Establishing Community Partnerships to Address Mental Health Disparities Among High-Risk Populations: Research and Implementation

Dominika Anne Winiarski, PhD Chair
Rush University Medical Center
Chicago, IL 
United States
 
Niranjan Karnik, MD, PhD Discussant
Rush University Medical Center
Chicago, IL 
United States
 
Saturday, March 30: 10:30 AM  - 12:00 PM 
306R 
Symposium 
Meeting Room Level 2 
Room: Erie 
Credits: 1.5 

Description

The presenters will discuss the development and implementation of various community-based mental health programs for underserved and marginalized populations. Specifically, each speaker will address the history and contextual factors involved in the development of their respective intervention/community-based program, and will also discuss the most common presenting mental health concerns that are encountered among these high-risk populations. Suggestions for expanding mental health services into the community to address overwhelming disparities in access to care will also be discussed. The first two presenters will discuss the development of a shelter-based clinic and a research program for high-risk homeless youth with pervasive histories of trauma. The second presenter will describe two HIV prevention interventions developed for high-risk urban youth, including juvenile offenders on probation and low-income African-American teenage women and their mothers. The final speaker will discuss how applications of a social network support model can help retain HIV+ men in healthcare and can also address psychological distress among this group.

Learning Objectives

1. Explain the unique and overlapping mental health needs among the high-risk youth and adult populations served through the community partnerships discussed in this presentation.
2. Discuss the logistical and ethical considerations that need to be accounted for when developing community partnerships to treat mental health disparities in marginalized populations.
3. Assess the strengths and weaknesses of the various community partnerships discussed, and recognize the future directions of community-based work. 

Audience Level

Introductory

Demographic

Multicultural

Diversity/Content

Diversity - Yes

Duration

90 minutes

Disorder

Comorbid Disorder

Treatment Approach

Transdiagnostic

Presentations

Developing a Research Program to Address Mental Health Disparities Among Homeless Youth

The Night Ministry is a Chicago-based organization dedicated to addressing the physical, social, and emotional needs of the homeless population in the city. A previous panelist discussed the clinical role Rush University Medical Center has played with this program. This presenter will discuss how information gleaned from the shelter-based clinics was used to develop several ongoing research programs, including a mobile mental health intervention study. In addition, the presenter will discuss a newly-initiated research program that explores the link between trauma, emotion dysregulation, and psychopathology. This presentation will also address the logistical and ethical factors that need to be considered when developing research programs with disadvantaged youth, and will highlight the critical need for this type of research given the significant mental health disparities among homeless youth.  

Presenter

Dominika Anne Winiarski, PhD, Rush University Medical Center Chicago, IL 
United States

Developing a Shelter-Based Mental Health Program to Address Mental Health Disparities Among Homeless Youth

The Night Ministry is a Chicago-based organization dedicated to addressing the physical, social, and emotional needs of the homeless population in the city. Rush University Medical Center has partnered with the Night Ministry since 2015 to provide therapeutic and psychiatric services to its youth at shelter locations. The presenter will discuss how this clinic was developed and will present on the patient characteristics of the youth who obtain services through this clinic. This session will also include a discussion of the unique ethical issues that warrant consideration when providing care to homeless youth and will conclude with suggestions from the speakers on how to expand such services in the city of Chicago.  

Presenter

Anne K Rufa, PhD, Rush University Medical Center Chicago, IL 
United States

Developing and Evaluating Social Network Support Interventions to Improve the Health and Well-Being of Young Black Men Who Have Sex with Men

Young Black men who have sex with men (YBMSM) carry the nation’s highest burden of HIV and experience poor engagement in HIV care. Among HIV+ YBMSM, mental health and low social support are common barriers to engaging in care, which is a key mediator of virologic failure and death. Despite these factors, few engagement in care interventions exist for YBMSM. We provide efficacy data on Project nGage, a social network support intervention based on a program of community-based research with YBMSM on the South Side of Chicago. We also discuss how this intervention is being adapted for HIV- YBMSM to improve engagement in Pre-Exposure Prophylaxis (PrEP) care. Project nGage was a pilot randomized controlled trial (RCT) conducted from 2012–2015. Ninety-eight YBMSM aged 16-29 were randomized to Project nGage (n=45) or a control (n=53) arm. The intervention mapped men’s social networks and selected a key network member, known as a support confidant (SC), to provide social support. A social work interventionist met with the SC-Index dyad and the SC alone to improve knowledge about engagement in care, activate dyadic social support, and develop a tailored care and support plan. SCs also received four booster sessions via text and/or telephone. The control condition was treatment as usual, i.e., standard clinical care. Survey and medical record data were collected at 0, 3, and 12 months to assess engagement in care, i.e., 3 or more visits over 12 months. Multivariate logistic regression analyses examined engagement in care at 12 months post intervention. At baseline, there were no differences in age (M=23.8 years), time since diagnosis (M<2 years), psychological distress (13%), and clinic visits in the prior 12 months (M=4.1). In multivariate logistic regression, YBMSM in Project nGage were 3.01 times more likely than control YBMSM to have had at least 3 clinic visits over 12 months (95% CI: 1.0-7.3). Study results suggest that engaging specific members of existing social support networks can improve retention in care for HIV+ YBMSM. We adapted nGage and are now conducting a pilot RCT of Project WERK (Wellness, Encouragement, Respect and Kinship) to improve engagement in PrEP care for N=160 HIV- YBMSM aged 18-35. Early results suggest that HIV- YBMSM face significant hardships and have high rates of depression (30%) and anxiety (25%). Information on how to harness social networks to address these issues in community programs serving YBMSM will be discussed. 

Presenter

Alida Bouris, PhD, University of Chicago Chicago, IL 
United States

Development, Long-Term Treatment Effects, and Scaling of Two HIV Prevention Interventions for High-Risk Urban Youth

The Center for Dissemination and Implementation Science at UIC seeks to evaluate the processes that promote or inhibit the adoption of evidence-based and empirically supported interventions in real-life settings. This presentation will describe two HIV prevention interventions developed in the Center for high-risk urban youth, one delivered to juvenile offenders on probation and the other to low-income African-American teenage girls and their mothers. The development of each program will be detailed, including theoretical foundations and logistical considerations. The samples will be described in terms of mental health and co-occurring behavioral concerns, particularly internalizing and externalizing symptoms, and sexual risk taking behaviors. The long-term effects of the interventions on mental health and risk behavior outcomes at 6- and 12-month follow-up will be presented. The panel will conclude with discussion of future directions for expanding delivery of each intervention, with particular consideration of factors related to scalability and sustainability. 

Presenter

Ashley D. Kendall, PhD, University of Illinois at Chicago Chicago, IL 
United States