <condition>Social Determinants of Health</condition>
  <arm_group>
    <arm_group_label>Resources for Services</arm_group_label>
    <arm_group_type>Active Comparator</arm_group_type>
    <description>The Resources for Services condition offers time-limited technical assistance to individual agencies, coupled with outreach from a community engagement specialty, to participate in structured reviews of components of the Quality Improvement Program Intervention as implemented by the Resources for Services Expert Team.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>Community Engagement and Planning</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>The Community Engagement and Planning arm supported 4 months of planning for the Community Engagement and Planning Council consisting representatives of all assigned programs in biweekly 2 hour meetings to fit trainings in the Quality Improvement Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites were provided with enrolled client lists.</description>
  </arm_group>
  <intervention>
    <intervention_type>Other</intervention_type>
    <intervention_name>Quality Improvement Program</intervention_name>
    <description>The quality improvement program is an evidence-based toolkit from prior studies (see Names above) that supported team leadership, case and care management, medication management, and Cognitive Behavioral Therapy for Depression. The Case management manual supported depression screening and monitoring/tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual.</description>
    <arm_group_label>Community Engagement and Planning</arm_group_label>
    <arm_group_label>Resources for Services</arm_group_label>
    <other_name>Partners in Care</other_name>
    <other_name>We Care</other_name>
    <other_name>IMPACT</other_name>
    <other_name>Mental Health Infrastructure and Training Project</other_name>
  </intervention>
  <intervention>
    <intervention_type>Behavioral</intervention_type>
    <intervention_name>Resources for Services Expert Team</intervention_name>
    <description>The expert team consisted for RS consisted of 3 psychiatrists, a psychologist expert in Cognitive Behavioral Therapy, a nurse care manager, a community engagement specialist, a quality improvement expert, and staff support. They team offered 12 web-based seminars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
    <arm_group_label>Resources for Services</arm_group_label>
    <other_name>Quality Improvement Team</other_name>
  </intervention>
  <intervention>
    <intervention_type>Behavioral</intervention_type>
    <intervention_name>Community Engagement and Planning Council</intervention_name>
    <description>The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
    <arm_group_label>Community Engagement and Planning</arm_group_label>
    <other_name>Quality Improvement Team</other_name>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
        Administrators&#xD;
&#xD;
          -  Age 18 and above&#xD;
&#xD;
          -  Work or volunteer for an enrolled program in the study and be designated as a liaison&#xD;
             by the program&#xD;
&#xD;
        Providers&#xD;
&#xD;
          -  Age 18 and above&#xD;
&#xD;
          -  Have direct contact with patients/clients&#xD;
&#xD;
        Clients&#xD;
&#xD;
          -  Age 18 and above&#xD;
&#xD;
          -  Score 10 or greater on modified Patient Health Questionnaire (PHQ-8)&#xD;
&#xD;
        Exclusion Criteria: grossly disorganized by screener staff assessment Not providing&#xD;
        personal contact information&#xD;
&#xD;
        Administrators - Under age 18&#xD;
&#xD;
        Providers&#xD;
&#xD;
        - Under age 18&#xD;
&#xD;
        Clients&#xD;
&#xD;
          -  Under age 18&#xD;
&#xD;
          -  Gross cognitive disorganization by screener staff assessment&#xD;
&#xD;
          -  Providing no contact information&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>18 Years</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>Kenneth B Wells, M.D., M.P.H</last_name>
    <role>Principal Investigator</role>
    <affiliation>RAND Corporation, UCLA Semel Institute</affiliation>
  </overall_official>
  <overall_official>
    <last_name>Bowen Chung, MD, MSHS</last_name>
    <role>Principal Investigator</role>
    <affiliation>Harbor-UCLA Medical Center, UCLA Semel Institute</affiliation>
  </overall_official>
  <overall_official>
    <last_name>Jeanne Miranda, PhD</last_name>
    <role>Principal Investigator</role>
    <affiliation>UCLA Semel Institute</affiliation>
  </overall_official>
  <location>
    <facility>
      <name>Krystal M Griffith</name>
      <address>
        <city>Gardena</city>
        <state>California</state>
        <zip>90249</zip>
        <country>United States</country>
      </address>
    </facility>
  </location>
  <location_countries>
    <country>United States</country>
  </location_countries>
  <link>
    <url>http://www.communitypartnersincare.org</url>
    <description>Click here for more information about this study: Community Partners in Care</description>
  </link>
  <reference>
    <citation>Chung B, Jones L, Dixon EL, Miranda J, Wells K; Community Partners in Care Steering Council. Using a community partnered participatory research approach to implement a randomized controlled trial: planning community partners in care. J Health Care Poor Underserved. 2010 Aug;21(3):780-95. doi: 10.1353/hpu.0.0345.</citation>
    <PMID>20693725</PMID>
  </reference>
  <reference>
    <citation>Khodyakov D, Mendel P, Dixon E, Jones A, Masongsong Z, Wells K. Community Partners in Care: Leveraging Community Diversity to Improve Depression Care for Underserved Populations. Int J Divers Organ Communities Nations. 2009;9(2):167-182.</citation>
    <PMID>21528111</PMID>
  </reference>
  <reference>
    <citation>Dixon EL, Flaskerud JH. Community tailored responses to depression care. Issues Ment Health Nurs. 2010 Sep;31(9):611-3. doi: 10.3109/01612841003675303. No abstract available.</citation>
    <PMID>20701424</PMID>
  </reference>
  <reference>
    <citation>Mango J, Cabiling E, Jones L, Lucas-Wright A, Williams P, Wells K, Pulido E, Meldrum M, Ramos A, Chung B. Community Partners in Care (CPIC): Video Summary of Rationale, Study Approach / Implementation, and Client 6-month Outcomes. CES4healthinfo. 2014 Feb 25;2014:87LWR5H2.</citation>
    <PMID>25364622</PMID>
  </reference>
  <reference>
    <citation>Khodyakov D, Pulido E, Ramos A, Dixon E. Community-partnered research conference model: the experience of Community Partners in Care study. Prog Community Health Partnersh. 2014 Spring;8(1):83-97. doi: 10.1353/cpr.2014.0008.</citation>
    <PMID>24859106</PMID>
  </reference>
  <reference>
    <citation>Mendel P, Ngo VK, Dixon E, Stockdale S, Jones F, Chung B, Jones A, Masongsong Z, Khodyakov D. Partnered evaluation of a community engagement intervention: use of a kickoff conference in a randomized trial for depression care improvement in underserved communities. Ethn Dis. 2011 Summer;21(3 Suppl 1):S1-78-88.</citation>
    <PMID>22352084</PMID>
  </reference>
  <reference>
    <citation>Belin TR, Jones A, Tang L, Chung B, Stockdale SE, Jones F, Wright A, Sherbourne CD, Perlman J, Pulido E, Ong MK, Gilmore J, Miranda J, Dixon E, Jones L, Wells KB. Maintaining Internal Validity in Community Partnered Participatory Research: Experience from the Community Partners in Care Study. Ethn Dis. 2018 Sep 6;28(Suppl 2):357-364. doi: 10.18865/ed.28.S2.357. eCollection 2018.</citation>
    <PMID>30202188</PMID>
  </reference>
  <reference>
    <citation>Mendel P, O'Hora J, Zhang L, Stockdale S, Dixon EL, Gilmore J, Jones F, Jones A, Williams P, Sharif MZ, Masongsong Z, Kadkhoda F, Pulido E, Chung B, Wells KB. Engaging Community Networks to Improve Depression Services: A Cluster-Randomized Trial of a Community Engagement and Planning Intervention. Community Ment Health J. 2021 Apr;57(3):457-469. doi: 10.1007/s10597-020-00632-5. Epub 2020 May 19.</citation>
    <PMID>32430557</PMID>
  </reference>
  <reference>
    <citation>Goodsmith N, Zhang L, Ong MK, Ngo VK, Miranda J, Hirsch S, Jones F, Wells K, Chung B. Implementation of a Community-Partnered Research Suicide-Risk Management Protocol: Case Study From Community Partners in Care. Psychiatr Serv. 2021 Mar 1;72(3):281-287. doi: 10.1176/appi.ps.202000095. Epub 2021 Jan 27.</citation>
    <PMID>33502218</PMID>
  </reference>
  <results_reference>
    <citation>Wells KB, Jones L, Chung B, Dixon EL, Tang L, Gilmore J, Sherbourne C, Ngo VK, Ong MK, Stockdale S, Ramos E, Belin TR, Miranda J. Community-partnered cluster-randomized comparative effectiveness trial of community engagement and planning or resources for services to address depression disparities. J Gen Intern Med. 2013 Oct;28(10):1268-78. doi: 10.1007/s11606-013-2484-3. Epub 2013 May 7. Erratum In: J Gen Intern Med. 2013 Nov;28(11):1534.</citation>
    <PMID>23649787</PMID>
  </results_reference>
  <results_reference>
    <citation>Miranda J, Ong MK, Jones L, Chung B, Dixon EL, Tang L, Gilmore J, Sherbourne C, Ngo VK, Stockdale S, Ramos E, Belin TR, Wells KB. Community-partnered evaluation of depression services for clients of community-based agencies in under-resourced communities in Los Angeles. J Gen Intern Med. 2013 Oct;28(10):1279-87. doi: 10.1007/s11606-013-2480-7. Epub 2013 May 14.</citation>
    <PMID>23670566</PMID>
  </results_reference>
  <results_reference>
    <citation>Chung B, Ong M, Ettner SL, Jones F, Gilmore J, McCreary M, Sherbourne C, Ngo V, Koegel P, Tang L, Dixon E, Miranda J, Belin TR, Wells KB. 12-month outcomes of community engagement versus technical assistance to implement depression collaborative care: a partnered, cluster, randomized, comparative effectiveness trial. Ann Intern Med. 2014 Nov 18;161(10 Suppl):S23-34. doi: 10.7326/M13-3011.</citation>
    <PMID>25402400</PMID>
  </results_reference>
  <results_reference>
    <citation>Chang ET, Wells KB, Gilmore J, Tang L, Morgan AU, Sanders S, Chung B. Comorbid depression and substance abuse among safety-net clients in Los Angeles: a community participatory study. Psychiatr Serv. 2015 Mar 1;66(3):285-94. doi: 10.1176/appi.ps.201300318. Epub 2014 Dec 1.</citation>
    <PMID>25727117</PMID>
  </results_reference>
  <results_reference>
    <citation>Chung B, Ngo VK, Ong MK, Pulido E, Jones F, Gilmore J, Stoker-Mtume N, Johnson M, Tang L, Wells KB, Sherbourne C, Miranda J. Participation in Training for Depression Care Quality Improvement: A Randomized Trial of Community Engagement or Technical Support. Psychiatr Serv. 2015 Aug 1;66(8):831-9. doi: 10.1176/appi.ps.201400099. Epub 2015 May 1.</citation>
    <PMID>25930037</PMID>
  </results_reference>
  <results_reference>
    <citation>Ngo VK, Sherbourne C, Chung B, Tang L, Wright AL, Whittington Y, Wells K, Miranda J. Community Engagement Compared With Technical Assistance to Disseminate Depression Care Among Low-Income, Minority Women: A Randomized Controlled Effectiveness Study. Am J Public Health. 2016 Oct;106(10):1833-41. doi: 10.2105/AJPH.2016.303304. Epub 2016 Aug 23.</citation>
    <PMID>27552274</PMID>
  </results_reference>
  <results_reference>
    <citation>Landry CM, Jackson AP, Tang L, Miranda J, Chung B, Jones F, Ong MK, Wells K. The Effects of Collaborative Care Training on Case Managers' Perceived Depression-Related Services Delivery. Psychiatr Serv. 2017 Feb 1;68(2):123-130. doi: 10.1176/appi.ps.201500550. Epub 2016 Sep 15.</citation>
    <PMID>27629796</PMID>
  </results_reference>
  <results_reference>
    <citation>Ong MK, Jones L, Aoki W, Belin TR, Bromley E, Chung B, Dixon E, Johnson MD, Jones F, Koegel P, Khodyakov D, Landry CM, Lizaola E, Mtume N, Ngo VK, Perlman J, Pulido E, Sauer V, Sherbourne CD, Tang L, Vidaurri E, Whittington Y, Williams P, Lucas-Wright A, Zhang L, Southard M, Miranda J, Wells K. A Community-Partnered, Participatory, Cluster-Randomized Study of Depression Care Quality Improvement: Three-Year Outcomes. Psychiatr Serv. 2017 Dec 1;68(12):1262-1270. doi: 10.1176/appi.ps.201600488. Epub 2017 Jul 17.</citation>
    <PMID>28712349</PMID>
  </results_reference>
  <results_reference>
    <citation>Mehta P, Brown A, Chung B, Jones F, Tang L, Gilmore J, Miranda J, Wells K. Community Partners in Care: 6-Month Outcomes of Two Quality Improvement Depression Care Interventions in Male Participants. Ethn Dis. 2017 Jul 20;27(3):223-232. doi: 10.18865/ed.27.3.223. eCollection 2017 Summer.</citation>
    <PMID>28811733</PMID>
  </results_reference>
  <results_reference>
    <citation>Castillo EG, Shaner R, Tang L, Chung B, Jones F, Whittington Y, Miranda J, Wells KB. Improving Depression Care for Adults With Serious Mental Illness in Underresourced Areas: Community Coalitions Versus Technical Support. Psychiatr Serv. 2018 Feb 1;69(2):195-203. doi: 10.1176/appi.ps.201600514. Epub 2017 Oct 16.</citation>
    <PMID>29032700</PMID>
  </results_reference>
  <results_reference>
    <citation>Sherbourne CD, Aoki W, Belin TR, Bromley E, Chung B, Dixon E, Gilmore JM, Johnson MD, Jones F, Koegel P, Khodyakov D, Landry CM, Lizaola E, Mtume N, Ngo VK, Ong MK, Perlman J, Pulido E, Sauer V, Tang L, Whittington Y, Vidaurri E, Williams P, Lucas-Wright A, Zhang L, Miranda J, Jones L, Wells K. Comparative Effectiveness of Two Models of Depression Services Quality Improvement in Health and Community Sectors. Psychiatr Serv. 2017 Dec 1;68(12):1315-1320. doi: 10.1176/appi.ps.201700170. Epub 2017 Nov 1.</citation>
    <PMID>29089009</PMID>
  </results_reference>
  <results_reference>
    <citation>Springgate B, Tang L, Ong M, Aoki W, Chung B, Dixon E, Johnson MD, Jones F, Landry C, Lizaola E, Mtume N, Ngo VK, Pulido E, Sherbourne C, Wright AL, Whittington Y, Williams P, Zhang L, Miranda J, Belin T, Gilmore J, Jones L, Wells KB. Comparative Effectiveness of Coalitions Versus Technical Assistance for Depression Quality Improvement in Persons with Multiple Chronic Conditions. Ethn Dis. 2018 Sep 6;28(Suppl 2):325-338. doi: 10.18865/ed.28.S2.325. eCollection 2018.</citation>
    <PMID>30202185</PMID>
  </results_reference>
  <results_reference>
    <citation>Choi KR, Sherbourne C, Tang L, Castillo E, Dixon E, Jones A, Chung B, Eisen C, Wells K. A Comparative Effectiveness Trial of Depression Collaborative Care: Subanalysis of Comorbid Anxiety. West J Nurs Res. 2019 Jul;41(7):1009-1031. doi: 10.1177/0193945918800333. Epub 2018 Sep 18.</citation>
    <PMID>30226112</PMID>
  </results_reference>
  <results_reference>
    <citation>Chung B, Ong M, Ettner SL, Jones F, Gilmore J, McCreary M, Ngo VK, Sherbourne C, Tang L, Dixon E, Koegel P, Miranda J, Wells KB. 12-Month Cost Outcomes of Community Engagement Versus Technical Assistance for Depression Quality Improvement: A Partnered, Cluster Randomized, Comparative-Effectiveness Trial. Ethn Dis. 2018 Sep 6;28(Suppl 2):349-356. doi: 10.18865/ed.28.S2.349. eCollection 2018.</citation>
    <PMID>30202187</PMID>
  </results_reference>
  <results_reference>
    <citation>Arevian AC, Jones F, Tang L, Sherbourne CD, Jones L, Miranda J; Community Partners in Care Writing Group. Depression Remission From Community Coalitions Versus Individual Program Support for Services: Findings From Community Partners in Care, Los Angeles, California, 2010-2016. Am J Public Health. 2019 Jun;109(S3):S205-S213. doi: 10.2105/AJPH.2019.305082.</citation>
    <PMID>31242001</PMID>
  </results_reference>
  <results_reference>
    <citation>Barcelo NE, Lopez A, Tang L, Aguilera Nunez MG, Jones F, Miranda J, Chung B, Arevian A, Bonds C, Izquierdo A, Dixon E, Wells K. Community Engagement and Planning versus Resources for Services for Implementing Depression Quality Improvement: Exploratory Analysis for Black and Latino Adults. Ethn Dis. 2019 Apr 18;29(2):277-286. doi: 10.18865/ed.29.2.277. eCollection 2019 Spring.</citation>
    <PMID>31057313</PMID>
  </results_reference>
  <results_reference>
    <citation>Morton I, Hurley B, Castillo EG, Tang L, Gilmore J, Jones F, Watkins K, Chung B, Wells K. Outcomes of two quality improvement implementation interventions for depression services in adults with substance use problems. Am J Drug Alcohol Abuse. 2020;46(2):251-261. doi: 10.1080/00952990.2019.1708085. Epub 2020 Jan 14.</citation>
    <PMID>31935133</PMID>
  </results_reference>
  <verification_date>June 2021</verification_date>
  <study_first_submitted>September 27, 2012</study_first_submitted>
  <study_first_submitted_qc>October 1, 2012</study_first_submitted_qc>
  <study_first_posted type="Estimate">October 4, 2012</study_first_posted>
  <results_first_submitted>May 6, 2014</results_first_submitted>
  <results_first_submitted_qc>November 6, 2014</results_first_submitted_qc>
  <results_first_posted type="Estimate">November 17, 2014</results_first_posted>
  <last_update_submitted>June 22, 2021</last_update_submitted>
  <last_update_submitted_qc>June 22, 2021</last_update_submitted_qc>
  <last_update_posted type="Actual">June 24, 2021</last_update_posted>
  <responsible_party>
    <responsible_party_type>Sponsor</responsible_party_type>
  </responsible_party>
  <keyword>Community Partnered Participatory Research</keyword>
  <keyword>Community Engagement</keyword>
  <keyword>Implementation</keyword>
  <keyword>Community Based Participatory Research</keyword>
  <keyword>Quality Improvement</keyword>
  <keyword>Evidence Based Practice</keyword>
  <keyword>Patient Centered Outcomes Research</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Depression</mesh_term>
  </condition_browse>
  <provided_document_section>
    <provided_document>
      <document_type>Study Protocol, Statistical Analysis Plan, and Informed Consent Form</document_type>
      <document_has_protocol>Yes</document_has_protocol>
      <document_has_icf>Yes</document_has_icf>
      <document_has_sap>Yes</document_has_sap>
      <document_date>January 27, 2021</document_date>
      <document_url>https://ClinicalTrials.gov/ProvidedDocs/89/NCT01699789/Prot_SAP_ICF_000.pdf</document_url>
    </provided_document>
  </provided_document_section>

