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Welcome to the
Institute for
Community Health's
Winter 2012/2013 Newsletter: Spotlight on Behavioral Health
Today, the integration of physical and mental health is a priority for the evolving health care system, and models are being piloted across the country to address these needs. With recent events such as the tragedy in Newtown, CT, this work becomes even more important. At the Institute for Community Health (ICH), we are proud to be contributing to the national dialogue on behavioral health and supporting our community partners in evaluating and addressing this complex public health issue.
This edition of our newsletter highlights our behavioral health work with diverse communities throughout Massachusetts. We are featuring several ICH projects and partnerships focused on this area, including Asian immigrant mental health needs, behavioral health and primary care integration at community health centers, and youth mental health.
Understanding and addressing mental health in vulnerable, diverse populations represents an important national challenge. Working collaboratively with our community partners, ICH has used innovative and progressive approaches to study, evaluate, and develop potential strategies to prevent and address behavioral health issues. With over a decade of success behind us and 2013 now underway, we reflect on our successes and challenges and look forward to another year of building sustainable community health, together.
Karen Hacker, MD, MPH
Executive Director,
Institute for Community Health
Associate Professor of Medicine,
Harvard Medical School
Associate Professor of Social and Behavioral Sciences, Harvard School of Public Health |
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Addressing Child Mental Health through Integration: ICH's Multidisciplinary Approach
Child behavioral and mental health represents a critical public health issue, with over four million children in the U.S suffering from mental disorders serious enough to impair functioning (National Alliance on Mental Illness). Untreated, child and adolescent mental health disorders can lead to many serious health and social consequences, ranging from poor school performance to criminal justice involvement and suicide.
Improving child mental health care depends in part on adequate identification. Today, it is evident that identification of children with mental health needs can be enhanced through improved screening for mental health in primary care settings (Hacker, et al, 2011). Behavioral health screening has been mandated for Massachusetts' Medicaid patients since the landmark Rosie D vs. Patrick remedy went into effect in 2008. However, studies suggest that even among children who are identified with mental health disorders, linking them to mental health services still presents a huge challenge.
Integration of mental health services into primary care settings - including strategies such as screening for mental health in pediatrics and co-locating mental health clinicians in the pediatric office - may offer value in promoting improved mental health care.
ICH Executive Director Karen Hacker, MD, MPH has a long history of work in this area. "We started doing this work way back in 2003, and we've had a sequential number of grants that have involved a lot of community partners. We have tried to implement integration and also think about other strategies for improving the mental health of children," says Hacker. Read on... |
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Dimock Integrates Pediatric, Mental Health Care
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Pictured: Dr. Nandini Sengupta and Rachel Bowers
Photo courtesy of The Dimock Center |
When it comes to improving mental health outcomes for children and adolescents, ICH and The Dimock Center - a community health center in Roxbury, Massachusetts - share a belief in the power of integrating mental health care into pediatrics to promote easier access to mental health services for families. In 2011, as part of The Dimock Center's Patient Centered Medical Home (PCMH) initiative, the center piloted the Behavioral Health-Pediatrics Integrated Program (BHPIP): an integrated, multi-disciplinary model of care delivery where mental health clinicians are co-located in pediatric clinics. BHPIP facilitates dialogue between primary care and mental health providers by having them share the same space, and this co-location has created a setting where mental health referrals can be made and completed with less hassle to the patient and barriers to care can be reduced.
To evaluate this program, the Dimock Center has partnered with ICH researcher Shalini Tendulkar, ScM, ScD, with support from the Harvard Catalyst Community Health Innovation and Research Program (HC-CHRP). Tendulkar has drawn upon ICH's expertise around mental health and primary care integration, adapting qualitative research tools from a similar study with pediatricians at the Cambridge Health Alliance to obtain the perspective of pediatric primary care and mental health providers at Dimock.
"[Interview] questions ranged from how the referrals are working to whether the physicians would be comfortable implementing a mental health intervention in their primary care visit with a patient," Tendulkar said. Read on...
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Defining Empowerment Amongst Asian Domestic Violence Survivors
In the Asian immigrant community, domestic violence represents an important public health problem, with unique challenges related to cultural and family norms, language barriers, and lack of access to resources for families. However, Asian communities are still often underrepresented in domestic violence research, and many gaps exist in understanding how to best serve and empower survivors.
