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B-RICH: Building Resiliency & Increasing Community Hope
B-RICH: Building Resiliency & Increasing Community Hope
B-RICH: Building Resiliency & Increasing Community Hope
B-RICH: Building Resiliency & Increasing Community Hope
B-RICH: Building Resiliency & Increasing Community Hope
B-RICH: Building Resiliency & Increasing Community Hope
B-RICH: Building Resiliency & Increasing Community Hope
B-RICH: Building Resiliency & Increasing Community Hope
B-RICH: Building Resiliency & Increasing Community Hope
B-RICH: Building Resiliency & Increasing Community Hope
B-RICH: Building Resiliency & Increasing Community Hope
B-RICH: Building Resiliency & Increasing Community Hope
B-RICH: Building Resiliency & Increasing Community Hope
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B-RICH: Building Resiliency & Increasing Community Hope

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This project, Building Resiliency and Increasing Community Hope (B-RICH) proposes to pilot and then …

This project, Building Resiliency and Increasing Community Hope (B-RICH) proposes to pilot and then
conduct a randomized, single blind trial of a psychosocial intervention called a “Resiliency Class” (RC), to provide depression education and health promotion to individuals with depressive symptoms, by training non- professionals to offer this class to clients receiving services within diverse community settings (e.g. health care clinic, church, community advocacy organization, social services agency). This class is not designed to be therapy, but rather is designed as a class that is informed on cognitive behavioral therapy (CBT) principles used to address depressive symptoms, on how to improve mood, and to enhance resiliency in the face of stress.

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  • 1. CERP Faculty and Community Partner meetingDecember 20, 2012First AfricanPresbyterianChurch1
  • 2. 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)2
  • 3. BackgroundBackground• Depressive symptoms are common and a significantsource of disability• Unmet need for mental health services is high forminorities in under-resourced communities• Stigma around depression care, literacy can bebarriers to accessing services• Community partners requested a depressionintervention that a) did not use the word depression,b) was culturally competent, c) usable by those witha 3rdgrade reading level, d) can be delivered bynon-professionals, e) emphasized wellness andresiliency3
  • 4. Research QuestionResearch Question• What is the feasibility and acceptability of acommunity developed resiliency class: 6 sessions ofCBT informed psycho-education, delivered by non –professionals?• Participants: 10 English and 10 Spanish speaking• Setting for services delivery: a community healthadvocacy agency, a federally qualified healthclinic, and an adult day school• Entry criteria: PHQ-2>1, PHQ-8<15, Age≥18 years,English or Spanish speaking, reliable contactinformation, can attend six, 90-120 minutes sessions.4
  • 5. MethodsMethods• Measures: demographics, PHQ-8, SF-12, FordyceEmotions measure (happiness), brief resiliency scale,housing, medical conditions, alcohol and substanceuse; use of health and mental health services, foodinsecurity; coping strategies; medication use; andhealth insurance status• Pilot the participant screener, baseline interview, andfollow-up interview for feasibility• Based on class instructor’s feedback and focusgroups with pilot class participants, the PI, Co-PI, andproject manager will revise recruitment and classmanual for a randomized trial5
  • 6. Methods Cont’dMethods Cont’dPhase II•RCT of RC (study group) compared to 2 telephonecase management calls and social services referrals(control group) between February 2013 and January2014.•Screen 1000 clients at community agencies. Eligibilitycriteria will be the same as for the pilot.•Enroll about 250 clients into the study.•Clients will be interviewed at baseline and 6 months.6
  • 7. OutcomesOutcomes• 99 approached and screened• 42.7 years (SD=14.7) – mean age• M=61; F=36• 64 English only; 10 Spanish speaking only; 16bilingual• 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 somewhatdifficult with symptoms.7
  • 8. 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)• <8thgrade: 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 affordfood in last 12 months”8
  • 9. CERP Aims AddressedCERP Aims Addressed• 1) Promoting and sustaining bidirectionalknowledge sharing between community andacademia:• 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 likeHAAFII and 1stAfrican Presbyterian Church• Evaluation of an intervention developed by community in CPIC study9
  • 10. CERP Aims AddressedCERP Aims AddressedCont’dCont’d• 3) Foster Innovation in Community EngagedResearch• Evaluation of an intervention developed by community inCPIC 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 withbeliefs of community for a stigmatized set of symptoms• Use non-licensed professionals• Less expensive• Will examine use of health and mental health services, useof social services, measures of food security, current livingsituation, alcohol and substance use, income, and forthose who are employed, days of work missed10
  • 11. TimelineTimeline• Phase I, Pilot Milestones• Class completion: Week of January 7• Follow-up survey and focus groups: Week of January14 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 ofFebruary 201411
  • 12. Added-Value from CTSIAdded-Value from CTSIFundingFunding• Research Assistants from CTSI CERP for pilot and RCTmade the study possible• IT Support from the Bio-informatics Core for REDCapSurvey• Additional support for CBT expertise, qualitativedata collection and analysis12
  • 13. Next StepsNext Steps• Engage additional community agencies includingclinics, churches, social services agencies for RCT.13

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