community engaged research for nimh outreach partnership

Holly Kiger, RN, MN, CNSResearch Navigator

Southern California Clinical and Translational Science InstituteNIMH Outreach Partner with Mental Health America Los Angeles

323-369-8648kiger@usc.edu

Community Engaged Research

For NIMH Outreach Partnership Annual Meeting

April 2014

COMMUNITY ENGAGED RESEARCH

• Overview of Clinical and Translational Science Awards (CTSAs)

• Overview of Community Engaged Research

• Recovery Oriented Care Collaborative —an example of a Community Engaged Research project with our NIMH Outreach Partner-Mental Health American Los Angeles

• Resources for you to get involved

RESEARCH DEVELOPMENT ……THE OLD WAY

RESEARCH FINDINGS

RESEARCH DISSEMINATION……..THE OLD WAY

Create 60 Clinical and Translational Science Institutes (CTSI) to serve as bridges

between research and the community

New members 2010MembersCTSA States

Participating Institutions

CLINICAL AND TRANSLATIONAL SCIENCE AWARDS

New members 2010MembersCTSA States

Participating Institutions

SoCal Consortium:•Southern California CTSI

(at USC)•UC San Diego•Scripps•UCLA•Providence Health &

Services Southern CA•MHALA

SoCal Consortium:•Southern California CTSI

(at USC)•UC San Diego•Scripps•UCLA•Providence Health &

Services Southern CA•MHALA

SOUTHERN CALIFORNIA CTSA CONSORTIUM

WHAT IS A CTSI?Southern California Clinical and Translational

Science Institute (SC CTSI)

LACDMH

LACDHS

Preclinical Translation and Regulatory Support

Biostatistics & Bioinformatics Resources

Translational Research Informatics

Research Development

Clinical Translation

Education, Career Development & Ethics

SOUTHERN CALIFORNIA CLINICAL AND TRANSLATIONAL SCIENCE INSTITUTE

IDENTIFY COMMUNITY MENTAL HEALTH RESEARCH PRIORITIES

FOSTER NEW ACADEMIC/COMMUNITY

PARTNERSHIPS

team matchmaking

training consultation

1

2PROVIDE PROGRAM SUPPORT

IMPLEMENT

EVALUATE

DISSEMINATE

3

4Mental Health/Physical

Health Integration

Age specific services

Access to Services

Paraprofessional approachesImplementing and sustaining EBP

Cost effectiveness

Integration of substance abuse

treatments

Multicultural barriers

Research assistance with specific projects

Track pilot projectsMentor post docs

Spirituality and MH

New project development

• I am a mental health nurse and I worked as a colleague of Dave Pilon, CEO of MHALA for over 20 years

• Three years ago I moved to SC CTSI as Research Navigator in Community Engagement

• Academic/Community Projects with MHALA:• Met with Dave to discuss potential projects• Connected him with researcher from USC School of Business

to do pilot work moving MHALA to evidence based practice status

• Invited MHALA to join PBRN group• Invited MHALA to collaborate on NIMH Outreach Partnership,

including our Special Project-Promotores Research Training Institute

PROJECTS WITH OUR NIMH OUTREACH PARTNER: MHALA

• Pilot testing of a “Health Navigator” project-- training persons with severe mental illness to improve their access and usage of primary medical care (instead of emergency rooms). Now have a PCORI grant to complete a larger RCT.

• Pilot testing mindfulness interventions for children in after school programs.

• Validation of a mental health screening tool for children entering foster care

• Pilot testing of a 12-week, psycho-educational curriculum designed to reduce substance use in Hispanic youth.

$1 MILLION ANNUALLY FOR SC-CTSI PILOT PROJECTS

OTHER GOALS

Present research findings to providers, partners, policy-makers, consumers and advocates

One way—monthly e-newsletter to 700+ and posted on LACDMH website

WHAT IS COMMUNITY-ENGAGED RESEARCH?

• A framework or approach for conducting research

• Requires partnership development between academic and community partners

• May be used with both qualitative (focus groups; interviews) and quantitative methods

• Recognizes and builds on community strengths, interests and perspectives

Traditional Research Process

Step 5: Interpret, write papers & Disseminate Results to Peers and Academic Community

Step 4: Analyze Data

Step 3: Intervention or Data Collection Data Collection Instruments Designed Researcher Recruits Community

Subjects

Step 2: Research Plan Developed Community Selected Funds Secured

Step 1: Problem Identified by Researcher

Community-Engaged Approach

Step 6: Disseminate Results to Community AND Academics

Step 5: Interpretation of Data with Community

Step 4: Analyze Data – Bring Results to Community

Step 3: Intervention or Data Collection All parties involved in design of data Collection instruments Community assists in participant recruitment

Step 2: Research Plan Developed Meetings with community members and researchers to determine best approach

Step 1: Problem Identified by StakeholderCould be community member or researcher

BARRIERS TO CONDUCTING COMMUNITY-ENGAGED RESEARCH

• Many researchers aren’t connected to CBOs

• Takes more time and money

• Need manuscripts in peer-reviewed journals for their career

• Researchers have to give up some control to community partners

• Poor communication and unrealistic expectations can lead to conflicts between academic and community partners