"Programs are developed [for domestic violence survivors] without really asking the clients what empowerment actually means to them," said researcher Jocelyn Chu, ScD, MPH, formerly at the Institute for Community Health. Starting the empowerment conversation with Asian survivors themselves, on the other hand, can help fill gaps and make programs more culturally competent.
With seed funding from the Tufts Community Research Center (TCRC), Chu and her colleague Dr. Carolyn Rubin at Tufts have been able to explore the idea of empowerment with Asian domestic violence survivors through a continued partnership with the Boston-based Asian Task Force Against Domestic Violence (ATASK). Driven by an empowerment-focused mission, ATASK serves domestic violence survivors and their families in the New England region Asian community in a culturally and linguistically competent manner. This collaboration grew out of the Tufts Clinical and Translational Science Institute (CTSI) training program Building Your Capacity: Advancing Research Through Community Engagement, through which ICH has been working with ATASK staff on developing their research capacity. Read on...
Pictured (L to R): Dr. Jocelyn Chu, Parul Kapoor, Dr. Carolyn Rubin, Sujata Ghosh, Purnima Sahgal, and Dawn Sauma
Photo courtesy of ATASK |
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Bridging the Culture Divides in Malden: The East Meets West Program
For immigrants, the process of settling in a new country can be an isolating experience. New immigrants typically face many challenges related to acculturation, including difficulty accessing local resources, changing family dynamics, and other stresses associated with navigating how to weave together different cultural ideals while adopting local cultural practices.
These challenges are among those faced by the growing Asian immigrant population in Malden, Massachusetts, a diverse and rapidly changing urban community north of Boston. To help bridge cultural gaps and ease the stress of acculturation for immigrant families, the Chinese Culture Connection (CCC) in Malden has created East Meets West, a program to support Malden's Asian immigrant community in gaining the skills and cultural understanding needed to adapt to their new environments and create positive bi-cultural identities. The program consists of workshops for immigrant families and a newer mentoring program for youth in the Malden Public Schools.
East Meets West has been funded by the Adelaide Breed Bayrd Foundation for nearly half a decade. ICH provides evaluative expertise to this project, helping to track program progress and learn about effects on participants. Read on... |
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Communicating Mental Health Through Art in Malden: The Youth "PhotoVoice" Project
In 2008, community and academic partners in Malden, Massachusetts completed a needs assessment to better understand the health and health needs of Asian immigrants in an urban community. Mental health arose as an area of concern among the city's growing Chinese and Vietnamese populations. However, according to Institute for Community Health (ICH) researcher Shalini Tendulkar, ScM, ScD, mental health is a sensitive topic in immigrant communities in general and not well understood in Asian American communities. In response to this community needs assessment, Dr. Tendulkar and Dr. Jocelyn Chu, formerly of the Institute for Community Health and now a consultant at John Snow, Inc sought to deconstruct the concept of mental health, from the perspective of young people in Asian communities with a grant from the Saffron Circle Fund.
"In Asian American communities - where there are few words to capture what mental health is - how can the idea of mental health be teased out? And how is it understood among Asian youth?" asked Chu.
Building on ICH's existing partnerships with the Malden Chinese Culture Connection (CCC) on both the 2008 needs assessment and the East Meets West project to ease acculturation stress amongst immigrant families, ICH, Chu, CCC, and the Asian American Civic Association (AACA) - an ICH Boston community partner - embarked on a collaboration with Asian youth in Malden and Boston to carry out a mental health "photovoice" project. "Photovoice" is a participatory, action-oriented methodology that involves training community members to express their ideas and generate discussion through photographs, and will be used to mobilize Asian youth in Malden and Boston to communicate their perceptions of mental health. Read on... |
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Through our varied community health partnerships and projects, ICH is committed to remaining at the forefront of the national behavioral health agenda. We hope that this newsletter issue has provided you with insight into our work around behavioral health.
The prevalence of mental health issues remains high nationally and in our area. Data from a local Five-City Behavioral Risk Factor Surveillance System (BRFSS), coordinated by ICH, showed that 4% of adults self-reported being depressed all or most of the time and 24% were depressed some or a little of the time. 14% of the adults felt that emotions kept them from work for between 1 to 30 days in the previous month, and, 14% were taking medicine or receiving treatment from a health professional for a mental health/emotional problem. These numbers show the prevalence and impact of mental health issues in this area. ICH is committed to improving mental health in communities using funding from grants, contracts, and our hospital underwriters.