  <clinical_results>

    <participant_flow>
      <recruitment_details>From March 2010 to November 2010, the study screened 4,440 clients from 93 programs in 50 agencies. The ninety-three programs, included 17 primary care/public health, 18 mental health, 20 substance abuse, ten homeless services, and 28 social/other community services.</recruitment_details>
      <group_list>
        <group group_id="P1">
          <title>Resources for Services RS</title>
          <description>The RS condition offers time-limited technical assistance to individual agencies, coupled with outreach from a community engagement specialty, to participate in structured reviews of components of the Quality Improvement (QI) Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The quality improvement program is an evidence-based toolkit from prior studies that supported team leadership, case and care management, medication management, and CBT for Depression. The Case management manual supported depression screening and monitoring/tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual.&#xD;
RS Expert Team: The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a quality improvement expert, and staff support. T</description>
        </group>
        <group group_id="P2">
          <title>Community Engagement and Planning CEP</title>
          <description>The CEP arm supported 4 months of planning for the CEP Council consisting of representatives from all assigned programs in biweekly 2 hour meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites were provided with enrolled client lists.&#xD;
QI Program: The QI program is an evidence-based toolkit from prior studies that supported team leadership, case and care management, medication management, and CBT for Depression. The Case management manual supported depression screening and monitoring/tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual.&#xD;
CEP Council: The CEP Council was supported by a workbook de</description>
        </group>
      </group_list>
      <period_list>
        <period>
          <title>Overall Study</title>
          <milestone_list>
            <milestone>
              <title>STARTED</title>
              <participants_list>
                <participants group_id="P1" count="606">606 eligible clients enrolled and contacted by telephone for baseline or follow-up survey in RS arm</participants>
                <participants group_id="P2" count="640">640 eligible clients enrolled and contacted by telephone for baseline or follow-up survey in CEP arm</participants>
              </participants_list>
            </milestone>
            <milestone>
              <title>Baseline</title>
              <participants_list>
                <participants group_id="P1" count="492"/>
                <participants group_id="P2" count="489"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>6-Month Follow-Up</title>
              <participants_list>
                <participants group_id="P1" count="380"/>
                <participants group_id="P2" count="379"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>12-Month Follow-Up</title>
              <participants_list>
                <participants group_id="P1" count="364"/>
                <participants group_id="P2" count="369"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>3-Year Follow-up</title>
              <participants_list>
                <participants group_id="P1" count="293"/>
                <participants group_id="P2" count="307"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>4-Year Follow-up</title>
              <participants_list>
                <participants group_id="P1" count="143"/>
                <participants group_id="P2" count="140"/>
              </participants_list>
            </milestone>
            <milestone>
              <title>COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="504">Clients in 44 programs with completed at least 1 data point at baseline, 6, or 12 mo FUP analyzed</participants>
                <participants group_id="P2" count="514">Clients in 46 programs with completed at least 1 data point at baseline, 6, or 12 mo FUP analyzed</participants>
              </participants_list>
            </milestone>
            <milestone>
              <title>NOT COMPLETED</title>
              <participants_list>
                <participants group_id="P1" count="102"/>
                <participants group_id="P2" count="126"/>
              </participants_list>
            </milestone>
          </milestone_list>
          <drop_withdraw_reason_list>
            <drop_withdraw_reason>
              <title>Withdrawal by Subject</title>
              <participants_list>
                <participants group_id="P1" count="18"/>
                <participants group_id="P2" count="23"/>
              </participants_list>
            </drop_withdraw_reason>
            <drop_withdraw_reason>
              <title>Death</title>
              <participants_list>
                <participants group_id="P1" count="1"/>
                <participants group_id="P2" count="2"/>
              </participants_list>
            </drop_withdraw_reason>
            <drop_withdraw_reason>
              <title>Lost to Follow-up</title>
              <participants_list>
                <participants group_id="P1" count="83"/>
                <participants group_id="P2" count="101"/>
              </participants_list>
            </drop_withdraw_reason>
          </drop_withdraw_reason_list>
        </period>
      </period_list>
    </participant_flow>

    <baseline>
      <group_list>
        <group group_id="B1">
          <title>Resources for Services RS</title>
          <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
        </group>
        <group group_id="B2">
          <title>Community Engagement and Planning CEP</title>
          <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
        </group>
        <group group_id="B3">
          <title>Total</title>
          <description>Total of all reporting groups</description>
        </group>
      </group_list>
      <analyzed_list>
        <analyzed>
          <units>Participants</units>
          <scope>Overall</scope>
          <count_list>
            <count group_id="B1" value="504"/>
            <count group_id="B2" value="514"/>
            <count group_id="B3" value="1018"/>
          </count_list>
        </analyzed>
      </analyzed_list>
      <measure_list>
        <measure>
          <title>Age</title>
          <units>years</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="44.9" spread="12.4"/>
                    <measurement group_id="B2" value="46.6" spread="13.2"/>
                    <measurement group_id="B3" value="45.8" spread="12.9"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Sex: Female, Male</title>
          <units>Participants</units>
          <param>Count of Participants</param>
          <class_list>
            <class>
              <category_list>
                <category>
                  <title>Female</title>
                  <measurement_list>
                    <measurement group_id="B1" value="286"/>
                    <measurement group_id="B2" value="309"/>
                    <measurement group_id="B3" value="595"/>
                  </measurement_list>
                </category>
                <category>
                  <title>Male</title>
                  <measurement_list>
                    <measurement group_id="B1" value="218"/>
                    <measurement group_id="B2" value="205"/>
                    <measurement group_id="B3" value="423"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Race/Ethnicity, Customized</title>
          <units>participants</units>
          <param>Number</param>
          <class_list>
            <class>
              <title>Latino</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="194"/>
                    <measurement group_id="B2" value="215"/>
                    <measurement group_id="B3" value="409"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>African American</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="239"/>
                    <measurement group_id="B2" value="249"/>
                    <measurement group_id="B3" value="488"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Non-Hispanic white</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="45"/>
                    <measurement group_id="B2" value="41"/>
                    <measurement group_id="B3" value="86"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Other (Asian, Native American etc)</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="26"/>
                    <measurement group_id="B2" value="9"/>
                    <measurement group_id="B3" value="35"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Education</title>
          <description>Note that the N's may differ slightly from published papers due to multiple imputation</description>
          <units>participants</units>
          <param>Number</param>
          <class_list>
            <class>
              <title>Less than high school education</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="221"/>
                    <measurement group_id="B2" value="224"/>
                    <measurement group_id="B3" value="445"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>High school or above</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="283"/>
                    <measurement group_id="B2" value="290"/>
                    <measurement group_id="B3" value="573"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <measure>
          <title>Health Insurance Status</title>
          <units>participants</units>
          <param>Number</param>
          <class_list>
            <class>
              <title>No health insurance</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="286"/>
                    <measurement group_id="B2" value="259"/>
                    <measurement group_id="B3" value="545"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
            <class>
              <title>Had health insurance</title>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="B1" value="218"/>
                    <measurement group_id="B2" value="255"/>
                    <measurement group_id="B3" value="473"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
      </measure_list>
    </baseline>

