Beat the Blues Case Study:
Everyone Wins
Community-Academic Partners
and
African American Older Adults
Supported by NIMH #RO1 MH 079814, R24 MH074779 and RC1MH090770.
Clinical Trial #NCT005116801
The Partners

Thomas Jefferson University (2007-2011)

Center in the Park (2007 to Present)

Johns Hopkins University (2011 to Present)
Unique Features

Academic-community partnership

Target an underserved population

Involvement of community partner in every
phase of project

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


Design
Intervention development
Implementation
Dissemination
Screening/Intervention - embedded in
senior center operation to optimize
translational potential
Time Line of Partners’ Collaborations
2003-2007
AOA - Harvest Health: CDSMP for AA Older Adults
Using Stanford University Model EBP
2006-2011
NIMH - In Touch: Mind, Body & Spirit (IP-RISP)
3 pilot studies and service programming
2007-2008
PA Department of Aging– Healthy Steps
Fall Prevention-SE PA Regional Pilot
2007-2013
NIMH –Beat the Blues
Mental Health Disparities


Primary care principle setting for depression
detection and treatment
Depression in older African Americans underdetected 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 Centers
Promotes Positive Aging and Reduces Isolation
BTB Study Design and Roles of Partners (N= 208)
CIP and TJU
•Focus groups
•Brochure development
Recruitment
CIP care managers
CIP research
coordinator
and TJU recruiter
TJU and CIP interviewers
Screening
Baseline Assessment
Randomization
Treatment
CIP/TJU
CIP care managers
CIP research
Coordinator
Criteria
African American
> 55 years
Community-dwelling
English speaking
Has telephone
Cognitively intact
(MMSE short form > 5)
Depression symptom score
> 5 twice within two weeks
TJU
4 Months
Post
randomization
8 Months
Post
randomization
Wait-list
Control
Follow-up Assessment
TJU/CIP
interviewers
Treatment
CIP/TJU
Follow-up Assessment
TJU/CIP
interviewers
4 Month Outcomes for PHQ-9 Severity Score
(N=182)
P=.001
Cohen’s d=.47
14
12
10
8
BTB
6
Control
4
2
0
Baseline
4 months
Secondary 4-Month Outcomes (N=182)
Domain
Difference
95%
of adjusted Confidence
mean
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-9
14
P=.001
Cohen’s d=.47
12
P<.001
for control group
10
8
BTB
6
Control
4
2
0
Baseline
4 months
8 months
Challenges
Challenges the Partnership Faced

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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





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 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)
BENEFITS
How Everyone Wins
For 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 evidencebased 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 selfesteem has improved.” Ben, age 75
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?

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 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 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 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
Conclusion




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

PI - Laura N. Gitlin, Ph.D.

Project manager - Nancy L. Chernett, MPH,


Intervention coordinator - Laraine Winter,
Ph. D.,
Marie Dennis, Ph.D.
Edward Hess, MA

Statistician – Walter Hauck, Ph.D.

Interviewing staff:

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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

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Laura Holbert, MSW
Karen Morrison, MSW
Barbara Parker
Christa Caruso
Daneen Whinna
Abby Schwartz, MSW
Intervention staff:



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Data analysts

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
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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

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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


Co-investigator - Lynn Fields Harris, MPA
Co-investigator - Renee Cunningham-Ginchereau, MSS, Coinvestigator

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