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.

1. CERP Faculty and Community Partner meeting
December 20, 2012
First African
Presbyterian
Church
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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)
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3. BackgroundBackground
• Depressive symptoms are common and a significant
source of disability
• Unmet need for mental health services is high for
minorities in under-resourced communities
• Stigma around depression care, literacy can be
barriers to accessing services
• Community partners requested a depression
intervention that a) did not use the word depression,
b) was culturally competent, c) usable by those with
a 3rd
grade reading level, d) can be delivered by
non-professionals, e) emphasized wellness and
resiliency
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4. Research QuestionResearch Question
• What is the feasibility and acceptability of a
community developed resiliency class: 6 sessions of
CBT informed psycho-education, delivered by non –
professionals?
• Participants: 10 English and 10 Spanish speaking
• Setting for services delivery: a community health
advocacy agency, a federally qualified health
clinic, and an adult day school
• Entry criteria: PHQ-2>1, PHQ-8<15, Age≥18 years,
English or Spanish speaking, reliable contact
information, can attend six, 90-120 minutes sessions.
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5. MethodsMethods
• Measures: demographics, PHQ-8, SF-12, Fordyce
Emotions measure (happiness), brief resiliency scale,
housing, medical conditions, alcohol and substance
use; use of health and mental health services, food
insecurity; coping strategies; medication use; and
health insurance status
• Pilot the participant screener, baseline interview, and
follow-up interview for feasibility
• Based on class instructor’s feedback and focus
groups with pilot class participants, the PI, Co-PI, and
project manager will revise recruitment and class
manual for a randomized trial
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6. Methods Cont’dMethods Cont’d
Phase II
•RCT of RC (study group) compared to 2 telephone
case management calls and social services referrals
(control group) between February 2013 and January
2014.
•Screen 1000 clients at community agencies. Eligibility
criteria will be the same as for the pilot.
•Enroll about 250 clients into the study.
•Clients will be interviewed at baseline and 6 months.
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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; 16
bilingual
• 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 somewhat
difficult with symptoms.
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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)
• <8th
grade: 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 afford
food in last 12 months”
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9. CERP Aims AddressedCERP Aims Addressed
• 1) Promoting and sustaining bidirectional
knowledge sharing between community and
academia:
• 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 like
HAAFII and 1st
African Presbyterian Church
• Evaluation of an intervention developed by community in CPIC study
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10. CERP Aims AddressedCERP Aims Addressed
Cont’dCont’d
• 3) Foster Innovation in Community Engaged
Research
• Evaluation of an intervention developed by community in
CPIC 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 with
beliefs of community for a stigmatized set of symptoms
• Use non-licensed professionals
• Less expensive
• Will examine use of health and mental health services, use
of social services, measures of food security, current living
situation, alcohol and substance use, income, and for
those who are employed, days of work missed
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11. TimelineTimeline
• Phase I, Pilot Milestones
• Class completion: Week of January 7
• Follow-up survey and focus groups: Week of January
14 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 of
February 2014
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12. Added-Value from CTSIAdded-Value from CTSI
FundingFunding
• Research Assistants from CTSI CERP for pilot and RCT
made the study possible
• IT Support from the Bio-informatics Core for REDCap
Survey
• Additional support for CBT expertise, qualitative
data collection and analysis
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13. Next StepsNext Steps
• Engage additional community agencies including
clinics, churches, social services agencies for RCT.
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