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.