H3: Healthy Minds, Healthy Children, Healthy Chicago Project Evaluation (H3)

The goal of this project is to develop and pilot test a community-based integrated care model to improve the prevention, early detection and treatment of child mental health problems that is replicable, effective, and sustainable. Project procedures include child mental health screening, on-site brief mental health interventions, referral to specialty mental health, use of co-located child psychiatrist, detection of need for primary care in specialty mental health program. Subjects will be enrolled for 1 year, with interviews at baseline and 3, 6 and 12 months.

Dr. Bonnie Zima at UCLA has been contracted by the project funder to design and implement the evaluation of the project, which includes developing data collection procedures, training staff on implementation of data collection workflow, coordinating with sites to ensure evaluation design and IRB protocols are followed, and coordinating with both study sites to verify data reliability.

Some potential anticipated risks include being uncomfortable answering questions associated with the measures used in the study, and although unlikely, someone may access participant information that is confidential. Some benefits include helping to find ways to improve how to deliver mental health care for children served in publicly-funded primary care and mental health clinics.

Study Overview

• Status: Completed
• Conditions: Mental Health Disorder; Developmental Delay
• Intervention / Treatment: Behavioral: H3 Services

Detailed Description

UCLA is in charge of the evaluation of the H3 project, including evaluation design and overseeing data collection by project sites. UCLA will receive data collected by each site and perform the analysis of the data for the sites to be shared with the Illinois Children's Healthcare Foundation and clinic sites. This study will evaluate an existing intervention, meaning that participation in the evaluation is not required in order to receive H3 services.

The information below is included in the evaluation design document attached in 10.1, 1.0:

The overarching goal of the Healthy Minds, Healthy Children, Healthy Chicago Initiative (H3) is to develop a community-based integrated care model to improve the prevention, early detection and treatment of child mental health problems that is replicable, effective, and sustainable.

The final study design is a longitudinal cohort study of 400 children ages 0-17 years and their families served at the two intervention clinic sites (n=200/site) The study time points are baseline, 3-, 6-, and 12-months.

The data sources are parent and youth report, and clinic administrative data when feasible for the programs to transfer these data following IRB-approved procedures. The unit of analysis is the child. The main proximal (or short term) clinical outcomes are related to the H3 intervention care processes (e.g., brief mental health interventions, referral to specialty mental health care, co-located child psychiatrist). The time period will likely vary by child depending on clinical need, but it is anticipated that most of these care processes will be provided during the early phase when the child and parent is introduced to the new care model. The main distal outcomes (or more long-term) are clinical improvement (e.g., child symptom reduction, improved functioning) and some correspond to the care process delivered (e.g., if parent receives parent training, improvement parenting skills are assessed). The time points for tracking clinical improvement are 3, 6 and 12 months after the baseline interview that is done when the parent and child are enrolled in the evaluation. The independent variables (or factors that may influence care processes and clinical outcomes) are child sociodemographic characteristics (e.g. age, sex, race/ethnicity), psychosocial complexity, and primary caregiver characteristics that the clinic team or Community Advisory Board deemed relevant (e.g., parenting stress, probable depression). Embedded within the description of a child's psychosocial complexity are indicators of social determinants (e.g. exposure to trauma) that may adversely impact a child's development and well-being.

Findings from this evaluation will provide data on the acceptability and feasibility of the H3 care models, as well as early indicators of whether these care models are promising.

• Study Type: Interventional
• Enrollment (Actual): 277
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Illinois
    • Chicago, Illinois, United States, 60621
      • Miles Square Health Center, Englewood
    • Chicago, Illinois, United States, 60622
      • Erie Family Health Center, West Town

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: No older than 16 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• between the ages of 0.0-16.99 years
• speaks Spanish or English
• screens positive for a developmental delay or mental health problem
• referral to the H3 care program by a pediatrician based on clinical judgment
• no prior history of receiving any H3 services in the past year

Exclusion Criteria (based on the child's characteristics):

• 17 years old (to avoid reconsent at 12 month follow-up)
• has previously had H3 services in the past year
• can not speak English or Spanish

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm

Intervention / Treatment

Experimental: H3 Parent/Child Dyads; A child is eligible for the H3 partnered evaluation if he or she is: 1) between the ages of 0.0-16.99 years; 2) speaks Spanish or English; 3) screens positive for a developmental delay or mental health problem. For children in the intervention groups, the additional eligibility criteria are: 1) referral to the H3 care program by a pediatrician based on clinical judgment; and 2) no prior history of receiving any H3 services in the past year.

Behavioral: H3 Services; A community-based integrated care model to improve the prevention, early detection and treatment of child mental health problems

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
H3 intervention care processes	tracking administration (yes/no) of "brief mental health interventions", "referral to specialty mental health care", "use of co-located child psychiatrist", "detected need for primary care"	12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Mental health functioning	PHQ9	Baseline, 3, 6 and 12 months
Child development	Pediatric Symptom Checklist	12 monthsBaseline, 3, 6 and 12 months
Child functioning	Columbia Impairment Scale	Baseline, 3, 6 and 12 months
Response to trauma and resilience	Traumatic Events Screening Inventory	Baseline, 3, 6 and 12 months
Care process delivered	Questionnaire administered at baseline, 3, 6, and 12 months asking parent and child about any care processes that he/she received.	Baseline, 3, 6 and 12 months

Collaborators and Investigators

• Sponsor: University of California, Los Angeles
• Collaborators: University of Illinois at Chicago
• Investigators: Principal Investigator: Bonnie Zima, MD, MPH, University of California, Los Angeles

Publications and helpful links

General Publications

• McCreary M, Arevian AC, Brady M, Mosqueda Chichits AE, Zhang L, Tang L, Zima B. A Clinical Care Monitoring and Data Collection Tool (H3 Tracker) to Assess Uptake and Engagement in Mental Health Care Services in a Community-Based Pediatric Integrated Care Model: Longitudinal Cohort Study. JMIR Ment Health. 2019 Apr 23;6(4):e12358. doi: 10.2196/12358.

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2016
• Primary Completion (Actual): August 1, 2018
• Study Completion (Actual): March 31, 2019

Study Registration Dates

• First Submitted: January 25, 2016
• First Submitted That Met QC Criteria: March 2, 2016
• First Posted (Estimate): March 4, 2016

Study Record Updates

• Last Update Posted (Actual): September 30, 2019
• Last Update Submitted That Met QC Criteria: September 26, 2019
• Last Verified: September 1, 2019

More Information

Terms related to this study

• Keywords: Depression; Anxiety; Children
• Additional Relevant MeSH Terms: Mental Disorders
• Other Study ID Numbers: IRB#15-000757