New Ground

Randomized clinical trials are the gold standard in medical research—they provide the foundation for treatment guidelines. Ell now heads these types of trials at USC and is testing what she’s learned from more than 40 years of depression and health care behavior research.

Her current work is focused on treating depression in low-income patients with other serious medical conditions such as cancer, heart disease and diabetes.

One of her latest studies adapts a proven team approach for treating chronic diseases to depression care for low-income minority patients with cancer. It’s the first large-scale trial of its kind.

Conducted at the Los Angeles County + USC Medical Center, the trial used social workers as the primary providers of depression care. Working together with oncologists and psychiatrists, bilingual social workers provided the mostly female Hispanic patient population with one-on-one depression screening, treatment and long-term support. “I’m trying to establish that we can provide care even in the most under-resourced health systems and with the most underserved populations,” Ell says.

		Leopoldo Cabassa, Ph.D., explores cultural perceptions to improve mental health care.Photograph by Mark Berndt

During the trial, culturally influenced treatment preferences, such as trying therapy before taking medications, were respected. Also, patients’ cancer treatments were integrated into their depression care. If a patient was in the hospital, social workers would come to them. If they were at home suffering from the effects of chemotherapy and radiation, social workers would provide therapy sessions by telephone.

Patients also had access to bilingual “patient navigators” who acted as their personal advocates. The navigators helped them set up appointments and manage problems in their lives related to family, work, transportation and child care. Culturally informed patient education materials were also used.

In the intervention group, researchers were able to detect depression better—approximately 62 percent more patients got the depression treatment they needed. Importantly, patients who entered treatment experienced a significant improvement in their depression symptoms and overall quality of life. At 12 months, patients who had received depression care were managing depressive symptoms much better than patients who were in the control group.

Over the next year, Ell and her fellow researchers will look at how the depression care patients received in the study is affecting their fight with cancer.

Although there’s debate, medical science is listening. The Institute of Medicine recently updated its recommendations, noting that all cancer patients should receive depression screening and care.

Real world

Translating clinical research into everyday practice can be more difficult than it seems. Even with depression treatment programs that seem to address access and quality of care issues, the task of adapting them to the real world is a big one.

Health administrators and providers are faced with a never-ending challenge: meet the growing needs of the patients with budgets that don’t change.

“The question from policymakers becomes, ‘Does this new program reduce costs so that we come out even, or is it an additional cost that we have to take into account?’” Ell explains.

It’s a question that’s not easily answered.

To facilitate the conversation, Ell is on a team of experts that leads the USC Clinical and Translational Science Institute. The organization was formed in response to an initiative by the National Institutes of Health that aims to get new research into practice sooner. The goal is to engage policymakers, clinicians and researchers in an ongoing discussion so the economics and infrastructure of change can be worked out.

Doing more

Ell is busy these days. She meets with health administrators and national policymakers to help them use what she’s learned about depression care. Her research at the School of Social Work continues, as does her work on a book about depression care management.

She’s collaborating with Cabassa and other colleagues in new clinical trials, one of which examines depression treatment in low-income Hispanics with diabetes. The trial’s team-based approach to depression care is similar to Ell’s study with cancer patients. It represents a process of adapting something that works to a new medical challenge.

Having bridged the fields of social work and medicine, Ell continues her work with psychiatrists, oncologists, endocrinologists and cardiologists. She encourages her younger colleagues to do the same.

With a smile, she says, “We’re all working in the same vineyard.”