CERP Faculty and Community Partner meeting December 20, 2012

First African Presbyterian Church

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PresentersPresenters

• Bowen Chung, Principal Investigator• Jeanne Miranda, Co-PI• Esmeralda Pulido, Class Instructor

(English/Spanish)• Felica Jones, Co-PI / Class Instructor (English) • Rev. Gwendolyn Stone, Class Instructor (English)• Karina Madrigal, Class Instructor (Spanish)

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BackgroundBackground• Depressive symptoms are common and a

significant source of disability• Unmet need for mental health services is high for

minorities in under-resourced communities• Stigma around depression care, literacy can be

barriers to accessing services• Community partners requested a depression

intervention that a) did not use the word depression, b) was culturally competent, c) usable by those with a 3rd grade reading level, d) can be delivered by non-professionals, e) emphasized wellness and resiliency

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Research QuestionResearch Question• What is the feasibility and acceptability of a

community developed resiliency class: 6 sessions of CBT informed psycho-education, delivered by non –professionals?

• Participants: 10 English and 10 Spanish speaking• Setting for services delivery: a community health

advocacy agency, a federally qualified health clinic, and an adult day school

• Entry criteria: PHQ-2>1, PHQ-8<15, Age≥18 years, English or Spanish speaking, reliable contact information, can attend six, 90-120 minutes sessions.

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MethodsMethods• Measures: demographics, PHQ-8, SF-12, Fordyce

Emotions measure (happiness), brief resiliency scale, housing, medical conditions, alcohol and substance use; use of health and mental health services, food insecurity; coping strategies; medication use; and health insurance status

• Pilot the participant screener, baseline interview, and follow-up interview for feasibility

• Based on class instructor’s feedback and focus groups with pilot class participants, the PI, Co-PI, and project manager will revise recruitment and class manual for a randomized trial

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Methods Cont’dMethods Cont’dPhase II•RCT of RC (study group) compared to 2 telephone case management calls and social services referrals (control group) between February 2013 and January 2014.•Screen 1000 clients at community agencies. Eligibility criteria will be the same as for the pilot.•Enroll about 250 clients into the study. •Clients will be interviewed at baseline and 6 months.

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OutcomesOutcomes• 99 approached and screened • 42.7 years (SD=14.7) – mean age• M=61; F=36 • 64 English only; 10 Spanish speaking only; 16

bilingual• N=70 - PHQ-2≥2; n=41 - PHQ-2≥3• PHQ-2 score≥2, n=21- "very difficult", n=39-

"somewhat difficult”• PHQ-2 Score≥3, all (n=41) “very or somewhat

difficult with symptoms.

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OutcomesOutcomes• Pilot participants (n=26)• Married 34% (n=6); Widowed or divorced 20%

(n=5); Single, never married 42% (n=11), missing n=4

• Latino 61% (n=16); African American 39% (n=10)• 40% born outside of U.S.• Insured: 54% (n=14); Uninsured: 38% (n=10);

something else: 8% (n=2)• <8th grade: 35% (n=9); HS or GED or some HS:

38% (n=10); some college or college: 23% (n=7)• 73% (n=19) unemployed• < 10% (n=2) homeless• 38% (n=10): “hungry due to not being able to

afford food in last 12 months”8

CERP Aims AddressedCERP Aims Addressed• 1) Promoting and sustaining bidirectional

knowledge sharing between community and academia: • Staff learned CPPR as a research approach • Staff attended Bridges to Optimum Health Series• CBT training and research training

• 2) Strengthen Community Capacity for Research• All aspects of research were completed with community partners like

HAAFII and 1st African Presbyterian Church• Evaluation of an intervention developed by community in CPIC study

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CERP Aims Addressed CERP Aims Addressed Cont’dCont’d

• 3) Foster Innovation in Community Engaged Research• Evaluation of an intervention developed by community

in CPIC study• Idea to pilot to RCT to dissemination in less than 5 years.

• 4) Health Services Research• Learn how to deliver “care” in a way that is consistent

with beliefs of community for a stigmatized set of symptoms

• Use non-licensed professionals• Less expensive • Will examine use of health and mental health services,

use of social services, measures of food security, current living situation, alcohol and substance use, income, and for those who are employed, days of work missed

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TimelineTimeline• Phase I, Pilot Milestones

• Class completion: Week of January 7• Follow-up survey and focus groups: Week of

January 14 and 21• Analyze pilot study data: Week of January 21• Submit IRB for RCT to UCLA IRB: Week of January

28• Pilot to be reviewed for safety

• Phase II, RCT Milestones• Start end of February or early March• Complete classes end of August 2013 • Complete client 6 month follow-up by end of

February 2014

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Added-Value from Added-Value from CTSI FundingCTSI Funding

• Research Assistants from CTSI CERP for pilot and RCT made the study possible

• IT Support from the Bio-informatics Core for REDCap Survey

• Additional support for CBT expertise, qualitative data collection and analysis

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Next StepsNext Steps• Engage additional community agencies including

clinics, churches, social services agencies for RCT.

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