    <outcome_list>
      <outcome>
        <type>Primary</type>
        <title>Percent of Participants With Poor Mental Health Quality of Life, MCS12≤ 40</title>
        <description>From the Short Form, 12-item quality of life measure, mental health-related quality of life is the primary client outcome. Poor mental health related quality of life is defined as MCS12≤ 40 (one standard deviation below population mean).</description>
        <time_frame>6 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Poor Mental Health Quality of Life, MCS12≤ 40</title>
          <description>From the Short Form, 12-item quality of life measure, mental health-related quality of life is the primary client outcome. Poor mental health related quality of life is defined as MCS12≤ 40 (one standard deviation below population mean).</description>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="504"/>
                <count group_id="O2" value="514"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="51.4"/>
                    <measurement group_id="O2" value="44.1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a logistic regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 1,018 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>0.74</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.57</ci_lower_limit>
            <ci_upper_limit>0.95</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Percent of Participants With PHQ-9 Score ≥ 10</title>
        <description>Patient Health Questionnaire 9-item version (PHQ-9) at least mild depression (score ≥ 10)</description>
        <time_frame>6 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With PHQ-9 Score ≥ 10</title>
          <description>Patient Health Questionnaire 9-item version (PHQ-9) at least mild depression (score ≥ 10)</description>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="504"/>
                <count group_id="O2" value="514"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="67.0"/>
                    <measurement group_id="O2" value="61.7"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a logistic regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 1,018 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>0.78</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.48</ci_lower_limit>
            <ci_upper_limit>1.26</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Percent of Participants With Poor Mental Health Quality of Life, MCS12≤ 40</title>
        <description>From the Short Form, 12-item quality of life measure, mental health-related quality of life is the primary client outcome. Poor mental health related quality of life is defined as MCS12≤ 40 (one standard deviation below population mean).</description>
        <time_frame>12 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Poor Mental Health Quality of Life, MCS12≤ 40</title>
          <description>From the Short Form, 12-item quality of life measure, mental health-related quality of life is the primary client outcome. Poor mental health related quality of life is defined as MCS12≤ 40 (one standard deviation below population mean).</description>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="501"/>
                <count group_id="O2" value="512"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="50.5"/>
                    <measurement group_id="O2" value="44.8"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat analyses of repeated measures were developed including all participants with data at baseline, 6-month, or 12-month. Missing data were imputed. A generalized estimating equation (GEE) with a logit link function was used with adjustment for covariates.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>0.77</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.61</ci_lower_limit>
            <ci_upper_limit>0.97</ci_upper_limit>
            <other_analysis_desc>In an analysis of change from baseline in likelihood of Poor Mental Health Quality of Life, CEP showed a significant advantage at 6 months, but not at 12 months.</other_analysis_desc>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Percent of Participants With Poor Mental Health Quality of Life, MCS12≤ 40</title>
        <description>From the Short Form, 12-item quality of life measure, mental health-related quality of life is the primary client outcome. Poor mental health related quality of life is defined as MCS12≤ 40 (one standard deviation below population mean).</description>
        <time_frame>36 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Poor Mental Health Quality of Life, MCS12≤ 40</title>
          <description>From the Short Form, 12-item quality of life measure, mental health-related quality of life is the primary client outcome. Poor mental health related quality of life is defined as MCS12≤ 40 (one standard deviation below population mean).</description>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="483"/>
                <count group_id="O2" value="497"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="39.4"/>
                    <measurement group_id="O2" value="45.0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using logistic regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 980 clients at 3 years to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>1.3</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.7</ci_lower_limit>
            <ci_upper_limit>2.3</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Primary</type>
        <title>Percent of Participants With PHQ-8 Score ≥ 10</title>
        <description>Patient Health Questionnaire 8-item version (PHQ-8) at least mild depression (score ≥ 10)</description>
        <time_frame>36 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With PHQ-8 Score ≥ 10</title>
          <description>Patient Health Questionnaire 8-item version (PHQ-8) at least mild depression (score ≥ 10)</description>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="483"/>
                <count group_id="O2" value="497"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="65.8"/>
                    <measurement group_id="O2" value="66.0"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a logistic regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 980 clients at 3 years to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>1.0</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.6</ci_lower_limit>
            <ci_upper_limit>1.7</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Mental Wellness</title>
        <description>Mental wellness is defined as at least a good bit of time in the prior 4 weeks on any of three items: feeling peaceful or calm, being a happy person, having energy</description>
        <time_frame>6 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Mental Wellness</title>
          <description>Mental wellness is defined as at least a good bit of time in the prior 4 weeks on any of three items: feeling peaceful or calm, being a happy person, having energy</description>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="504"/>
                <count group_id="O2" value="514"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="33.6"/>
                    <measurement group_id="O2" value="45.9"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a logistic regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 1,018 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>1.75</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>1.19</ci_lower_limit>
            <ci_upper_limit>2.59</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants Reported Organized Life</title>
        <description>A response of somewhat or definitely true to &quot;my life is organized&quot; versus unsure or somewhat false or definitely false</description>
        <time_frame>6 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants Reported Organized Life</title>
          <description>A response of somewhat or definitely true to &quot;my life is organized&quot; versus unsure or somewhat false or definitely false</description>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="504"/>
                <count group_id="O2" value="514"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="42.7"/>
                    <measurement group_id="O2" value="51.7"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a logistic regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 1,018 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>1.45</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>1.03</ci_lower_limit>
            <ci_upper_limit>2.04</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Physically Active</title>
        <description>Physically Active is defined as at least active to &quot;How physically active you are?&quot;</description>
        <time_frame>6 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Physically Active</title>
          <description>Physically Active is defined as at least active to &quot;How physically active you are?&quot;</description>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="504"/>
                <count group_id="O2" value="514"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="40.3"/>
                    <measurement group_id="O2" value="49.6"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a logistic regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 1,018 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>1.50</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>1.14</ci_lower_limit>
            <ci_upper_limit>1.98</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Homeless or ≥ 2 Risk Factors for Homelessness</title>
        <description>Defined as current homelessness or living in a shelter or having at least 2 risk factors (e.g., no place to stay for at least 2 nights or eviction from a primary residence, financial crisis, or food insecurity in the past 6 months)</description>
        <time_frame>6 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Homeless or ≥ 2 Risk Factors for Homelessness</title>
          <description>Defined as current homelessness or living in a shelter or having at least 2 risk factors (e.g., no place to stay for at least 2 nights or eviction from a primary residence, financial crisis, or food insecurity in the past 6 months)</description>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="504"/>
                <count group_id="O2" value="514"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="39.8"/>
                    <measurement group_id="O2" value="29.7"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a logistic regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 1,018 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>0.61</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.38</ci_lower_limit>
            <ci_upper_limit>0.96</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Working for Pay</title>
        <time_frame>6 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Working for Pay</title>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="504"/>
                <count group_id="O2" value="514"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="23.5"/>
                    <measurement group_id="O2" value="24.7"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a logistic regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 1,018 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>1.09</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.69</ci_lower_limit>
            <ci_upper_limit>1.70</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Any Missed Work Day in Last 30 Days, if Working</title>
        <time_frame>6 months follow-up</time_frame>
        <population>Population of individuals who are working</population>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Any Missed Work Day in Last 30 Days, if Working</title>
          <population>Population of individuals who are working</population>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="123"/>
                <count group_id="O2" value="126"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="63.1"/>
                    <measurement group_id="O2" value="51.5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Adjusted analyses used multiply imputed data (N= 249), weighted for eligible sample for enrollment; logistic regression model adjusted for baseline and covariates and accounted for the design effect of the cluster randomization.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>.59</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.32</ci_lower_limit>
            <ci_upper_limit>1.09</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Hospitalization for Behavioral Health in the Past 6 Months</title>
        <description>self-reported services use in the past 6 months for overnight hospital stays for mental health or substance abuse</description>
        <time_frame>6 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Hospitalization for Behavioral Health in the Past 6 Months</title>
          <description>self-reported services use in the past 6 months for overnight hospital stays for mental health or substance abuse</description>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="504"/>
                <count group_id="O2" value="514"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="10.5"/>
                    <measurement group_id="O2" value="5.8"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a logistic regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 1,018 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>0.51</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.28</ci_lower_limit>
            <ci_upper_limit>0.95</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With &gt;=4 Hospital Nights for Behavioral Health in the Past 6 Months</title>
        <description>self-reported services use in the past 6 months with &gt;=4 overnight hospital stays for any emotional, mental, alcohol, or drug problem, median cut point for baseline variable</description>
        <time_frame>6 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With &gt;=4 Hospital Nights for Behavioral Health in the Past 6 Months</title>
          <description>self-reported services use in the past 6 months with &gt;=4 overnight hospital stays for any emotional, mental, alcohol, or drug problem, median cut point for baseline variable</description>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="504"/>
                <count group_id="O2" value="514"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="5.8"/>
                    <measurement group_id="O2" value="2.1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a logistic regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 1,018 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>0.34</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.14</ci_lower_limit>
            <ci_upper_limit>0.88</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With &gt;=2 Emergency Room Visits in the Past 6 Months</title>
        <description>self-reported services use in the past 6 months with &gt;=2 emergency room visits in past 6 months, median cut point for baseline variable</description>
        <time_frame>6 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With &gt;=2 Emergency Room Visits in the Past 6 Months</title>
          <description>self-reported services use in the past 6 months with &gt;=2 emergency room visits in past 6 months, median cut point for baseline variable</description>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="504"/>
                <count group_id="O2" value="512"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="28.3"/>
                    <measurement group_id="O2" value="24.5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a logistic regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 1,018 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>0.81</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.52</ci_lower_limit>
            <ci_upper_limit>1.25</ci_upper_limit>
            <estimate_desc>Median cut point for baseline variable.</estimate_desc>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Any MHS Outpatient Visit in the Past 6 Months</title>
        <description>self-reported mental health outpatient visit from mental health provider, including psychiatrists, psychologists, social workers, psychiatric nurses, or counselors in the past 6 months</description>
        <time_frame>6 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Any MHS Outpatient Visit in the Past 6 Months</title>
          <description>self-reported mental health outpatient visit from mental health provider, including psychiatrists, psychologists, social workers, psychiatric nurses, or counselors in the past 6 months</description>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="504"/>
                <count group_id="O2" value="514"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="53.9"/>
                    <measurement group_id="O2" value="53.6"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a logistic regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 1,018 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>0.99</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.69</ci_lower_limit>
            <ci_upper_limit>1.41</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Any PCP Visit With Depression Service in the Past 6 Months</title>
        <description>self-reported services use in the past 6 months with any primary care visit for depression</description>
        <time_frame>6 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Any PCP Visit With Depression Service in the Past 6 Months</title>
          <description>self-reported services use in the past 6 months with any primary care visit for depression</description>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="504"/>
                <count group_id="O2" value="514"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="29.2"/>
                    <measurement group_id="O2" value="29.4"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using logistic regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 1,018 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>1.01</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.70</ci_lower_limit>
            <ci_upper_limit>1.46</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With &gt;= 2 PCP Visits With Depression Services, if Any</title>
        <time_frame>6 months follow-up</time_frame>
        <population>Individuals who reported any PCP visit in past 6 months</population>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With &gt;= 2 PCP Visits With Depression Services, if Any</title>
          <population>Individuals who reported any PCP visit in past 6 months</population>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="145"/>
                <count group_id="O2" value="153"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="61.9"/>
                    <measurement group_id="O2" value="79.8"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Adjusted analyses used multiply imputed data (N=298), weighted for eligible sample for enrollment; logistic regression model adjusted for baseline and covariates and accounted for the design effect of the cluster randomization.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <p_value>&lt;.01</p_value>
            <method>Regression, Logistic</method>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>2.63</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>1.40</ci_lower_limit>
            <ci_upper_limit>4.94</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Faith-based Program Participation in the Past 6 Months</title>
        <description>Went to any religious or spiritual places such as a church, mosque, temple, or synagogue in the past 6 months</description>
        <time_frame>6 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Faith-based Program Participation in the Past 6 Months</title>
          <description>Went to any religious or spiritual places such as a church, mosque, temple, or synagogue in the past 6 months</description>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="504"/>
                <count group_id="O2" value="514"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="59.5"/>
                    <measurement group_id="O2" value="57.1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a generalized estimating equation logistic regression model adjusted for covariates, accounted for the design effect of the cluster randomization. We weighted data for 1,018 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>0.89</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.66</ci_lower_limit>
            <ci_upper_limit>1.21</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Any Use of Park and Recreation or Community Centers in the Past 6 Months</title>
        <time_frame>6 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Any Use of Park and Recreation or Community Centers in the Past 6 Months</title>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="504"/>
                <count group_id="O2" value="514"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="41.1"/>
                    <measurement group_id="O2" value="39.4"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using logistic regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 1,018 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>0.92</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.61</ci_lower_limit>
            <ci_upper_limit>1.40</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Use of an Antidepressant Medication for 2 Months or More in the Past 6 Months</title>
        <time_frame>6 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Use of an Antidepressant Medication for 2 Months or More in the Past 6 Months</title>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="504"/>
                <count group_id="O2" value="514"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="39.2"/>
                    <measurement group_id="O2" value="31.5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using logistic regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 1,018 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>0.65</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.34</ci_lower_limit>
            <ci_upper_limit>1.25</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Medication Visits Among MHS Users in the Past 6 Months</title>
        <time_frame>6 months follow-up</time_frame>
        <population>Individuals who reported any mental health specialty outpatient visit in past 6 months</population>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Medication Visits Among MHS Users in the Past 6 Months</title>
          <population>Individuals who reported any mental health specialty outpatient visit in past 6 months</population>
          <units>visits</units>
          <param>Mean</param>
          <dispersion>95% Confidence Interval</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="276"/>
                <count group_id="O2" value="277"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="10.9" lower_limit="6.2" upper_limit="15.5"/>
                    <measurement group_id="O2" value="5.3" lower_limit="4.1" upper_limit="6.6"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Adjusted analyses used multiply imputed data (N=553), weighted for eligible sample for enrollment; Poisson regression model adjusted for baseline and covariates and accounted for the design effect of the cluster randomization.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Rate Ratio (RR)</param_type>
            <param_value>0.49</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.30</ci_lower_limit>
            <ci_upper_limit>0.82</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Faith-based Visits With Depression Service if Faith Participation in the Past 6 Months</title>
        <description>For this sector, depression/mental health service is defined by client report of having assessment, counseling, education, medication discussion or referral for depression or emotional or mental health problems.</description>
        <time_frame>6 months follow-up</time_frame>
        <population>Individuals who reported any faith based participation in past 6 months</population>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Faith-based Visits With Depression Service if Faith Participation in the Past 6 Months</title>
          <description>For this sector, depression/mental health service is defined by client report of having assessment, counseling, education, medication discussion or referral for depression or emotional or mental health problems.</description>
          <population>Individuals who reported any faith based participation in past 6 months</population>
          <units>visits</units>
          <param>Mean</param>
          <dispersion>95% Confidence Interval</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="299"/>
                <count group_id="O2" value="289"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0.7" lower_limit="0.3" upper_limit="1.0"/>
                    <measurement group_id="O2" value="1.9" lower_limit="0.9" upper_limit="2.9"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Adjusted analyses used multiply imputed data (N=588), weighted for eligible sample for enrollment; Poisson regression model adjusted for baseline status of the dependent variable and covariates and accounted for the design effect of the cluster randomization.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <param_type>Rate Ratio (RR)</param_type>
            <param_value>2.84</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>1.39</ci_lower_limit>
            <ci_upper_limit>5.80</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Park or Community Center Visits With Depression Service if Went to Park or Community Center in Past 6 Months</title>
        <description>For this sector, depression/mental health service is defined by client report of having assessment, counseling, education, medication discussion or referral for depression or emotional or mental health problems.</description>
        <time_frame>6 months follow-up</time_frame>
        <population>Individuals who reported any park or community center visit in past 6 months</population>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Park or Community Center Visits With Depression Service if Went to Park or Community Center in Past 6 Months</title>
          <description>For this sector, depression/mental health service is defined by client report of having assessment, counseling, education, medication discussion or referral for depression or emotional or mental health problems.</description>
          <population>Individuals who reported any park or community center visit in past 6 months</population>
          <units>visits</units>
          <param>Mean</param>
          <dispersion>95% Confidence Interval</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="210"/>
                <count group_id="O2" value="199"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0.3" lower_limit="0.0" upper_limit="0.5"/>
                    <measurement group_id="O2" value="1.6" lower_limit="0.2" upper_limit="3.1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Adjusted analyses used multiply imputed data (N=410), weighted for eligible sample for enrollment; Poisson regression model adjusted for baseline and covariates and accounted for the design effect of the cluster randomization.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Rate Ratio (RR)</param_type>
            <param_value>6.20</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>1.5</ci_lower_limit>
            <ci_upper_limit>24.9</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Total Mental Health Related Outpatient Visits in the Past 6 Months</title>
        <description>Total outpatient visits for depression, mental health or substance abuse from emergency rooms, primary care or public health, mental health, substance abuse, or social-community services sectors in the past 6 months</description>
        <time_frame>6 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Total Mental Health Related Outpatient Visits in the Past 6 Months</title>
          <description>Total outpatient visits for depression, mental health or substance abuse from emergency rooms, primary care or public health, mental health, substance abuse, or social-community services sectors in the past 6 months</description>
          <units>visits</units>
          <param>Mean</param>
          <dispersion>95% Confidence Interval</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="504"/>
                <count group_id="O2" value="514"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="22.9" lower_limit="14.8" upper_limit="30.9"/>
                    <measurement group_id="O2" value="21.9" lower_limit="16.3" upper_limit="27.4"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a Poisson regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 1,018 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Rate Ratio (RR)</param_type>
            <param_value>0.96</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.59</ci_lower_limit>
            <ci_upper_limit>1.57</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Hospitalization for Behavioral Health in the Past 6 Months</title>
        <description>self-reported services use in the past 6 months for overnight hospital stays for mental health or substance abuse</description>
        <time_frame>12 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Hospitalization for Behavioral Health in the Past 6 Months</title>
          <description>self-reported services use in the past 6 months for overnight hospital stays for mental health or substance abuse</description>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="501"/>
                <count group_id="O2" value="512"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="5.0"/>
                    <measurement group_id="O2" value="4.3"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a generalized estimating equation logistic regression model adjusted for covariates, accounted for the design effect of the cluster randomization. We weighted data for 1,018 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>0.70</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>.40</ci_lower_limit>
            <ci_upper_limit>1.22</ci_upper_limit>
            <estimate_desc>When analyzed as change from baseline, CEP showed significant reductions in likelihood of behavioral health hospitalizations at 6 months (P &lt; 0.01) and 12 months (P &lt; 0.01).</estimate_desc>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Any MHS Outpatient Visit in the Past 6 Months</title>
        <description>self-reported mental health outpatient visit from mental health provider, including psychiatrists, psychologists, social workers, psychiatric nurses, or counselors in the past 6 months</description>
        <time_frame>12 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Any MHS Outpatient Visit in the Past 6 Months</title>
          <description>self-reported mental health outpatient visit from mental health provider, including psychiatrists, psychologists, social workers, psychiatric nurses, or counselors in the past 6 months</description>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="501"/>
                <count group_id="O2" value="512"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="44.5"/>
                    <measurement group_id="O2" value="42.6"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat analyses of repeated measures were developed including all participants with data at baseline, 6-month, or 12-month. Missing data were imputed. A generalized estimating equation (GEE) with a logit link function was used with adjustment for covariates.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>1.05</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>.66</ci_lower_limit>
            <ci_upper_limit>1.66</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Any PCP Visit With Depression Service in the Past 6 Months</title>
        <description>self-reported services use in the past 6 months with any primary care visit for depression</description>
        <time_frame>12 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Any PCP Visit With Depression Service in the Past 6 Months</title>
          <description>self-reported services use in the past 6 months with any primary care visit for depression</description>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="501"/>
                <count group_id="O2" value="512"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="25.1"/>
                    <measurement group_id="O2" value="28.4"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a generalized estimating equation logistic regression model adjusted for covariates, accounted for the design effect of the cluster randomization. We weighted data for 1,018 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>1.03</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.74</ci_lower_limit>
            <ci_upper_limit>1.42</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Faith-based Program Participation in the Past 6 Months</title>
        <description>Went to any religious or spiritual places such as a church, mosque, temple, or synagogue in the past 6 months</description>
        <time_frame>12 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Faith-based Program Participation in the Past 6 Months</title>
          <description>Went to any religious or spiritual places such as a church, mosque, temple, or synagogue in the past 6 months</description>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="501"/>
                <count group_id="O2" value="512"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="57.0"/>
                    <measurement group_id="O2" value="53.9"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat analyses of repeated measures were developed including all participants with data at baseline, 6-month, or 12-month. Missing data were imputed. A generalized estimating equation (GEE) with a logit link function was used with adjustment for covariates.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>.79</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>.60</ci_lower_limit>
            <ci_upper_limit>1.05</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Any Use of Park and Recreation or Community Centers in the Past 6 Months</title>
        <time_frame>12 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Any Use of Park and Recreation or Community Centers in the Past 6 Months</title>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="501"/>
                <count group_id="O2" value="512"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="34.5"/>
                    <measurement group_id="O2" value="36.6"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat analyses of repeated measures were developed including all participants with data at baseline, 6-month, or 12-month. Missing data were imputed. A generalized estimating equation (GEE) with a logit link function was used with adjustment for covariates.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>.97</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.72</ci_lower_limit>
            <ci_upper_limit>1.32</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Use of an Antidepressant Medication for 2 Months or More in the Past 6 Months</title>
        <time_frame>12 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Use of an Antidepressant Medication for 2 Months or More in the Past 6 Months</title>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="501"/>
                <count group_id="O2" value="512"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="34.0"/>
                    <measurement group_id="O2" value="28.7"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat analyses of repeated measures were developed including all participants with data at baseline, 6-month, or 12-month. Missing data were imputed. A generalized estimating equation (GEE) with a logit link function was used with adjustment for covariates.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>.87</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.55</ci_lower_limit>
            <ci_upper_limit>1.39</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Total Mental Health Related Outpatient Visits in the Past 6 Months</title>
        <description>Total outpatient visits for depression, mental health or substance abuse from emergency rooms, primary care or public health, mental health, substance abuse, or social-community services sectors in the past 6 months</description>
        <time_frame>12 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Total Mental Health Related Outpatient Visits in the Past 6 Months</title>
          <description>Total outpatient visits for depression, mental health or substance abuse from emergency rooms, primary care or public health, mental health, substance abuse, or social-community services sectors in the past 6 months</description>
          <units>visits</units>
          <param>Mean</param>
          <dispersion>95% Confidence Interval</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="501"/>
                <count group_id="O2" value="512"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="18.7" lower_limit="13.6" upper_limit="23.8"/>
                    <measurement group_id="O2" value="17.0" lower_limit="12.0" upper_limit="22.1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat analyses of repeated measures were developed including all participants with data at baseline, 6-month, or 12-month. Missing data were imputed. A generalized estimating equation (GEE) with a log link function was used with adjustment for covariates.</groups_desc>
            <non_inferiority_type>Superiority or Other (legacy)</non_inferiority_type>
            <param_type>Rate Ratio (RR)</param_type>
            <param_value>.91</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.65</ci_lower_limit>
            <ci_upper_limit>1.29</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>PCS-12 Scores on 12-Item Physical Health Summary Measure, Comparison Between CEP and RS Groups</title>
        <description>12-item physical composite score (PCS-12). Possible scores on range from 0 to 100, with higher scores indicating better physical health</description>
        <time_frame>36 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>PCS-12 Scores on 12-Item Physical Health Summary Measure, Comparison Between CEP and RS Groups</title>
          <description>12-item physical composite score (PCS-12). Possible scores on range from 0 to 100, with higher scores indicating better physical health</description>
          <units>units on a scale</units>
          <param>Mean</param>
          <dispersion>95% Confidence Interval</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="483"/>
                <count group_id="O2" value="497"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="38.7" lower_limit="37.9" upper_limit="39.5"/>
                    <measurement group_id="O2" value="39.9" lower_limit="39.2" upper_limit="40.6"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a linear regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 980 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <param_type>Mean Difference (Final Values)</param_type>
            <param_value>1.2</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.2</ci_lower_limit>
            <ci_upper_limit>2.0</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Nights Hospitalized for Behavioral Health Reason in the Past 6 Months</title>
        <description>self-reported number of overnight hospital stays for any emotional, mental, alcohol, or drug problem in past 6 months</description>
        <time_frame>36 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Nights Hospitalized for Behavioral Health Reason in the Past 6 Months</title>
          <description>self-reported number of overnight hospital stays for any emotional, mental, alcohol, or drug problem in past 6 months</description>
          <units>nights</units>
          <param>Mean</param>
          <dispersion>95% Confidence Interval</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="483"/>
                <count group_id="O2" value="497"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1.2" lower_limit="0.3" upper_limit="4.6"/>
                    <measurement group_id="O2" value="0.2" lower_limit="0.1" upper_limit="0.4"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a Poisson regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 980 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <param_type>Rate Ratio (RR)</param_type>
            <param_value>0.2</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.1</ci_lower_limit>
            <ci_upper_limit>0.8</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>N of Emergency Room or Urgent Care Visits in the Past 6 Months</title>
        <time_frame>36 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>N of Emergency Room or Urgent Care Visits in the Past 6 Months</title>
          <units>visits</units>
          <param>Mean</param>
          <dispersion>95% Confidence Interval</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="483"/>
                <count group_id="O2" value="497"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1.5" lower_limit="1.0" upper_limit="2.2"/>
                    <measurement group_id="O2" value="1.9" lower_limit="0.7" upper_limit="4.9"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a Poisson regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 980 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <param_type>Rate Ratio (RR)</param_type>
            <param_value>1.2</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.4</ci_lower_limit>
            <ci_upper_limit>3.7</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>N of Visits to Primary Care in Past 6 Months</title>
        <time_frame>36 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>N of Visits to Primary Care in Past 6 Months</title>
          <units>visits</units>
          <param>Mean</param>
          <dispersion>95% Confidence Interval</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="483"/>
                <count group_id="O2" value="497"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="3.9" lower_limit="2.7" upper_limit="5.4"/>
                    <measurement group_id="O2" value="4.1" lower_limit="3.5" upper_limit="4.9"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a Poisson regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 980 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <param_type>Rate Ratio (RR)</param_type>
            <param_value>1.1</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.8</ci_lower_limit>
            <ci_upper_limit>1.5</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>N of Outpatient Visits to Primary Care for Depression Services in the Past 6 Months</title>
        <time_frame>36 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>N of Outpatient Visits to Primary Care for Depression Services in the Past 6 Months</title>
          <units>visits</units>
          <param>Mean</param>
          <dispersion>95% Confidence Interval</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="483"/>
                <count group_id="O2" value="497"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="1.1" lower_limit="0.6" upper_limit="2.1"/>
                    <measurement group_id="O2" value="1.1" lower_limit="0.8" upper_limit="1.5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a Poisson regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 980 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <param_type>Rate Ratio (RR)</param_type>
            <param_value>1.0</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.5</ci_lower_limit>
            <ci_upper_limit>2.1</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>N of Outpatient Mental Health Visits in Past 6 Months</title>
        <time_frame>36 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>N of Outpatient Mental Health Visits in Past 6 Months</title>
          <units>visits</units>
          <param>Mean</param>
          <dispersion>95% Confidence Interval</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="483"/>
                <count group_id="O2" value="497"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="5.5" lower_limit="3.7" upper_limit="8.0"/>
                    <measurement group_id="O2" value="5.6" lower_limit="3.2" upper_limit="9.8"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a Poisson regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 980 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <param_type>Rate Ratio (RR)</param_type>
            <param_value>1.0</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.7</ci_lower_limit>
            <ci_upper_limit>1.6</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>N of Outpatient Visits to a Substance Abuse Treatment Agency or Self Help Group in the Past 6 Months</title>
        <time_frame>36 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>N of Outpatient Visits to a Substance Abuse Treatment Agency or Self Help Group in the Past 6 Months</title>
          <units>visits</units>
          <param>Mean</param>
          <dispersion>95% Confidence Interval</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="483"/>
                <count group_id="O2" value="497"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="11.1" lower_limit="4.7" upper_limit="24.5"/>
                    <measurement group_id="O2" value="12.3" lower_limit="5.6" upper_limit="25.8"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a Poisson regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 980 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <param_type>Rate Ratio (RR)</param_type>
            <param_value>1.1</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.3</ci_lower_limit>
            <ci_upper_limit>4.0</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>N of Social Services for Depression Visits in the Past 6 Months</title>
        <time_frame>36 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>N of Social Services for Depression Visits in the Past 6 Months</title>
          <units>visits</units>
          <param>Mean</param>
          <dispersion>95% Confidence Interval</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="483"/>
                <count group_id="O2" value="497"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0.6" lower_limit="0.3" upper_limit="1.2"/>
                    <measurement group_id="O2" value="0.6" lower_limit="0.4" upper_limit="0.9"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a Poisson regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 980 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <param_type>Rate Ratio (RR)</param_type>
            <param_value>1.1</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.4</ci_lower_limit>
            <ci_upper_limit>2.7</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Number of Calls to Hotline for Substance Use or Mental Health Problem in the Past 6 Months</title>
        <time_frame>36 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Number of Calls to Hotline for Substance Use or Mental Health Problem in the Past 6 Months</title>
          <units>calls</units>
          <param>Mean</param>
          <dispersion>95% Confidence Interval</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="483"/>
                <count group_id="O2" value="497"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="0.2" lower_limit="0.1" upper_limit="0.6"/>
                    <measurement group_id="O2" value="0.3" lower_limit="0.1" upper_limit="1.1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a Poisson regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 980 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <param_type>Rate Ratio (RR)</param_type>
            <param_value>1.4</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.2</ci_lower_limit>
            <ci_upper_limit>8.6</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>N of Days on Which a Self-help Visit for Mental Health Was Made in the Past 6 Months</title>
        <time_frame>36 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>N of Days on Which a Self-help Visit for Mental Health Was Made in the Past 6 Months</title>
          <units>days</units>
          <param>Mean</param>
          <dispersion>95% Confidence Interval</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="483"/>
                <count group_id="O2" value="497"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="6.3" lower_limit="4.1" upper_limit="9.6"/>
                    <measurement group_id="O2" value="5.6" lower_limit="3.4" upper_limit="9.1"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a Poisson regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 980 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <param_type>Rate Ratio (RR)</param_type>
            <param_value>0.9</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.4</ci_lower_limit>
            <ci_upper_limit>1.8</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Any Faith-based Services for Depression in the Past 6 Months</title>
        <time_frame>36 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Any Faith-based Services for Depression in the Past 6 Months</title>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="483"/>
                <count group_id="O2" value="497"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="9.4"/>
                    <measurement group_id="O2" value="15.2"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a logistic regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 980 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>1.8</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>1.2</ci_lower_limit>
            <ci_upper_limit>2.6</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Use of Any Antidepressant in the Past 6 Months</title>
        <time_frame>36 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Use of Any Antidepressant in the Past 6 Months</title>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="483"/>
                <count group_id="O2" value="497"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="28.7"/>
                    <measurement group_id="O2" value="26.9"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a logistic regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 980 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>0.9</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.5</ci_lower_limit>
            <ci_upper_limit>1.5</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Use of Any Mood Stabilizer in the Past 6 Months</title>
        <time_frame>36 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Use of Any Mood Stabilizer in the Past 6 Months</title>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="483"/>
                <count group_id="O2" value="497"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="2.5"/>
                    <measurement group_id="O2" value="6.4"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a logistic regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 980 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>2.9</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>1.0</ci_lower_limit>
            <ci_upper_limit>8.3</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Use of Any Antipsychotic in the Past 6 Months</title>
        <time_frame>36 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Use of Any Antipsychotic in the Past 6 Months</title>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="483"/>
                <count group_id="O2" value="497"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="21.7"/>
                    <measurement group_id="O2" value="23.4"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a logistic regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 980 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>1.1</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.7</ci_lower_limit>
            <ci_upper_limit>1.7</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Any Visit in Health Care Sector in the Past 6 Months</title>
        <time_frame>36 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Any Visit in Health Care Sector in the Past 6 Months</title>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="483"/>
                <count group_id="O2" value="497"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="84.2"/>
                    <measurement group_id="O2" value="84.3"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a logistic regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 980 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>1.0</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.5</ci_lower_limit>
            <ci_upper_limit>2.0</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Any Community-sector Visit for Depression in the Past 6 Months</title>
        <time_frame>36 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Any Community-sector Visit for Depression in the Past 6 Months</title>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="483"/>
                <count group_id="O2" value="497"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="28.3"/>
                    <measurement group_id="O2" value="35.6"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a logistic regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 980 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>1.4</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>1.0</ci_lower_limit>
            <ci_upper_limit>2.0</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Any Depression Treatment in the Past 6 Months</title>
        <description>Antidepressant use for at least two months or at least four outpatient visits to mental health or primary care setting for depression services</description>
        <time_frame>36 months follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Any Depression Treatment in the Past 6 Months</title>
          <description>Antidepressant use for at least two months or at least four outpatient visits to mental health or primary care setting for depression services</description>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="483"/>
                <count group_id="O2" value="497"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="43.2"/>
                    <measurement group_id="O2" value="43.5"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a logistic regression model adjusted for baseline and covariates, and accounted for the design effect of the cluster randomization. We weighted data for 980 clients to characteristics of the eligible sample, with item-level imputation for missing data and wave-level imputation for missing surveys. Weights account for non-enrollment among eligible clients and attrition.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>1.0</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.6</ci_lower_limit>
            <ci_upper_limit>1.7</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Survival Analysis for Time to the First Clinical Remission</title>
        <description>clinical remission: Patient Health Questionnaire, PHQ-8 score &lt;10. Cox Proportional Hazard model was used to examine the impact of the intervention on speed of clinical remission over the 3 years follow-up period, defined as the first assessment with clinical remission (PHQ-8&lt;10).</description>
        <time_frame>from baseline to 3 years</time_frame>
        <population>Sample does not include persons in clinical remission at baseline</population>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Survival Analysis for Time to the First Clinical Remission</title>
          <description>clinical remission: Patient Health Questionnaire, PHQ-8 score &lt;10. Cox Proportional Hazard model was used to examine the impact of the intervention on speed of clinical remission over the 3 years follow-up period, defined as the first assessment with clinical remission (PHQ-8&lt;10).</description>
          <population>Sample does not include persons in clinical remission at baseline</population>
          <units>months to remission</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="491"/>
                <count group_id="O2" value="504"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="21.14" spread="13.98"/>
                    <measurement group_id="O2" value="20.05" spread="14.14"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a Cox proportional-hazards model adjusted for baseline covariates. Data were multiply imputed and weighted for eligible sample for enrollment, accounted for the design effect of the cluster randomization.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <p_value>&gt;.05</p_value>
            <method>Regression, Cox</method>
            <param_type>Cox Proportional Hazard</param_type>
            <param_value>1.12</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.83</ci_lower_limit>
            <ci_upper_limit>1.50</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Survival Analysis for Time to the First Community-Defined Remission</title>
        <description>Community-Defined Remission: PHQ-8&lt;10 or MCS-12&gt;40 or any mental wellness. Cox Proportional Hazard model was used to examine the impact of the intervention on speed of community-defined remission over the 3 years follow-up period, defined as the first assessment with community-defined (PHQ-8&lt;10 or MCS-12&gt;40 or any mental wellness)</description>
        <time_frame>from baseline to 3 years</time_frame>
        <population>Sample does not include persons in community-defined remission at baseline</population>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
          </group>
        </group_list>
        <measure>
          <title>Survival Analysis for Time to the First Community-Defined Remission</title>
          <description>Community-Defined Remission: PHQ-8&lt;10 or MCS-12&gt;40 or any mental wellness. Cox Proportional Hazard model was used to examine the impact of the intervention on speed of community-defined remission over the 3 years follow-up period, defined as the first assessment with community-defined (PHQ-8&lt;10 or MCS-12&gt;40 or any mental wellness)</description>
          <population>Sample does not include persons in community-defined remission at baseline</population>
          <units>months to remission</units>
          <param>Mean</param>
          <dispersion>Standard Deviation</dispersion>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="203"/>
                <count group_id="O2" value="205"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="14.05" spread="11.97"/>
                    <measurement group_id="O2" value="12.14" spread="10.93"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a Cox proportional-hazards model adjusted for baseline covariates. Data were multiply imputed and weighted for eligible sample for enrollment, accounted for the design effect of the cluster randomization.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <p_value>&gt;0.05</p_value>
            <method>Regression, Cox</method>
            <param_type>Cox Proportional Hazard</param_type>
            <param_value>1.23</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>0.99</ci_lower_limit>
            <ci_upper_limit>1.52</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Clinical Remission</title>
        <description>Clinical remission defined as Patient Health Questionnaire-2 (PHQ-2) score &lt; 3.</description>
        <time_frame>4 years follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>The RS condition offers time-limited technical assistance to individual agencies, coupled with outreach from a community engagement specialty, to participate in structured reviews of components of the Quality Improvement (QI) Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The quality improvement program is an evidence-based toolkit from prior studies that supported team leadership, case and care management, medication management, and CBT for Depression. The Case management manual supported depression screening and monitoring/tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual.&#xD;
RS Expert Team: The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a quality improvement expert, and staff support. T</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>The CEP arm supported 4 months of planning for the CEP Council consisting of representatives from all assigned programs in biweekly 2 hour meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites were provided with enrolled client lists.&#xD;
QI Program: The QI program is an evidence-based toolkit from prior studies that supported team leadership, case and care management, medication management, and CBT for Depression. The Case management manual supported depression screening and monitoring/tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual.&#xD;
CEP Council: The CEP Council was supported by a workbook de</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Clinical Remission</title>
          <description>Clinical remission defined as Patient Health Questionnaire-2 (PHQ-2) score &lt; 3.</description>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="143"/>
                <count group_id="O2" value="140"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="39.7"/>
                    <measurement group_id="O2" value="51.7"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a logistic regression model adjusted for baseline covariates. Data were multiply imputed and weighted for eligible sample for enrollment, accounted for the design effect of the cluster randomization.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>1.73</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>1.00</ci_lower_limit>
            <ci_upper_limit>2.99</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
      <outcome>
        <type>Secondary</type>
        <title>Percent of Participants With Community-Defined Remission</title>
        <description>Community-Defined Remission defined as PHQ-2&lt;3, MCS-12&gt;40, or mental wellness</description>
        <time_frame>4 years follow-up</time_frame>
        <group_list>
          <group group_id="O1">
            <title>Resources for Services RS</title>
            <description>The RS condition offers time-limited technical assistance to individual agencies, coupled with outreach from a community engagement specialty, to participate in structured reviews of components of the Quality Improvement (QI) Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The quality improvement program is an evidence-based toolkit from prior studies that supported team leadership, case and care management, medication management, and CBT for Depression. The Case management manual supported depression screening and monitoring/tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual.&#xD;
RS Expert Team: The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a quality improvement expert, and staff support. T</description>
          </group>
          <group group_id="O2">
            <title>Community Engagement and Planning CEP</title>
            <description>The CEP arm supported 4 months of planning for the CEP Council consisting of representatives from all assigned programs in biweekly 2 hour meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites were provided with enrolled client lists.&#xD;
QI Program: The QI program is an evidence-based toolkit from prior studies that supported team leadership, case and care management, medication management, and CBT for Depression. The Case management manual supported depression screening and monitoring/tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual.&#xD;
CEP Council: The CEP Council was supported by a workbook de</description>
          </group>
        </group_list>
        <measure>
          <title>Percent of Participants With Community-Defined Remission</title>
          <description>Community-Defined Remission defined as PHQ-2&lt;3, MCS-12&gt;40, or mental wellness</description>
          <units>percentage of participants</units>
          <param>Number</param>
          <analyzed_list>
            <analyzed>
              <units>Participants</units>
              <scope>Measure</scope>
              <count_list>
                <count group_id="O1" value="143"/>
                <count group_id="O2" value="140"/>
              </count_list>
            </analyzed>
          </analyzed_list>
          <class_list>
            <class>
              <category_list>
                <category>
                  <measurement_list>
                    <measurement group_id="O1" value="69.0"/>
                    <measurement group_id="O2" value="84.2"/>
                  </measurement_list>
                </category>
              </category_list>
            </class>
          </class_list>
        </measure>
        <analysis_list>
          <analysis>
            <group_id_list>
              <group_id>O1</group_id>
              <group_id>O2</group_id>
            </group_id_list>
            <groups_desc>Intent-to-treat, comparative-effectiveness analyses with intervention status as the independent variable, using a logistic regression model adjusted for baseline covariates. Data were multiply imputed and weighted for eligible sample for enrollment, accounted for the design effect of the cluster randomization.</groups_desc>
            <non_inferiority_type>Superiority</non_inferiority_type>
            <param_type>Odds Ratio (OR)</param_type>
            <param_value>2.62</param_value>
            <ci_percent>95</ci_percent>
            <ci_n_sides>2-Sided</ci_n_sides>
            <ci_lower_limit>1.24</ci_lower_limit>
            <ci_upper_limit>5.54</ci_upper_limit>
          </analysis>
        </analysis_list>
      </outcome>
    </outcome_list>

