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Innovative Community Academic Partnership (iCAP)

Funded Projects 2012-2013

1. METRIHC: Measuring and Tracking Integrated Health Care
2. Study on Homeless Housing and Supportive Services for Children and Families
3. Rise: Reaching Independence Through Self Empowerment
4. Refugee Mental Health: A Comparison of Three Treatments

METRIHC: Measuring and Tracking Integrated Health Care

Principal Investigators: Dr. Katherine Sanchez, Dr. Madhukar H. Trivedi
Community Partners: North Texas Area Community Health Centers, Inc. and MHMR of Tarrant County

ABSTRACT The current study seeks to establish the feasibility of universal screening for depression in an adult primary care medical setting, implement a Measurement-based Integrated Health Care model and measure the effectiveness of subsequent collaborative, multi-disciplinary treatment and care management intervention. The study builds on previous research establishing collaborative care as an effective model for the identification and treatment of depression. Clinical depression, bipolar disorder, and related conditions (termed “depressive illnesses” in this proposal) are leading causes of medical disability, health burden, and increased medical cost in the United States. One in six Americans is afflicted in their lifetime and chronicity is common. Depressive illnesses are the second leading causes of medical disability, costing an estimated $83-125 billion each year, and more than half these expenses are publicly funded. We propose a re- engineering of care delivery while improving quality of care.

Primary care settings often are the gateway to identifying undiagnosed or untreated behavioral health disorders through effective screening, particularly for people with comorbid physical health conditions. Even with the well-documented prevalence of common mental disorders in primary care, and their associated substantial morbidity, most treatments for mental disorders fall below the minimal standards of quality (Kessler et al., 2005). Recent recommendations from the U.S. Preventive Services Task Force are that primary care providers screen adult patients for behavioral health disorders only if systems are in place to ensure treatment and follow-up. Measurement-based Integrated Health Care is equally essential yet infrequently used.

Integrated health care models for the treatment of depression are often based on the principles of chronic disease management. And though these models vary in terms of the best means of achieving integration, some essential elements are 1) mental health services are co-located in the primary care setting, 2) systematic clinical care management is provided by a social worker, or other licensed mental health provider, 3) communication about the clinical evaluation and treatment plan transpires between the clinical care manager and the primary care provider, 4) systematic consultation by a psychiatrist focusing on patients who are not improving as expected, and 5) proactive follow-up and outcome monitoring in a patient registry by the care manager.

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Study on Homeless Housing and Supportive Services for Children and Families

Principal Investigators: Dr. Courtney Cronley
Community Partners: Metro Dallas Homeless Alliance

ABSTRACT In the proposed project, we will conduct a first-time, university-based study on housing and support services currently provided, gap analysis and review of potential system change strategies in Dallas County, TX, for children and families who are homeless. The study seeks to address whether the development of an integrated services model of housing and services located on a single site is the best community wide change strategy for addressing the growing numbers of children and families who are homeless in the region, the continuous disintegration of families resulting from homelessness, and the lack of an integrated system of care. The study is propelled by evidence of a growing population of families with children who are homeless in northeast Texas, in concert with fragmented access to and inconsistent quality of services. In fact, almost half of the families now served in transitional settings fail to realize permanent housing and many single parents lose care of their children soon after becoming homeless.

We will use a community needs assessment framework adapted from The Community Toolbox and the Community Concerns Report Method to address the research question. This will include developing a community advisory board, conducting a focus group and key informant interviews, analyzing secondary data, and conducting a cost-benefit analysis of emergency/transitional housing versus permanent supportive housing. We will conclude the study with a strategic plan that incorporates the diverse perspectives of the community to document the needs and existing gaps in services, change strategies to improve access and outcomes for the existing network of housing and support services, and what resources are necessary to implement an integrated services model.

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Rise: Reaching Independence Through Self Empowerment

Principal Investigators: Dr. Joan Blakey, Dr. Joan Rycraft
Community Partners: 9th Circuit Criminal Court and Community Supervision and Corrections Department of Tarrant County

There is growing concern about sex trafficking in the United States. To date, most of the research has focused on the international context (Brennan, 2008). Although international and domestic sex trafficking are similar in that they both have elements of force, fraud, and coercion, sex trafficking in the United States tends to concentrate on children primarily because it is easier to classify children as victims. Consequently, women from the United States have more difficulty being seen as victims of sex trafficking despite the elements of force, fraud and coercion that are central to many of their experiences (Brennan, 2008).

Using a mixed method design (quantitative and qualitative components), this study focuses on sex trafficked victims who have been arrested repeatedly for prostitution. A target sample of 50 women and 20 stakeholders (i.e. judge, probation officers, county commissioners, service providers) will be involved in the study. Data collection will consist of quantitative measures, in-depth semi-structured interviews, focus groups, file review, and court observations.