RATIONALE FOR COMMUNITY-ENGAGED RESEARCH

• Complex health and social problems ill-suited to “outside expert” research

• Increasing interest in health disparities

• Disappointing results with introducing “Evidence Based Practices” in the real world

• Increasing community demands for collaborative efforts

• Increasing funder interests in community-driven versus community-placed research

SOUTHERN CALIFORNIA CLINICAL AND TRANSLATIONAL SCIENCE INSTITUTE

Recovery Oriented Care Collaborative

A Practice Based Research Network (PBRN) focused on the integration of physical and

mental health of persons with severe mental illness

A PBRN is defined as a group of providers who come together to study topics/questions directly impacting their practice, engage researchers in answering those

questions, and use the results to improve service delivery.

RECOVERY ORIENTED CARE COLLABORATIVE• Funding: SC CTSI Pilot, July 1, 2012-June 30, 2013

• Project PIso John Brekke, PhD, USC School of Social Worko Rebecca Gaba, PhD, Didi Hirsch Mental Health Services o Co-Investigator: Lyndee Knox, Ph.D., Chief Executive

Officer, L.A. Net

• Mental Health Agency Partners (contract agencies with Los Angeles County Department of Mental Health) o Mental Health America Los Angeleso Didi Hirsch Community Mental Health Centero Exodus Recoveryo Pacific Clinics

ROCC PROCESS

• Formalize partner relationshipso MOUs with 4 based mental agency

organizationso Establish steering committee

• Assemble the research teamo SC CTSIo USC School of Social Worko Community partners

• Select research question using reflective practitioner process

• Conduct card study• Analyze results• Disseminate results

FOLLOW-UPROCC researchers analyzed findings and are in the process of presenting findings to the ROCC, community members and other researchers.

STEP 1: GENERATIONROCC members polled 20 mental health providers from four participating agencies at an all day forum. We identified 99 potential research questions that were then categorized into 23 domains by post doctoral Fellows.

STEP 2: SELECTIONAt a second all day forum, 10 topics were discussed and refined into researchable questions. Identified questions were evaluated based on criteria*. A score was given for each criterion. These scores were tallied up for a composite score for each question. The four highest-scoring questions advanced to the next step.

Criteria*1) Will it change my practice?2) Will it change my colleagues’ practices? 3) Is it feasible? 4) Is it publishable? 5) Is it fundable? 6) Is there a provider champion? * Knox & Lomonaco, 2005

STEP 3: EVALUATION Following the forum, the Fellows added literature reviews for the four highest scoring topics and created sample card studies for

each research question.

STEP 4: VOTEROCC members voted electronically for their preferred research question for the card study.

STEP 5: STUDYThe selected card study was refined and piloted by the research team. Following Institutional Review Board approval data collection occurred over several weeks at ROCC member sites. place at member sites.

Card Study* *Westfall et al., 2011A card study is a simple, immediate, and cost-effective method for gathering observational data by clinicians at the point of care. Requiring less than a minute to complete, the survey consists of patient demographic information, a qualifying question and, for those who qualify, follow-up questions. Patient identifiers are not collected. PBRNs use card studies because they make it easy to gather data across sites.

Reflective Practitioner Steps

REFLECTIVE PRACTITIONER PROCESS

CARD STUDY QUESTION AND FINDINGS

Research Question: “What is the impact of integrated healthcare services on emergency room and primary care usage; physical health; mental health; lifestyle; and ability to meet mental health treatment plan goals and overall satisfaction with services?”

Sample: 237 participants with serious mental illness from 4 clinics• Didi Hirsch (n = 52) • Exodus Recovery (n = 99)• Mental Health America (n = 48)• Pacific Clinics (n= 38)

The majority of the sample had been receiving services for at least 6 months (79%)

SAMPLE FINDINGS

SAMPLE FINDINGS

SAMPLE FINDINGS

SAMPLE FINDINGS

RECOVERY ORIENTED CARE COLLABORATIVENEXT STEPS

• Disseminate research findings

o ROCC members

o Los Angeles County Department of Mental Health

o Potential new ROCC members

o White paper

o Professional journals

o Local, state, and national conferences

• Decide on next research project

• Secure funding

Resources

For a list of CTSAs: https://www.ctsacentral.org/institutions

Other Potential Research Partners:• Schools of Nursing, Social Work, or Psychology• Authors of relevant research articles

For more information about Community Engaged Research • A Quick Start Guide to Conducting Community Engaged Researchhttp://sc-ctsi.org/assets/ce/Booklet.pdf• Community Engaged Research 101 videohttp://vimeopro.com/scctsiecde/sc-ctsi-ecde-studio-catalog/video/55632203For information about PBRNs: http://pbrn.ahrq.gov/

More information: Contact Holly Kiger @ kiger@usc.eduor 323-369-8648