    <reported_events>
      <time_frame>Mortality data obtained from back up contact person identified by participants in prior survey periods. The suicidal ideation within the last two weeks data was collected over the 12 months study duration.</time_frame>
      <desc>Screening for suicidal ideation in the baseline utilized the Mini-International Neuropsychiatric Interview (MINI) item: &quot;Over the past two weeks, when you felt depressed or uninterested, did you repeatedly consider hurting yourself, feel suicidal, or wish that you were dead? Did you attempt suicide or plan a suicide? At 6 and 12 months, screening utilized the item 9 of the Patient Health Questionnaire with a follow-up question: &quot;Are these thoughts bothering you now?&quot; if responding affirmatively.</desc>
      <group_list>
        <group group_id="E1">
          <title>Resources for Services RS</title>
          <description>RS offers time-limited technical assistance to individual agencies and outreach from a community engagement specialty, to review components of the QI Program Intervention as implemented by the RS Expert Team.&#xD;
QI Program: The QI program is an evidence-based toolkit that supported team leadership, case and care management, medication management, and CBT for depression. The Case management manual supported depression screening and tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual. The expert team for RS consisted of 3 psychiatrists, a psychologist expert in CBT, a nurse care manager, a community engagement specialist, a QI expert, and staff support. The team offered 12 webinars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.</description>
        </group>
        <group group_id="E2">
          <title>Community Engagement and Planning CEP</title>
          <description>CEP supports 4 months of planning for the CEP Council of representatives from assigned programs in biweekly 2-hr meetings to fit trainings in the QI Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites received enrolled client lists. The toolkit is the same as RS. The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.</description>
        </group>
      </group_list>
      <serious_events>
        <category_list>
          <category>
            <title>Total</title>
            <event_list>
              <event>
                <sub_title>Total, all-cause mortality</sub_title>
                <counts group_id="E1" subjects_affected="4" subjects_at_risk="606"/>
                <counts group_id="E2" subjects_affected="4" subjects_at_risk="640"/>
              </event>
              <event>
                <sub_title>Total, serious adverse events</sub_title>
                <counts group_id="E1" subjects_affected="0" subjects_at_risk="606"/>
                <counts group_id="E2" subjects_affected="0" subjects_at_risk="640"/>
              </event>
            </event_list>
          </category>
        </category_list>
      </serious_events>
      <other_events>
        <frequency_threshold>0</frequency_threshold>
        <default_assessment>Systematic Assessment</default_assessment>
        <category_list>
          <category>
            <title>Total</title>
            <event_list>
              <event>
                <sub_title>Total, other adverse events</sub_title>
                <counts group_id="E1" subjects_affected="126" subjects_at_risk="606"/>
                <counts group_id="E2" subjects_affected="126" subjects_at_risk="640"/>
              </event>
            </event_list>
          </category>
          <category>
            <title>Psychiatric disorders</title>
            <event_list>
              <event>
                <sub_title>Suicidality Screening Tool (MINI) at baseline</sub_title>
                <description>Over the past two weeks, when you felt depressed or uninterested, did you repeatedly consider hurting yourself, feel suicidal, or wish that you were dead? Did you attempt suicide or plan a suicide?</description>
                <counts group_id="E1" subjects_affected="76" subjects_at_risk="606"/>
                <counts group_id="E2" subjects_affected="67" subjects_at_risk="640"/>
              </event>
              <event>
                <sub_title>Suicidal ideation on the 9 item of PHQ-9 at 6 months</sub_title>
                <description>the 9 item of Patient Health Questionnaire (PHQ-9): In the past two weeks, have you been bothered by thoughts that you would be better off dead or of hurting yourself in some way?</description>
                <counts group_id="E1" subjects_affected="53" subjects_at_risk="606"/>
                <counts group_id="E2" subjects_affected="46" subjects_at_risk="640"/>
              </event>
              <event>
                <sub_title>Suicidal ideation on the 9 item of PHQ-9 with positive follow-up at 6 months</sub_title>
                <description>a participant responding affirmatively to the 9 item of PHQ-9 answered &quot;yes&quot; to the follow-up question: &quot;Are these thoughts bothering you now?&quot;</description>
                <counts group_id="E1" subjects_affected="13" subjects_at_risk="606"/>
                <counts group_id="E2" subjects_affected="16" subjects_at_risk="640"/>
              </event>
              <event>
                <sub_title>Suicidal ideation on the 9 item of PHQ-9 at 12 months</sub_title>
                <description>the 9 item of Patient Health Questionnaire (PHQ-9): In the past two weeks, have you been bothered by thoughts that you would be better off dead or of hurting yourself in some way?</description>
                <counts group_id="E1" subjects_affected="72" subjects_at_risk="606"/>
                <counts group_id="E2" subjects_affected="74" subjects_at_risk="640"/>
              </event>
              <event>
                <sub_title>Suicidal ideation on the 9 item of PHQ-9 with positive follow-up at 12 months</sub_title>
                <description>a participant responding affirmatively to the 9 item of PHQ-9 answered &quot;yes&quot; to the follow-up question: &quot;Are these thoughts bothering you now?&quot;</description>
                <counts group_id="E1" subjects_affected="23" subjects_at_risk="606"/>
                <counts group_id="E2" subjects_affected="21" subjects_at_risk="640"/>
              </event>
            </event_list>
          </category>
        </category_list>
      </other_events>
    </reported_events>