Analysis will begin with open coding the transcripts, documents and field notes using NVIVO, a qualitative data management program. Based on the codes, higher order themes will be developed. Pattern matching, the most desirable technique for case study analysis will be used to condense large quantities of information into smaller, more manageable analytic units (Yin, 2003). Pattern matching also lays the foundation for cross-case analysis as emergent themes, configurations, or explanations continue to surface (Miles & Huberman, 1994; Stake, 1995).
The proposed study has the potential to make significant advances in understanding sex trafficking among women from the United States in several ways: First, little is known about sex trafficking among women in the United States as the majority of the literature focuses on international victims and children (Newton, Mulcahy & Martin, 2008). Second, this study highlights domestic sex trafficked victims that are being overlooked (e.g. women repeatedly arrested for prostitution). Finally, this study would allow the victims to tell their story using their words as studies that privilege the victims’ voices are limited (Sadruddin et al., 2005).

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Refugee Mental Health: A Comparison of Three Treatments

Principal Investigators: Dr. Diane Mitschke, Dr. Eusebius Small, Dr. Regina Aguirre
Community Partners: Catholic Charities of Fort Worth

Introduction: This is a community participatory project designed collaboratively with Catholic Charities of Fort Worth (CCFW) and three faculty of the University of Texas at Arlington School of Social Work. The project engages a unique and innovative approach involving a community run cultural psychoeducational group (CPG) to address systematic barriers faced by refugees. As recent resettled refugees in Fort Worth, Texas, refugees face a myriad of hardships in adjusting to their new surroundings. As victims of painful atrocities of persecution, violence, rape, and torture, refugees are extremely susceptible to psychiatric morbidity and traumatic life events. Studies on refugees indicate that post-traumatic stress disorder (PTSD) and depression are perverse and ten times more likely to occur in this population than in the general population. Purpose: This project is guided by the principles of community organization theory and aims to evaluate the effectiveness of cultural psychoeducational groups (CPG), in conjunction with two other approaches, in addressing the mental health needs of international refugees.

Method: Approximately 360 will be randomly assigned to one of three groups.

The first of the intervention groups, CPG, will assist clients in need of greater attention in mental health education, acculturation and acclimation by providing referrals, group meetings, and follow-up support. The second group, CPG plus, will, in addition to CPG, include in-office clinical counseling by a licensed mental health professional; and the third group, CPG plus enhanced, will, in addition to CPG, include in-home clinical counseling by a licensed mental health professional. All participants will complete a written survey that includes the Patient Health Questionnaire-Somatic, Anxiety and Depressive Symptoms Scale (PHQ-SADS), the Post-Traumatic Stress Disorder Checklist-Civilian (PCL-C), and the Medical Outcomes Study-Social Support Survey (MOS-SSS). In addition, all participants will complete a self-administered assessment with demographic questions including questions about alcohol use and the nature of traumas experienced. Data collection time points include a pre-test at intake and a post-test at the conclusion of the intervention (8 weeks).

Anticipated Results: Based on the results of previous research and the application of community organization principles, the anticipated results of this intervention research will support the concept that group cohesion and social support will contribute to better outcomes in the areas of post-traumatic stress, somatization, depression, anxiety, and treatment compliance. In addition we expect to find an inverse correlation between number of CPG meetings attended and levels of social support as measured by the Medical Outcomes Study-Social Support Survey (MOS-SSS). We expect that participants in CPG plus and CPG plus enhanced will experience significantly less post-traumatic stress symptoms, somatization, depression and anxiety as measured by the Post-traumatic Stress Checklist-Civilian (PCL-C) and Patient Health Questionnaire (PHQ-SADS) from baseline to post-test than participants in CPG only with CPG plus enhanced experiencing the greatest decreases. Finally, we expect participants in CPG plus enhanced to have the highest level of treatment compliance and least amount of attrition as compared to CPG plus.

Innovation and Sustainability: This project is unique for several notable reasons. Although many mental health interventions for the effects of trauma exist, few are formulated specifically to address the needs of newly arrived refugees. The support of psychoeducational groups and their cultural ambassadors in building social support echoes an identified need by Catholic Charities of Fort Worth as an effective formula to address individual refugee needs. It is an empowering project that provides an opportunity for refugees to build their social support network while learning about how to better care for their mental health needs. Little is known about the possible indirect impact of psychoeducation on past trauma. This project will assess the unique contributions of group psychoeducation and counseling delivered in-office or in-home to refugee mental health.

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