A Stepped Care Intervention to Reduce Disparities in Mental Health Services Among Cancer Patients and Caregivers

LC and HNC patients:

Inclusion Criteria:

Newly diagnosed LC and/or HNC (within a month of recruitment date from the date of 1st visit oncology, Ear Nose and Throat (ENT), or radiation clinic visit/consultation upon pathologic tissue diagnosis;
LC and/or HNC patients at any stage of diagnosis (Stages 0-IV);
Over 18 years old;
English and/or Spanish speaking;

Medically underserved, as defined by at least one or several of the following:

Low-income: Below 400% of the 2016 Federal poverty levels;
Uninsured: No health insurance (public or private insurance);
Underinsured: e.g.: Public insurance (Medicaid, Medicare exclusive, VA); and/or 10% of annual income on out-of-pocket medical expenses for individuals below 200% of the 2016 Federal poverty levels.

Exclusion Criteria:

Individuals who do not meet eligibility criteria, including individuals who do not speak English or Spanish;
Those who refuse treatment at one of three hospital sites;
Decisionally-challenged adults with cognitive or personality impairment;
Suicidal ideation, or
Intoxication (alcohol or drugs) that might interfere with their ability to consent or participate in the study;
Individuals from vulnerable populations (e.g., inmates or individuals on probation,
homeless,
pregnant women, and
those with auditory impairment.

Note: Individuals who become pregnant or develop auditory impairments after they have been randomized to study condition may remain in the study until completion.

Caregivers of LC and/or HNC patients

Inclusion Criteria:

Primary caregiver of a newly diagnosed LC and/or HNC patient (per criteria for patients);
Over 18 years old;
English and/or Spanish speaking;

Medically underserved, as defined by at least one or several of the following:

Low-income: Below 400% of the 2016 Federal poverty levels;
Uninsured: No health insurance (public or private insurance);
Underinsured:
(c.1) Public insurance (i.e., Medicaid, Medicare exclusive, VA);
(c.2) 10% of annual income spent on out-of-pocket medical expenses for individuals below 200% of the 2016 Federal poverty level.

Exclusion criteria:

Individuals who do not meet eligibility criteria, including individuals who do not speak English or Spanish [at the discretion of the Site Coordinators upon recruitment];
Caregivers of patients who refuse treatment at one of three hospital sites.

Decisionally challenged adults with:

cognitive or personality impairment,
suicidal ideation, or
intoxication (alcohol or drugs) that might interfere with their ability to consent or participate in the study [at the discretion of the Site Coordinators upon recruitment or the Counselor during the intervention];

Individuals from:

vulnerable populations (e.g., inmates or individuals on probation, homeless,
pregnant women, and
those with auditory impairment [at the discretion of the Site Coordinators upon recruitment]).
Individuals who become pregnant or develop auditory impairments after they have been randomized to study condition may remain in the study until completion.