Beat the Blues Case Study:Everyone Wins

Community-Academic Partnersand

African American Older Adults

Beat the Blues Case Study:Everyone Wins

Community-Academic Partnersand

African American Older Adults

Supported by NIMH #RO1 MH 079814, R24 MH074779 and RC1MH090770.

Clinical Trial #NCT005116801

The PartnersThe Partners

Thomas Jefferson University (2007-2011)

Center in the Park (2007 to Present)

Johns Hopkins University (2011 to Present)

Unique FeaturesUnique Features Academic-community partnership Target an underserved population Involvement of community partner in

every phase of project Design Intervention development Implementation Dissemination

Screening/Intervention - embedded in senior center operation to optimize translational potential

Time Line of Partners’ Collaborations

Time Line of Partners’ Collaborations2003-2007

AOA - Harvest Health: CDSMP for AA Older Adults

Using Stanford University Model EBP2006-2011

NIMH - In Touch: Mind, Body & Spirit (IP-RISP)

3 pilot studies and service programming

2007-2008PA Department of Aging– Healthy StepsFall Prevention-SE PA Regional Pilot

2007-2013NIMH –Beat the Blues

Mental Health DisparitiesMental Health Disparities Primary care principle setting for

depression detection and treatment Depression in older African Americans

under-detected and undertreated in that setting Prevalence ranges from 10 to 35% depending

upon sample, clinical comorbidities, life circumstances

Depression one of the primary sources of burden and disability New depression care models a public health

priority Need to create multiple access points for

depression care

Why Senior Centers?Linking Depression Treatment to Senior CentersPromotes Positive Aging and Reduces Isolation

Why Senior Centers?Linking Depression Treatment to Senior CentersPromotes Positive Aging and Reduces Isolation

BTB Study Design and Roles of Partners (N= 208)

BTB Study Design and Roles of Partners (N= 208)

4 MonthsPost

randomization

Follow-up AssessmentTJU/CIP

interviewers

TreatmentCIP/TJU

Wait-list Control

Recruitment Screening Baseline Assessment Randomization

Follow-up AssessmentTJU/CIP

interviewers

8 MonthsPost

randomization

TreatmentCIP/TJU

CIP care managersCIP researchcoordinator

and TJU recruiter

CIP care managersCIP research CoordinatorCriteriaAfrican American> 55 yearsCommunity-dwellingEnglish speakingHas telephoneCognitively intact (MMSE short form > 5) Depression symptom score > 5 twice within two weeks

CIP and TJU• Focus groups

• Brochure development TJU and CIP interviewers TJU

4 Month Outcomes for PHQ-9 Severity Score

(N=182)

4 Month Outcomes for PHQ-9 Severity Score

(N=182)

Baseline4 months

0

2

4

6

8

10

12

14

BTBControl

P=.001Cohen’s d=.47

Secondary 4-Month Outcomes (N=182)

Secondary 4-Month Outcomes (N=182) Domain Difference

of adjusted

mean

95% Confidence Interval

P- value Cohen’s d

Depression knowledge

0.3 0.2,0.4 .000 .69

Well-being 0.6 0.4,0.8 .000 .89

Quality of life

2.9 1.7,4.2 .000 .54

Behavior activation

0.8 0.5,1.1 .000 .84

Anxiety -0.4 -0.6,-0.2 .000 .59

Functional difficulty

-0.2 -0.3.0.0 .019 .25

8 Month Outcomes for PHQ-98 Month Outcomes for PHQ-9

Baseline4 months

8 months

0

2

4

6

8

10

12

14

BTBControl

P<.001 for control group

P=.001Cohen’s d=.47

ChallengesChallenges

Challenges the Partnership Faced

Challenges the Partnership Faced

Identifying and training appropriate staff Defining roles and supervision to reduce

conflict – exp., 2 project managers Differing pay scales – academic vs.

community-based non profit Time and priority conflicts Management of different funding sources

and shifting roles Keeping the commitment alive and on-

going Assuring on-going mutual respect and

trust

Unique Challenges for Community Partner Setting

Unique Challenges for Community Partner Setting

Staff understanding of importance of research and evidence based programs

Juggling competing demands of the funded collaboration and other service contracts

Adjusting to time line of research which is more prolonged than service delivery

Assuring appropriate levels of staffing, juggling budgets and grant reporting demands

Managing uncertainty and expectations around sustainability

Unique Challenges for the Academic/Research SettingUnique Challenges for the

Academic/Research Setting Need for flexibility in research design Time spent in training non-researchers in

basic research tasks E.g., importance of documentation, communicating

alerts, keeping records up to date Knowing when to take the lead and when to

step back Juggling competing demands/needs of the

funded collaboration and other funded studies

Managing the unknowns (e.g., staff changes, new service demands on community partner that necessitate changes in research design)