    <certain_agreements>
      <pi_employee>Principal Investigators are NOT employed by the organization sponsoring the study.</pi_employee>
      <restrictive_agreement>There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed. </restrictive_agreement>
    </certain_agreements>
    <limitations_and_caveats>Communities had history of using CPPR for depression. Response rates moderate for agencies, high for programs. Convenience samples of sites. Client retention rates lower than other QI studies. Outcomes rely on client self-report at 6-month follow-up.</limitations_and_caveats>
    <point_of_contact>
      <name_or_title>Kenneth B. Wells</name_or_title>
      <organization>RAND Corporation</organization>
      <phone>310-794-3728</phone>
      <email>kwells@mednet.ucla.edu</email>
    </point_of_contact>
  </clinical_results>
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT01699789
org study id: CPIC-2012-KW
secondary id: R01MH078853
secondary id: P30MH082760
secondary id: P30MH068639
secondary id: PPRN-1501-26518
secondary id: R01MD007721
secondary id: G08LM011058
secondary id: UL1TR000124
secondary id: 64244
nct id: NCT01699789
lead sponsor: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
collaborator: 
has dmc: No
CPIC is a community initiative and research study funded by the NIH. CPIC was developed and
      is being run by community and academic partners in Los Angeles underserved communities of
      color. CPIC compares two ways of supporting diverse health and social programs in
      under-resourced communities to improve their services to depressed clients. One approach is
      time-limited expert technical assistance coupled with culturally-competent community outreach
      to individual programs, on how to use quality improvement toolkits for depression that have
      already been proven to be effective or helpful in primary care settings, but adapted for this
      study for use in diverse community-based programs in underserved communities. The other
      approach brings different types of agencies and members in a community together in a 4 to
      6-month planning process, to fit the same depression quality improvement programs to the
      needs and strengths of the community and to develop a network of programs serving the
      community to support clients with depression together. The study is designed to determine the
      added value of community engagement and planning over and above what might be offered through
      a community-oriented, disease management company. Both intervention models are based on the
      same quality improvement toolkits that support team leadership, care management, Cognitive
      Behavioral Therapy, medication management, and patient education and activation.
      Investigators hypothesized that the community engagement approach would increase agency and
      clinician participation in evidence-based trainings and improve client mental health-related
      quality of life. In addition, during the design phase, community participants prioritized
      adding as outcomes indicators of social determinants of mental health, including physical
      functioning, risk factors for homelessness and employment. Investigators hypothesized by
      activating community agencies that can address health and social services needs to engage
      depressed clients, these outcomes would also be improved more in the collaboration condition.
      Investigators also hypothesized that the collaboration approach would increase use of
      services.
Underserved communities of color in low income, largely ethnic-minority neighborhoods face an
      excessive burden of illness from depression due to higher prevalence of depression and lower
      access to quality care. Evidence-based quality improvement (QI) programs for depression in
      primary care settings-where many low-income and minority patients receive their only mental
      health care-can enhance quality of depression care and improve health outcomes. These
      programs are under-utilized in community-based health care settings, and have not been
      adapted for use across diverse agencies (social service, faith based, primary and specialty
      care) that could partner to support disease management for depression. Partners in Care
      (PIC)and WE Care are interventions designed to improve access to evidence-based depression
      treatments (medication management or psychotherapy) for primary care patients and, in WE
      Care, social service clients. PIC evaluated a services delivery intervention while WE Care
      was an effectiveness trial with study-provided treatments. Both studies promoted use of the
      same evidence-based treatments. Both PIC and WE Care programs improved use of evidence-based
      treatments for depression and health outcomes for African Americans and Latinos. The PIC
      interventions reduced health outcome disparities evident in usual care in the first follow-up
      year and at five-year follow-up. While these findings offer hope to underserved communities,
      such communities have poor resources to support implementation of these programs, and may
      have historical distrust in research and health care settings. There is no evidence-based
      approach to support agency networks in underserved communities in implementing QI programs
      for depression. To address this information gap, investigators created Community Partners in
      Care (CPIC), a group-level randomized, controlled trial, with randomization at the level of
      an agency site or "unit." The trial is being fielded in two underserved communities,
      Hollywood and South Los Angeles, and conducted through a community- participatory, partnered
      research (CPPR) approach.

