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• Overall, the results of the impact evaluation did not provide evidence of the effectiveness of the C2C model of task-shifting. Although C2C participants as a whole improved in most of the outcome domains investigated in the impact study, the comparison group as a whole improved by a similar amount.
• Although the impact evaluation results do not support broad scale-up of the C2C model of task-shifting, there are some key insights about the task-shifting approach that should be considered by practitioners, policymakers, and researchers interested in further exploring how to design, implement, and evaluate task-shifting interventions.
• Reaching full implementation of a complex task-shifting model requires significant investment of time and resources, but it is feasible.
• Although C2C was well received by clients and providers, such barriers as stigma and access challenges were hard to overcome.
• There were some benefits of C2C for certain subpopulations and in certain settings.

Mental health problems, such as depression and anxiety, affect a substantial portion of the U.S. population. About 20 percent of Americans deal with these problems, and, among young adults, that figure is even higher, at just above 25 percent. Mental health problems disproportionately affect low-income individuals, racial and ethnic minorities, and those with low English proficiency. Left unaddressed, these problems can profoundly affect people's lives and their ability to care for themselves physically and emotionally.

Easy-to-administer screening can detect mental health problems, and early intervention can stop or slow the progression of mild symptoms to more severe illness. But obtaining early intervention can be difficult because of a nationwide shortage of mental health care professionals. In both rural and urban areas, mental health professionals — particularly those who can deliver evidence-based treatments — are in short supply.

To fill gaps in the mental health care workforce and lower barriers to accessing mental health care, regional governments and coalitions have been exploring new strategies to address mental health care delivery. One such effort, begun in 2016, is the Connections to Care (C2C) Collaborative in New York City, which has built an innovative model of delivering mental health screening and evidence-based interventions through staff at community-based organizations (CBOs) that already serve at-risk populations. RAND researchers describe the C2C model and their evaluation of its implementation; whether it had the intended effects on access and utilization of mental health care, mental health symptoms, and related outcomes (such as employment); and how much it costs CBOs.

• Part I

  Introduction

  • Chapter One

    Introduction

  • Chapter Two

    Background and Rationale for C2C

  • Chapter Three

    C2C Program and Logic Model

• Part II

  Implementation

  • Chapter Four

    Adaptation of C2C at Community-Based Organizations in Early-Stage Implementation

  • Chapter Five

    Evolution of C2C Implementation

  • Chapter Six

    How C2C Transformed Organizational Culture and Approaches to Client Care Coordination

• Part III

  Impact

  • Chapter Seven

    Impact of C2C on Mental Health Care Access and Utilization

  • Chapter Eight

    Impact of C2C on Mental Health Symptoms

  • Chapter Nine

    Impact of C2C on Employment, Education, Housing, and Incarceration

• Part IV

  Cost

  • Chapter Ten

    Resources Required to Implement and Maintain the C2C Program

• Part V

  Conclusions and Recommendations

  • Chapter Eleven

    Conclusions and Recommendations

• Appendix A

  C2C Program Summaries

• Appendix B

  Implementation Evaluation Methods

• Appendix C

  Impact Evaluation Methods

• Appendix D

  Cost Evaluation and Sensitivity Analyses