BENEFITSBENEFITS

How Everyone Wins

For Older African AmericansFor Older African Americans Integrated as a member of the team to help

inform the research process Able to give back to future generations (a

key value of target population) in a significant way

Benefits derived from participation in evidence-based programs

Help shape and engage in the programming offered at the community site

Help shape systematically the program of research pursued by the academic site

Help shape training of future health professionals

“I never realized I was depressed and learned a great deal about depression. I have a new outlook on life and think more positively about things.” Lenny, age 80

“You not only helped me to recognize that I had symptoms of depression and that having those feelings was a problem, but how to get myself out of it.” Jo, age 61

“I have a positive outlook for the future, have become more active, and my self-esteem has improved.” Ben, age 75

For the Academic and Senior Center

For the Academic and Senior Center Access to new funding streams

Avenue for professional development of participants from each site Important role of the collaborative is mentorship and

personal/professional growth of key staff Community partner gains access to

intellectual resources it may not have had previously

Academic partner gains access to research participants, helping to close the gap between research and practice

Senior Center benefits from increased participation in programs and activities.

What Makes the Partnership Work?

What Makes the Partnership Work?

Trust Mutual Respect Clear identification of roles Understanding the expertise of each

partner On-going communication Partners are passionate about project

goals Top leadership at the table talking Having partners you really like being with!

Some of the Nuts and BoltsSome of the Nuts and Bolts Layers of meetings in which academic

and community leaders attend Executive committee phone meetings monthly

if possible Weekly interviewer meetings Bi-weekly interventionist meetings

Problem solving with staff concerning oversight/turf issues that can emerge

Assuring that solutions work for all partners and meet the goals of the project

More of the Nuts and BoltsMore of the Nuts and Bolts As Kellogg defines the collaborative

approach: Equity & Recognition Being intentional about informing and

involving each other Giving each other “credit” and recognition for

unique roles and strengths Managing Expectations Respecting each other’s mission

Next Steps for our PartnershipNext Steps for our Partnership Working together to translate BTB in other

settings and with other populations Seeking grant funds to support continuation of

BTB Intervention at CIP Seeking grant funds to advance BTB as a

replicable and sustainable service Identifying value proposition of BTB and

how to scale it up and have widespread dissemination

Developing manuals, training materials, on-line and face-to-face trainings

Licensure agreements for equal use of materials

ConclusionConclusion Addressing multi-faceted problems such

as depressive symptoms in older African Americans requires an academic-community partnerships

Embedding research within the aging network and specifically senior centers is complex BUT DOABLE

Embedded designs using CBPR principles enhances senior center practice AND improves science

Attention to the collaborative process and partnership building is critical for success

Team Members Thomas Jefferson University and Johns Hopkins

University

Team Members Thomas Jefferson University and Johns Hopkins

University PI - Laura N. Gitlin, Ph.D. Project manager - Nancy L. Chernett,

MPH, Intervention coordinator - Laraine

Winter, Ph. D., Data analysts

Marie Dennis, Ph.D. Edward Hess, MA

Statistician – Walter Hauck, Ph.D. Interviewing staff:

Laura Holbert, MSW Karen Morrison, MSW Barbara Parker Christa Caruso Daneen Whinna Abby Schwartz, MSW

Intervention staff: Laura Holbert, MSW Karen Morrison, MSW

IRB coordinator and research assistantship– Lauren Acquarole, MS

Data entry staff: Mary Barnett Barbara Parker

Administrative assistance – Helen Jones

Cost effectiveness Team Laura Pizzi, PharmD, MPH Eric Jutkowitz

Consultants Nancy Wilson, MSW Melinda Stanley, Ph.D. Barry Rovner, MD Nancy Whitelaw, Ph.D. NCOA Alixe McNeill, MPA, NCOA

Data safety and monitoring board members

Neville E. Strumpf, Ph.D., R.N. Kimberly Van Haitsma, Ph.D. Mary D. Sammel, Sc.D. Virginia Smith, Ph.D. Frances Barg, Ph.D. Robin S. Goldberg-Glen, Ph.D.

Team Members – Center in the Park

Team Members – Center in the Park

Co-investigator - Lynn Fields Harris, MPA Co-investigator - Renee Cunningham-Ginchereau, MSS, Co-

investigator On-site project manager - Megan McCoy, MSS, MLSP Recruiter, screener - Erika Barber Interventionist supervisor - Barbara R. Davis, A.C.S.W.,

L.S.W. Interventionist - Susan Burgos, MSW, LSW Social Services Supervisor – Courtney White Intake specialist – Dorcas Essilfie 17 care managers over 5 years (trained in screening

procedures) CIP administrative staff