      The specific aims of the study are:

        1. To engage two underserved communities in improving safety-net care for depression.

        2. To examine the effects of a community-engagement approach to implementing evidence-based
           depression quality improvement toolkits (PIC/WE Care) through a community collaborative
           network across services sectors, compared to technical assistance to individual programs
           from the same services sectors coupled with culturally-competent outreach to implement
           the same toolkits. The outcomes are: a) client access to care, quality of care and
           health outcomes, with the primary outcome being mental-health related quality of life
           and additional outcomes reflecting social determinants of mental health of interest to
           the community (physical health, homelessness risk factors, employment); b) services
           utilization and costs; c) agency adoption of PIC/WE Care; d) and provider attitudes,
           knowledge and practice.

        3. To describe the process of implementation of the community engagement intervention.

      CPIC was awarded funds from the Patient Centered Outcomes Research Institute (PCORI) in 2013
      to accomplish the following 3 aims:

        1. To compare the long-term (3-year) effectiveness of community engagement and planning
           versus agency technical assistance to implement depression QI and improve depressed
           clients' health status and risk for homelessness

        2. To determine how depressed clients in under-resourced communities prioritize diverse
           health and social outcomes and identify their preferences for services to address
           priority outcomes

        3. To identify capacities of providers to respond to depressed clients' priorities and to
           generate recommendations for building capacity to better address clients'priorities.

      We hypothesize that community engagement and planning will be more effective than technical
      assistance in improving 3-year outcomes and that clients will prioritize quality of life. We
      expect to find gaps in provider capacities to address client priorities that network
      strategies could address.

