Design Component	Original Study Goal	Community Feedback	Partnered Solution
Study Goals	To demonstrate effectiveness of a community engagement and planning approach to disseminating evidence-based programs to improve depression care, versus technical assistance.	The win for agencies is not clear. Technical assistance suggests that study leaders are experts and not the community.	Study re-framed to offer two-way knowledge-exchange: 1) resources (academic and community) for individual agencies to improve services for depression; 2) those resources plus a mulit-agency community-academic planning process to promote sharing resources and adapting programs to the community to expand the reach of programs to all. We also emphasized the post-trial dissemination phase.
Sampling Design and Procedures
Definition of Community	Hollywood and South Los Angeles.	Base on Los Angeles County service areas but also follow clients along referral lines.	Expand to include full county service planning areas plus surrounding areas; study priorities for agency recruitment based on community knowledge of use and referral patterns;
Agency Sample	Primary care/community clinics, mental health clinics, Social service agencies	Expand locations to include “community trusted locations”	Expand to include churches and church health fairs, community centers and senior centres of parks and recreation, barber/beauty shops, women's gyms
Provider Sample	Service providers and case workers in recruited agencies	A range of leaders in the community and staff at agencies can influence clients	Expand to include faith-based leaders, community center program staff, staff at other community locations such as exercise clubs
Patient/Client Sample	Adults receiving services in established agencies.	Include the most vulnerable community members if possible and those not receiving services.	Agencies added that serve transitional age youth, elderly, homeless, and prison/jail release populations.
Randomization Procedure	Group-level (site, program, or clinical team as unit), randomized controlled (comparison) design with assignment to resources and encouragement for services (choice-based model); wait list for effective intervention at dissemination phase; randomization before kickoff conference	Choice-based model (agencies, providers, and clients are free to choose treatments or no treatment) and wait list for resources are valued types of design in the community. Acceptability of randomization in the community remains somewhat uncertain.	Provide clear explanations of this complex design (transparency). Involve community partners in implementing the randomization procedure. All respondents are free to participate or not as they choose. Those who do not want services or choose the treatments can remain in the study. Randomization will take place after kick-off conference.
Theory Basis of Intervention Implementation Evaluation	Diffusion of Innovation Theory, Quality improvement frameworks, Organizational Learning, Communities of Practice	Use community knowledge of services, practice, and populations; select theories that reflect the group or community values	Expand theory to include Collective Efficacy. Expand community input into concepts based on the principles of Community-Partnered Participatory Research.
Intervention Design
Resources for Services	Standard components of collaborative care for depression: Resources for primary care providers, nurse care managers, psychotherapists and counselors, patient education and activation, tracking and coordination, and team management/quality review	Resources are limited, especially primary care clinician time for training and services; few community clinics have available nurse or other trained staff for care manager roles	Train-the-trainers approach to training; identify potential community leaders for training early on. Simplify and clarify care manager materials for a range of staff levels
Community Engagement and Planning	Manual to guide use of action plans to review resources and adapt for agencies, plan trainings, and develop a collaboration plan	Communities of color may be reluctant to engage in more traditional or Western treatment models Many value alternative therapies Community-trusted locations such as parks do not have staff with clinical backgrounds; develop outreach.	Collaborate with community agencies to identify cultural competence resources Identify outreach models for mental health and supplement with locally-developed materials for diverse cultural groups
Outcome Measures (Clients)	See Figure One	Relevance of economic stress and strain with job losses Other outcomes of interest such as housing stability	Expand to include employment status/workforce participation outcomes; and housing, recent victimization, and other common sources of stress in the community
Survey payments	Checks	Many community members do not use banks, and check cashing locations charge fees.	Cash or gift cards instead of checks.