The Community The Community Mental Health and Mental Health and Cancer Prevention Cancer Prevention Partnership ProjectPartnership Project

PI: Elisa Weiss, PhDPI: Elisa Weiss, PhDCo-I: Hayley Thompson, PhDCo-I: Hayley Thompson, PhD

Dept. of Epidemiology and Population Dept. of Epidemiology and Population HealthHealth

April 12, 2010 April 12, 2010 Health Inequities Think Tank Meeting Health Inequities Think Tank Meeting

Overview of the ProjectOverview of the Project

Two-year pilot study to identify feasible Two-year pilot study to identify feasible strategies to improve access to mental health strategies to improve access to mental health care in the Bronx, in the context of efforts to care in the Bronx, in the context of efforts to promote timely, age-appropriate utilization of promote timely, age-appropriate utilization of cancer screening services.cancer screening services.

Study recognizes that effectively responding Study recognizes that effectively responding to the complexities surrounding health care to the complexities surrounding health care access and utilization by diverse Bronx access and utilization by diverse Bronx residents will necessitate working with the residents will necessitate working with the community from the inception of the research community from the inception of the research process.process.

BackgroundBackground In meetings to discuss cancer-related In meetings to discuss cancer-related

projects, CBOs in the Bronx reported a projects, CBOs in the Bronx reported a dearth of mental health services to staff and dearth of mental health services to staff and investigators of the Community Assessment investigators of the Community Assessment and Capacity Building Core.and Capacity Building Core.

Literature indicates that untreated mental Literature indicates that untreated mental illness hinders preventive healthcare, illness hinders preventive healthcare, including cancer screening; regular care for including cancer screening; regular care for mental illness increases likelihood of mental illness increases likelihood of regular screening.regular screening.

Roughly half of Bronx is designated Mental Roughly half of Bronx is designated Mental Health Professional Shortage area by HRSA, Health Professional Shortage area by HRSA, making obtaining care particularly making obtaining care particularly challenging.challenging.

ICTR Grant MechanismICTR Grant Mechanism

2 years of pilot funding to support 2 years of pilot funding to support “community-engaged research” from the “community-engaged research” from the Einstein-Montefiore Institute for Clinical Einstein-Montefiore Institute for Clinical and Translational Research (ICTR)and Translational Research (ICTR)

Project must be launched through one of Project must be launched through one of Einstein’s NIH-funded centers (Cancer Einstein’s NIH-funded centers (Cancer Center).Center).

Over 60% of funding must go back to Over 60% of funding must go back to the community.the community.

Specific AimsSpecific Aims Describe the individual-level and system-level Describe the individual-level and system-level

barriers and facilitators to accessing mental barriers and facilitators to accessing mental health services in the Bronx.health services in the Bronx.

Begin to identify how the lack of sufficient Begin to identify how the lack of sufficient mental healthcare in the Bronx affects use of mental healthcare in the Bronx affects use of cancer screening services for breast, cancer screening services for breast, cervical, prostate, and colon cancer.cervical, prostate, and colon cancer.

Understand past and current efforts to Understand past and current efforts to address inadequate access to mental health address inadequate access to mental health care in the Bronx and their outcomes.care in the Bronx and their outcomes.

Build a sustainable partnership with a range Build a sustainable partnership with a range of key stakeholders in the Bronx that will of key stakeholders in the Bronx that will develop a grant applications to improve develop a grant applications to improve mental health services and preventive care in mental health services and preventive care in the Bronx.the Bronx.

Conceptual FrameworkConceptual Framework

Behavioral ecological Behavioral ecological framework (see framework (see figure)figure)

Community-Based Community-Based Participatory Participatory Research Methods Research Methods (CBPR)(CBPR) Working Group of 6 Working Group of 6

Bronx CBOs and Bronx CBOs and project project investigators/staffinvestigators/staff

www.cdc.gov 2010

The Working Group – 6 The Working Group – 6 CBOsCBOs

Bronx Works Bronx Works Good Shepherds Good Shepherds Love, Power, and GraceLove, Power, and Grace Montefiore Family Health Center Montefiore Family Health Center Neighborhood Initiatives Development Neighborhood Initiatives Development