      Our primary outcome for the long-term follow-up is mental health related quality of life and
      secondary outcomes are use of healthcare and community services for depression and physical
      functioning and homeless risk factors.

      In 2014, CPIC was awarded funds from the National Institute on Minority Health and Health
      Disparities (NIMHD) to use existing quantitative CPIC data and collect new qualitative data
      to describe pathways to reducing disparities. The funding allows us to longitudinally track
      the implementation of the CEP model in a new county-wide initiative to develop community
      networks to promote healthy neighborhoods. The aims under this additional funding are:

        1. To determine pathways to reducing mental health and social disparities by conducting
           community-academic partnered analyses of CPIC data by 1) examining intervention effects
           for disparity subgroups (African Americans, Latinos, gender groups, insurance and
           housing status groups); 2) identifying predictors and mediators of barriers to
           access/services and client outcomes; 3) analyzing intervention effects on provider
           workforce diversity; and 4) generating explanatory models for intervention effects and
           their sustainability by interviewing CPIC administrators and providers, as well as prior
           and current clients.

        2. To explore the generalizability and replicability of the CPIC partnered model and, more
           broadly, to inform the process of incorporating science into policy by conducting a
           longitudinal case study of the CEP model implementation in a county-wide "neighborhood
           health" initiative in Los Angeles to reduce mental health and social disparities.

