To lower barriers to accessing mental health care and fill gaps in the mental health care workforce, regional governments and coalitions have been exploring new strategies to address mental health care delivery. The Connections to Care (C2C) Collaborative with the Mayor’s Fund for the Advancement of NYC borrowed a concept of delivering care under constrained resources from global health initiatives called “task-shifting” and applied it to low-income communities in NYC. Using the task-shifting concept, C2C built an innovative model that delivers mental health screening and evidence-based treatments by pairing mental health providers (MHPs) with lay (non-specialist) staff at community-based organizations (CBOs) that already serve low-income and at-risk populations.
Study Goals:
This report describes the C2C model and RAND Corporation’s evaluation, detailing:
- How it was implemented
- Whether it had the intended effect on mental health treatment, symptoms, and related outcomes
- How much it costs CBOs
Research Questions:
There were two primary research questions, as well as additional questions broken down into three categories:
- How were CBOs and MHPs provided training, coaching, and supervision to support staff in implementing C2C?
- How were C2C services provided to clients?
Implementation:
- How were the C2C program strategies implemented?
- To what extent have the CBOs identified clients with mental health or substance use issues as a result of C2C implementation?
- Does the CBO staff have improved knowledge of mental health and C2C modalities, attitudes, and behaviors about mental health issues and services?
- What are the key facilitators of and barriers to effective implementation of C2C program strategies within and across CBO and MHP partnerships?
Impact:
- Relative to comparison group participants, do C2C participants:
- have greater reductions in barriers to mental health care and greater increases in utilization of mental health services?
- show greater positive improvement in depression, generalized anxiety, PTSD, alcohol use, substance use, and general psychological distress?
- show improved outcomes in the domains of employment, housing, education, and incarceration?
Cost: What are the costs to CBOs associated with implementation of the C2C program, overall and average per program client?
Findings:
The evaluation found the following:
- Reaching full implementation of a complex task-shifting model requires significant investment of time and resources—but is feasible.
- Although C2C was well received by staff and providers, barriers such as stigma and access challenges were hard to overcome.
- C2C positively affected some populations and settings but not others.
For more information, download the full report and brief.
Full report
Further information
Program/Intervention
Connections to Care
Implementing Organization
Connections to Care
Intermediary(s)
Mayor's Fund to Advance New York City
AmeriCorps Program(s)
Social Innovation Fund
Age(s) Studied
13-17 (Adolescent)
18-25 (Young adult)
26-55 (Adult)
55+ (Older adult)
Focus Population(s)/Community(s)
Opportunity Youth
Non-profits
Veterans and Military Families
Urban
Low Income
Outcome Category
Employment
Access to care
Nonprofit development
Study Type(s)
Cost-Benefit or Cost Effectiveness Study
Impact
Implementation
Study Design(s)
Quasi-Experimental (QED)
Level of Evidence
Preliminary
Researcher/Evaluator
RAND Health Care
Published Year
2020
Study Site Location (State)
New York