Corp. (NIDC)Corp. (NIDC) Phipps CDCPhipps CDC

Working Group - Project Working Group - Project Investigators and StaffInvestigators and Staff

Elisa Weiss, Ph.D. (Sociology), Partnership ResearchElisa Weiss, Ph.D. (Sociology), Partnership Research Hayley Thompson, Ph.D. (Psychology), Medical Hayley Thompson, Ph.D. (Psychology), Medical

Mistrust ResearchMistrust Research Pamela Valera, Ph.D. (Social Work), Qualitative Pamela Valera, Ph.D. (Social Work), Qualitative

ResearchResearch Joanna Dognin, Psy.D. (Psychology), Access to Joanna Dognin, Psy.D. (Psychology), Access to

Mental Health CareMental Health Care Jennifer Erb-Downward, M.P.H, Community Jennifer Erb-Downward, M.P.H, Community

OrganizingOrganizing Abigail Williams, M.P.H., Qualitative ResearchAbigail Williams, M.P.H., Qualitative Research Nicole Maysonet, Community Administrative Nicole Maysonet, Community Administrative

AssistantAssistant Research AssistantResearch Assistant

Research DesignResearch DesignYear 1 (2010)Year 1 (2010)

The Working Group will:The Working Group will: Create a qualitative interview guide Create a qualitative interview guide

that relates to the aims.that relates to the aims. Select appropriate stakeholders from Select appropriate stakeholders from

social service and health delivery social service and health delivery organizations as well as community organizations as well as community leaders to participate in approximately leaders to participate in approximately 40 qualitative interviews.40 qualitative interviews.

Interpret the qualitative data Interpret the qualitative data gathered.gathered.

Identify organizations to be part of a Identify organizations to be part of a larger partnership for Year 2.larger partnership for Year 2.

Research DesignResearch DesignYear 2 (2011)Year 2 (2011)

Build on the Working Group to create Build on the Working Group to create a sustainable, multi-sector Bronx a sustainable, multi-sector Bronx partnership that will use the data partnership that will use the data collected in the first year as a basis for collected in the first year as a basis for discussion about how we can improve discussion about how we can improve access to mental health care and access to mental health care and utilization of cancer screening services utilization of cancer screening services among those with mental health needs.among those with mental health needs.

Develop intervention strategies and Develop intervention strategies and begin to develop a grant proposal to begin to develop a grant proposal to fund one or more of these strategies.fund one or more of these strategies.

Partnership Evaluation to Partnership Evaluation to Maximize Partnership Maximize Partnership

FunctioningFunctioning 2-3 evaluation points in year 22-3 evaluation points in year 2 Evaluation will be anonymous, Evaluation will be anonymous,

web-based survey (based on web-based survey (based on Elisa Weiss’s published work)Elisa Weiss’s published work)

Evaluation will facilitate Evaluation will facilitate discussion and allow for mid-discussion and allow for mid-course adjustments as neededcourse adjustments as needed

Partnership Characteristics Partnership Characteristics for Evaluationfor Evaluation

IndividualIndividual Benefits and costs Benefits and costs

to memberto member Participation and Participation and

rolesroles ExpectationsExpectations SatisfactionSatisfaction CommitmentCommitment OwnershipOwnership

GroupGroup Administration and Administration and

managementmanagement Meeting qualityMeeting quality LeadershipLeadership Group SynergyGroup Synergy CommunicationCommunication Decision-makingDecision-making EfficiencyEfficiency Sufficiency of financial and Sufficiency of financial and

non-financial resourcesnon-financial resources TrustTrust Conflict and CooperationConflict and Cooperation Perceived ProgressPerceived Progress

Future PlansFuture Plans

Study will serve as a launching point Study will serve as a launching point for the Community Mental Health for the Community Mental Health and Cancer Prevention Partnership, and Cancer Prevention Partnership, an ongoing platform for CBPR an ongoing platform for CBPR Research in area of mental health Research in area of mental health and cancer screeningand cancer screening

Development of future grants and Development of future grants and interventionsinterventions

Questions/Questions/Comments??Comments??

THANK YOUTHANK YOU

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