      As a result of this study, we will be able to explain how community-engaged and participatory
      models of intervention implementation can reduce health and social disparities and ultimately
      achieve public health impact. Study findings will be disseminated widely using traditional
      academic, community-valued, and policy-relevant dissemination channels.
allocation: Randomized
intervention model: Parallel Assignment
primary purpose: Health Services Research
masking: Single (Outcomes Assessor)
measure: Percent of Participants With Poor Mental Health Quality of Life, MCS12≤ 40
time frame: 6 months follow-up
description: From the Short Form, 12-item quality of life measure, mental health-related quality of life is the primary client outcome. Poor mental health related quality of life is defined as MCS12≤ 40 (one standard deviation below population mean).
measure: Percent of Participants With PHQ-9 Score ≥ 10
time frame: 6 months follow-up
description: Patient Health Questionnaire 9-item version (PHQ-9) at least mild depression (score ≥ 10)
measure: Percent of Participants With Poor Mental Health Quality of Life, MCS12≤ 40
time frame: 12 months follow-up
description: From the Short Form, 12-item quality of life measure, mental health-related quality of life is the primary client outcome. Poor mental health related quality of life is defined as MCS12≤ 40 (one standard deviation below population mean).
measure: Percent of Participants With Poor Mental Health Quality of Life, MCS12≤ 40
time frame: 36 months follow-up
description: From the Short Form, 12-item quality of life measure, mental health-related quality of life is the primary client outcome. Poor mental health related quality of life is defined as MCS12≤ 40 (one standard deviation below population mean).
measure: Percent of Participants With PHQ-8 Score ≥ 10
time frame: 36 months follow-up
description: Patient Health Questionnaire 8-item version (PHQ-8) at least mild depression (score ≥ 10)
measure: Percent of Participants With Mental Wellness
time frame: 6 months follow-up
description: Mental wellness is defined as at least a good bit of time in the prior 4 weeks on any of three items: feeling peaceful or calm, being a happy person, having energy
measure: Percent of Participants Reported Organized Life
time frame: 6 months follow-up
description: A response of somewhat or definitely true to "my life is organized" versus unsure or somewhat false or definitely false
measure: Percent of Participants With Physically Active
time frame: 6 months follow-up
description: Physically Active is defined as at least active to "How physically active you are?"
measure: Percent of Participants With Homeless or ≥ 2 Risk Factors for Homelessness
time frame: 6 months follow-up
description: Defined as current homelessness or living in a shelter or having at least 2 risk factors (e.g., no place to stay for at least 2 nights or eviction from a primary residence, financial crisis, or food insecurity in the past 6 months)
measure: Percent of Participants With Working for Pay
time frame: 6 months follow-up
measure: Percent of Participants With Any Missed Work Day in Last 30 Days, if Working
time frame: 6 months follow-up
measure: Percent of Participants With Hospitalization for Behavioral Health in the Past 6 Months
time frame: 6 months follow-up
description: self-reported services use in the past 6 months for overnight hospital stays for mental health or substance abuse
measure: Percent of Participants With >=4 Hospital Nights for Behavioral Health in the Past 6 Months
time frame: 6 months follow-up
description: self-reported services use in the past 6 months with >=4 overnight hospital stays for any emotional, mental, alcohol, or drug problem, median cut point for baseline variable
measure: Percent of Participants With >=2 Emergency Room Visits in the Past 6 Months
time frame: 6 months follow-up
description: self-reported services use in the past 6 months with >=2 emergency room visits in past 6 months, median cut point for baseline variable
measure: Percent of Participants With Any MHS Outpatient Visit in the Past 6 Months
time frame: 6 months follow-up
description: self-reported mental health outpatient visit from mental health provider, including psychiatrists, psychologists, social workers, psychiatric nurses, or counselors in the past 6 months
measure: Percent of Participants With Any PCP Visit With Depression Service in the Past 6 Months
time frame: 6 months follow-up
description: self-reported services use in the past 6 months with any primary care visit for depression
measure: Percent of Participants With >= 2 PCP Visits With Depression Services, if Any
time frame: 6 months follow-up
measure: Percent of Participants With Faith-based Program Participation in the Past 6 Months
time frame: 6 months follow-up
description: Went to any religious or spiritual places such as a church, mosque, temple, or synagogue in the past 6 months
measure: Percent of Participants With Any Use of Park and Recreation or Community Centers in the Past 6 Months
time frame: 6 months follow-up
measure: Percent of Participants With Use of an Antidepressant Medication for 2 Months or More in the Past 6 Months
time frame: 6 months follow-up
measure: Medication Visits Among MHS Users in the Past 6 Months
time frame: 6 months follow-up
measure: Faith-based Visits With Depression Service if Faith Participation in the Past 6 Months
time frame: 6 months follow-up
description: For this sector, depression/mental health service is defined by client report of having assessment, counseling, education, medication discussion or referral for depression or emotional or mental health problems.
measure: Park or Community Center Visits With Depression Service if Went to Park or Community Center in Past 6 Months
time frame: 6 months follow-up
description: For this sector, depression/mental health service is defined by client report of having assessment, counseling, education, medication discussion or referral for depression or emotional or mental health problems.
measure: Total Mental Health Related Outpatient Visits in the Past 6 Months
time frame: 6 months follow-up
description: Total outpatient visits for depression, mental health or substance abuse from emergency rooms, primary care or public health, mental health, substance abuse, or social-community services sectors in the past 6 months
measure: Percent of Participants With Hospitalization for Behavioral Health in the Past 6 Months
time frame: 12 months follow-up
description: self-reported services use in the past 6 months for overnight hospital stays for mental health or substance abuse
measure: Percent of Participants With Any MHS Outpatient Visit in the Past 6 Months
time frame: 12 months follow-up
description: self-reported mental health outpatient visit from mental health provider, including psychiatrists, psychologists, social workers, psychiatric nurses, or counselors in the past 6 months
measure: Percent of Participants With Any PCP Visit With Depression Service in the Past 6 Months
time frame: 12 months follow-up
description: self-reported services use in the past 6 months with any primary care visit for depression
measure: Percent of Participants With Faith-based Program Participation in the Past 6 Months
time frame: 12 months follow-up
description: Went to any religious or spiritual places such as a church, mosque, temple, or synagogue in the past 6 months
measure: Percent of Participants With Any Use of Park and Recreation or Community Centers in the Past 6 Months
time frame: 12 months follow-up
measure: Percent of Participants With Use of an Antidepressant Medication for 2 Months or More in the Past 6 Months
time frame: 12 months follow-up
measure: Total Mental Health Related Outpatient Visits in the Past 6 Months
time frame: 12 months follow-up
description: Total outpatient visits for depression, mental health or substance abuse from emergency rooms, primary care or public health, mental health, substance abuse, or social-community services sectors in the past 6 months
measure: PCS-12 Scores on 12-Item Physical Health Summary Measure, Comparison Between CEP and RS Groups
time frame: 36 months follow-up
description: 12-item physical composite score (PCS-12). Possible scores on range from 0 to 100, with higher scores indicating better physical health
measure: Nights Hospitalized for Behavioral Health Reason in the Past 6 Months
time frame: 36 months follow-up
description: self-reported number of overnight hospital stays for any emotional, mental, alcohol, or drug problem in past 6 months
measure: N of Emergency Room or Urgent Care Visits in the Past 6 Months
time frame: 36 months follow-up
measure: N of Visits to Primary Care in Past 6 Months
time frame: 36 months follow-up
measure: N of Outpatient Visits to Primary Care for Depression Services in the Past 6 Months
time frame: 36 months follow-up
measure: N of Outpatient Mental Health Visits in Past 6 Months
time frame: 36 months follow-up
measure: N of Outpatient Visits to a Substance Abuse Treatment Agency or Self Help Group in the Past 6 Months
time frame: 36 months follow-up
measure: N of Social Services for Depression Visits in the Past 6 Months
time frame: 36 months follow-up
measure: Number of Calls to Hotline for Substance Use or Mental Health Problem in the Past 6 Months
time frame: 36 months follow-up
measure: N of Days on Which a Self-help Visit for Mental Health Was Made in the Past 6 Months
time frame: 36 months follow-up
measure: Percent of Participants With Any Faith-based Services for Depression in the Past 6 Months
time frame: 36 months follow-up
measure: Percent of Participants With Use of Any Antidepressant in the Past 6 Months
time frame: 36 months follow-up
measure: Percent of Participants With Use of Any Mood Stabilizer in the Past 6 Months
time frame: 36 months follow-up
measure: Percent of Participants With Use of Any Antipsychotic in the Past 6 Months
time frame: 36 months follow-up
measure: Percent of Participants With Any Visit in Health Care Sector in the Past 6 Months
time frame: 36 months follow-up
measure: Percent of Participants With Any Community-sector Visit for Depression in the Past 6 Months
time frame: 36 months follow-up
measure: Percent of Participants With Any Depression Treatment in the Past 6 Months
time frame: 36 months follow-up
description: Antidepressant use for at least two months or at least four outpatient visits to mental health or primary care setting for depression services
measure: Survival Analysis for Time to the First Clinical Remission
time frame: from baseline to 3 years
description: clinical remission: Patient Health Questionnaire, PHQ-8 score <10. Cox Proportional Hazard model was used to examine the impact of the intervention on speed of clinical remission over the 3 years follow-up period, defined as the first assessment with clinical remission (PHQ-8<10).
measure: Survival Analysis for Time to the First Community-Defined Remission
time frame: from baseline to 3 years
description: Community-Defined Remission: PHQ-8<10 or MCS-12>40 or any mental wellness. Cox Proportional Hazard model was used to examine the impact of the intervention on speed of community-defined remission over the 3 years follow-up period, defined as the first assessment with community-defined (PHQ-8<10 or MCS-12>40 or any mental wellness)
measure: Percent of Participants With Clinical Remission
time frame: 4 years follow-up
description: Clinical remission defined as Patient Health Questionnaire-2 (PHQ-2) score < 3.
measure: Percent of Participants With Community-Defined Remission
time frame: 4 years follow-up
description: Community-Defined Remission defined as PHQ-2<3, MCS-12>40, or mental wellness
arm group label: Resources for Services
arm group type: Active Comparator
description: The Resources for Services condition offers time-limited technical assistance to individual agencies, coupled with outreach from a community engagement specialty, to participate in structured reviews of components of the Quality Improvement Program Intervention as implemented by the Resources for Services Expert Team.
arm group label: Community Engagement and Planning
arm group type: Experimental
description: The Community Engagement and Planning arm supported 4 months of planning for the Community Engagement and Planning Council consisting representatives of all assigned programs in biweekly 2 hour meetings to fit trainings in the Quality Improvement Program to the community and develop strategies across programs to collaborate as a network. The CEP Council developed a written plan for training and monitoring and supported implementation of the training plan. CEP sites were provided with enrolled client lists.
intervention type: Other
intervention name: Quality Improvement Program
description: The quality improvement program is an evidence-based toolkit from prior studies (see Names above) that supported team leadership, case and care management, medication management, and Cognitive Behavioral Therapy for Depression. The Case management manual supported depression screening and monitoring/tracking of outcomes; patient education and activation, care coordination, and behavioral activation and problem solving. The toolkit includes education on depression and a community health worker manual.
arm group label: Community Engagement and Planning
arm group label: Resources for Services
other name: Partners in Care
other name: We Care
other name: IMPACT
other name: Mental Health Infrastructure and Training Project
intervention type: Behavioral
intervention name: Resources for Services Expert Team
description: The expert team consisted for RS consisted of 3 psychiatrists, a psychologist expert in Cognitive Behavioral Therapy, a nurse care manager, a community engagement specialist, a quality improvement expert, and staff support. They team offered 12 web-based seminars to each community on components of collaborative care as well as site visits to primary care clinics on clinical assessment and medication management.
arm group label: Resources for Services
other name: Quality Improvement Team
intervention type: Behavioral
intervention name: Community Engagement and Planning Council
description: The CEP Council was supported by a workbook developed by the overall CPIC Council that provided principles, approach, agendas, and resources for the multi-sector planning meetings. The CEP Councils met twice a month for 4-6 months to develop their plan and met monthly during implementation of trainings. The study Council supported CEP meetings. Community leaders co-led trainings with study experts to help assure sustainability. Each CEP council had $15K to defray costs of venues, materials, and consultations, while the study provided that for RS.
arm group label: Community Engagement and Planning
other name: Quality Improvement Team
criteria: 
gender: All
minimum age: 18 Years
maximum age: N/A
healthy volunteers: No
last name: Kenneth B Wells, M.D., M.P.H
role: Principal Investigator
affiliation: RAND Corporation, UCLA Semel Institute
last name: Bowen Chung, MD, MSHS
role: Principal Investigator
affiliation: Harbor-UCLA Medical Center, UCLA Semel Institute
last name: Jeanne Miranda, PhD
role: Principal Investigator
affiliation: UCLA Semel Institute
facility: 
country: United States
url: http://www.communitypartnersincare.org
description: Click here for more information about this study: Community Partners in Care
citation: Chung B, Jones L, Dixon EL, Miranda J, Wells K; Community Partners in Care Steering Council. Using a community partnered participatory research approach to implement a randomized controlled trial: planning community partners in care. J Health Care Poor Underserved. 2010 Aug;21(3):780-95. doi: 10.1353/hpu.0.0345.
PMID: 20693725
citation: Khodyakov D, Mendel P, Dixon E, Jones A, Masongsong Z, Wells K. Community Partners in Care: Leveraging Community Diversity to Improve Depression Care for Underserved Populations. Int J Divers Organ Communities Nations. 2009;9(2):167-182.
PMID: 21528111
citation: Dixon EL, Flaskerud JH. Community tailored responses to depression care. Issues Ment Health Nurs. 2010 Sep;31(9):611-3. doi: 10.3109/01612841003675303. No abstract available.
PMID: 20701424
citation: Mango J, Cabiling E, Jones L, Lucas-Wright A, Williams P, Wells K, Pulido E, Meldrum M, Ramos A, Chung B. Community Partners in Care (CPIC): Video Summary of Rationale, Study Approach / Implementation, and Client 6-month Outcomes. CES4healthinfo. 2014 Feb 25;2014:87LWR5H2.
PMID: 25364622
citation: Khodyakov D, Pulido E, Ramos A, Dixon E. Community-partnered research conference model: the experience of Community Partners in Care study. Prog Community Health Partnersh. 2014 Spring;8(1):83-97. doi: 10.1353/cpr.2014.0008.
PMID: 24859106
citation: Mendel P, Ngo VK, Dixon E, Stockdale S, Jones F, Chung B, Jones A, Masongsong Z, Khodyakov D. Partnered evaluation of a community engagement intervention: use of a kickoff conference in a randomized trial for depression care improvement in underserved communities. Ethn Dis. 2011 Summer;21(3 Suppl 1):S1-78-88.
PMID: 22352084
citation: Belin TR, Jones A, Tang L, Chung B, Stockdale SE, Jones F, Wright A, Sherbourne CD, Perlman J, Pulido E, Ong MK, Gilmore J, Miranda J, Dixon E, Jones L, Wells KB. Maintaining Internal Validity in Community Partnered Participatory Research: Experience from the Community Partners in Care Study. Ethn Dis. 2018 Sep 6;28(Suppl 2):357-364. doi: 10.18865/ed.28.S2.357. eCollection 2018.
PMID: 30202188
citation: Mendel P, O'Hora J, Zhang L, Stockdale S, Dixon EL, Gilmore J, Jones F, Jones A, Williams P, Sharif MZ, Masongsong Z, Kadkhoda F, Pulido E, Chung B, Wells KB. Engaging Community Networks to Improve Depression Services: A Cluster-Randomized Trial of a Community Engagement and Planning Intervention. Community Ment Health J. 2021 Apr;57(3):457-469. doi: 10.1007/s10597-020-00632-5. Epub 2020 May 19.
PMID: 32430557
citation: Goodsmith N, Zhang L, Ong MK, Ngo VK, Miranda J, Hirsch S, Jones F, Wells K, Chung B. Implementation of a Community-Partnered Research Suicide-Risk Management Protocol: Case Study From Community Partners in Care. Psychiatr Serv. 2021 Mar 1;72(3):281-287. doi: 10.1176/appi.ps.202000095. Epub 2021 Jan 27.
PMID: 33502218
citation: Wells KB, Jones L, Chung B, Dixon EL, Tang L, Gilmore J, Sherbourne C, Ngo VK, Ong MK, Stockdale S, Ramos E, Belin TR, Miranda J. Community-partnered cluster-randomized comparative effectiveness trial of community engagement and planning or resources for services to address depression disparities. J Gen Intern Med. 2013 Oct;28(10):1268-78. doi: 10.1007/s11606-013-2484-3. Epub 2013 May 7. Erratum In: J Gen Intern Med. 2013 Nov;28(11):1534.
PMID: 23649787
citation: Miranda J, Ong MK, Jones L, Chung B, Dixon EL, Tang L, Gilmore J, Sherbourne C, Ngo VK, Stockdale S, Ramos E, Belin TR, Wells KB. Community-partnered evaluation of depression services for clients of community-based agencies in under-resourced communities in Los Angeles. J Gen Intern Med. 2013 Oct;28(10):1279-87. doi: 10.1007/s11606-013-2480-7. Epub 2013 May 14.
PMID: 23670566
citation: Chung B, Ong M, Ettner SL, Jones F, Gilmore J, McCreary M, Sherbourne C, Ngo V, Koegel P, Tang L, Dixon E, Miranda J, Belin TR, Wells KB. 12-month outcomes of community engagement versus technical assistance to implement depression collaborative care: a partnered, cluster, randomized, comparative effectiveness trial. Ann Intern Med. 2014 Nov 18;161(10 Suppl):S23-34. doi: 10.7326/M13-3011.
PMID: 25402400
citation: Chang ET, Wells KB, Gilmore J, Tang L, Morgan AU, Sanders S, Chung B. Comorbid depression and substance abuse among safety-net clients in Los Angeles: a community participatory study. Psychiatr Serv. 2015 Mar 1;66(3):285-94. doi: 10.1176/appi.ps.201300318. Epub 2014 Dec 1.
PMID: 25727117
citation: Chung B, Ngo VK, Ong MK, Pulido E, Jones F, Gilmore J, Stoker-Mtume N, Johnson M, Tang L, Wells KB, Sherbourne C, Miranda J. Participation in Training for Depression Care Quality Improvement: A Randomized Trial of Community Engagement or Technical Support. Psychiatr Serv. 2015 Aug 1;66(8):831-9. doi: 10.1176/appi.ps.201400099. Epub 2015 May 1.
PMID: 25930037
citation: Ngo VK, Sherbourne C, Chung B, Tang L, Wright AL, Whittington Y, Wells K, Miranda J. Community Engagement Compared With Technical Assistance to Disseminate Depression Care Among Low-Income, Minority Women: A Randomized Controlled Effectiveness Study. Am J Public Health. 2016 Oct;106(10):1833-41. doi: 10.2105/AJPH.2016.303304. Epub 2016 Aug 23.
PMID: 27552274
citation: Landry CM, Jackson AP, Tang L, Miranda J, Chung B, Jones F, Ong MK, Wells K. The Effects of Collaborative Care Training on Case Managers' Perceived Depression-Related Services Delivery. Psychiatr Serv. 2017 Feb 1;68(2):123-130. doi: 10.1176/appi.ps.201500550. Epub 2016 Sep 15.
PMID: 27629796
citation: Ong MK, Jones L, Aoki W, Belin TR, Bromley E, Chung B, Dixon E, Johnson MD, Jones F, Koegel P, Khodyakov D, Landry CM, Lizaola E, Mtume N, Ngo VK, Perlman J, Pulido E, Sauer V, Sherbourne CD, Tang L, Vidaurri E, Whittington Y, Williams P, Lucas-Wright A, Zhang L, Southard M, Miranda J, Wells K. A Community-Partnered, Participatory, Cluster-Randomized Study of Depression Care Quality Improvement: Three-Year Outcomes. Psychiatr Serv. 2017 Dec 1;68(12):1262-1270. doi: 10.1176/appi.ps.201600488. Epub 2017 Jul 17.
PMID: 28712349
citation: Mehta P, Brown A, Chung B, Jones F, Tang L, Gilmore J, Miranda J, Wells K. Community Partners in Care: 6-Month Outcomes of Two Quality Improvement Depression Care Interventions in Male Participants. Ethn Dis. 2017 Jul 20;27(3):223-232. doi: 10.18865/ed.27.3.223. eCollection 2017 Summer.
PMID: 28811733
citation: Castillo EG, Shaner R, Tang L, Chung B, Jones F, Whittington Y, Miranda J, Wells KB. Improving Depression Care for Adults With Serious Mental Illness in Underresourced Areas: Community Coalitions Versus Technical Support. Psychiatr Serv. 2018 Feb 1;69(2):195-203. doi: 10.1176/appi.ps.201600514. Epub 2017 Oct 16.
PMID: 29032700
citation: Sherbourne CD, Aoki W, Belin TR, Bromley E, Chung B, Dixon E, Gilmore JM, Johnson MD, Jones F, Koegel P, Khodyakov D, Landry CM, Lizaola E, Mtume N, Ngo VK, Ong MK, Perlman J, Pulido E, Sauer V, Tang L, Whittington Y, Vidaurri E, Williams P, Lucas-Wright A, Zhang L, Miranda J, Jones L, Wells K. Comparative Effectiveness of Two Models of Depression Services Quality Improvement in Health and Community Sectors. Psychiatr Serv. 2017 Dec 1;68(12):1315-1320. doi: 10.1176/appi.ps.201700170. Epub 2017 Nov 1.
PMID: 29089009
citation: Springgate B, Tang L, Ong M, Aoki W, Chung B, Dixon E, Johnson MD, Jones F, Landry C, Lizaola E, Mtume N, Ngo VK, Pulido E, Sherbourne C, Wright AL, Whittington Y, Williams P, Zhang L, Miranda J, Belin T, Gilmore J, Jones L, Wells KB. Comparative Effectiveness of Coalitions Versus Technical Assistance for Depression Quality Improvement in Persons with Multiple Chronic Conditions. Ethn Dis. 2018 Sep 6;28(Suppl 2):325-338. doi: 10.18865/ed.28.S2.325. eCollection 2018.
PMID: 30202185
citation: Choi KR, Sherbourne C, Tang L, Castillo E, Dixon E, Jones A, Chung B, Eisen C, Wells K. A Comparative Effectiveness Trial of Depression Collaborative Care: Subanalysis of Comorbid Anxiety. West J Nurs Res. 2019 Jul;41(7):1009-1031. doi: 10.1177/0193945918800333. Epub 2018 Sep 18.
PMID: 30226112
citation: Chung B, Ong M, Ettner SL, Jones F, Gilmore J, McCreary M, Ngo VK, Sherbourne C, Tang L, Dixon E, Koegel P, Miranda J, Wells KB. 12-Month Cost Outcomes of Community Engagement Versus Technical Assistance for Depression Quality Improvement: A Partnered, Cluster Randomized, Comparative-Effectiveness Trial. Ethn Dis. 2018 Sep 6;28(Suppl 2):349-356. doi: 10.18865/ed.28.S2.349. eCollection 2018.
PMID: 30202187
citation: Arevian AC, Jones F, Tang L, Sherbourne CD, Jones L, Miranda J; Community Partners in Care Writing Group. Depression Remission From Community Coalitions Versus Individual Program Support for Services: Findings From Community Partners in Care, Los Angeles, California, 2010-2016. Am J Public Health. 2019 Jun;109(S3):S205-S213. doi: 10.2105/AJPH.2019.305082.
PMID: 31242001
citation: Barcelo NE, Lopez A, Tang L, Aguilera Nunez MG, Jones F, Miranda J, Chung B, Arevian A, Bonds C, Izquierdo A, Dixon E, Wells K. Community Engagement and Planning versus Resources for Services for Implementing Depression Quality Improvement: Exploratory Analysis for Black and Latino Adults. Ethn Dis. 2019 Apr 18;29(2):277-286. doi: 10.18865/ed.29.2.277. eCollection 2019 Spring.
PMID: 31057313
citation: Morton I, Hurley B, Castillo EG, Tang L, Gilmore J, Jones F, Watkins K, Chung B, Wells K. Outcomes of two quality improvement implementation interventions for depression services in adults with substance use problems. Am J Drug Alcohol Abuse. 2020;46(2):251-261. doi: 10.1080/00952990.2019.1708085. Epub 2020 Jan 14.
PMID: 31935133
responsible party type: Sponsor
mesh term: Depression
provided document: 
participant flow: 
baseline: 
outcome list: 
reported events: 
certain agreements: 
limitations and caveats: Communities had history of using CPPR for depression. Response rates moderate for agencies, high for programs. Convenience samples of sites. Client retention rates lower than other QI studies. Outcomes rely on client self-report at 6-month follow-up.
point of contact: 