As part of our ongoing effort to share our work and successes with partners and supporters, we invite you to visit our new website, follow us on Twitter (@icommhealth) and "like" our business page on Facebook to promote ICH's work in the community and among public health stakeholders.
We thank you for your continued support and wish all of our partners a happy and healthy new year!
Lise Fried, DSc, MS
Interim Managing Director, Institute for Community Health
Instructor in Medicine, Harvard Medical School |
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Our Vision
The Institute for Community Health is a nationally recognized catalyst for sustainable community health improvement, uniting real world practice with academic research.
Our Mission
The Institute for Community Health utilizes participatory research and evaluation approaches to generate and disseminate knowledge about public health issues affecting communities. Core to ICH's approach is the development of long-term partnerships, a commitment to co-learning and capacity building, and a deep appreciation for the diverse experiences, perspectives, values and resources that partners contribute to community health improvement.
Our Values
The values of our organization are aligned with many of the principles that are foundational to community-based participatory research:
- Our work builds on the strengths and resources within the community;
- A belief in the power of collaborative and equitable partnerships in all phases of a research or evaluation project;
- A commitment to co-learning and capacity building for all partners;
- Valuing the diversity of experience, perspective and skill sets that partners contribute;
- Balance research and action for the mutual benefit of all partners;
- Shared generation of knowledge can lead to community health improvement.
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ICH Social Media Corner
The new ICH website has been up and running for almost six months! In that time we've been able to expand our social media presence and increase our visibility to better connect with colleagues and partners like you:
We invite you to check in regularly for project updates, news and blog posts on how we are working towards Building Sustainable Community Health, Together! We also welcome your feedback on how we can better connect with you. |
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ICH Board Member Profile:
Derri Shtasel, MD, MPH
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Photo ©2012 Bill Truslow,
Courtesy of Derri Shtasel |
Derri Shtasel, MD, MPH is the Executive Director of the Kraft Family National Center for Leadership and Training in Community Health, Director of the Division of Public and Community Psychiatry at the Massachusetts General Hospital, and an Associate Professor of Psychiatry at the Harvard Medical School. She has dedicated her psychiatric career to providing direct clinical care for underserved and marginalized patients, teaching medical students and psychiatry residents, providing clinical, administrative and educational leadership at academic institutions, and creating academic-community collaborations as a platform for integrated service delivery models.
A graduate of Swarthmore College, Dr. Shtasel completed her medical training at Temple University School of Medicine and residency training at New York University/Bellevue where she served as Chief Resident in Psychiatry. In addition, she completed a Masters in Public Health degree at the Harvard School of Public Health. Read on... |
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Asian Mental Health Forum
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Forum Planning Committee Pictured (L to R): Niem Nay-kret, Dr. Ed Wang, Dr. Shalini Tendulkar, Dr. Carolyn Leung, Chien-Chi Huang, Dr. Jocelyn Chu, Dr. DJ Ida, Latifa Hasan, Henry Thien. (Missing Dr. Pata Suyemoto.)
Photo courtesy of the Asian Mental Health Forum |
In June of this year, Massachusetts-based community researchers, care providers, and advocates came together for the third annual Asian American and Pacific Islander Mental Health Forum. ICH researcher Shalini Tendulkar, ScD, ScM and former ICH researcher Jocelyn Chu, ScD, MPH, both of whom have expertise in the area of Asian mental health, participated on the planning committee for this event.
The topic of this year's forum was "Fostering Healthy Minds in Children and Families," which sought to address mental health issues such as post-partum depression, depression in the youth, and maternal and paternal depression in the Asian American and Pacific Islander (AAPI) population of the Dorchester neighborhood in Boston.
These forums have been held in communities where mental health concerns are prevalent in the population, and aim to bring together mental health practitioners, educators, public health organizations, policy makers, researchers, educators, and the community to talk about mental health and address the silence and stigma surrounding the issue.
Read on... |
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Mental Health Data Corner
The Youth Risk Behavior Survey (YRBS) monitors health-risk behaviors that contribute to the leading causes of death and disability among youth. Check out these compelling statistics on mental health from the 2011 YRBS the past few months.
In the past 12 months, among MA high school students:
48% reported feeling the need to talk to someone other than family about their feelings. Many students reported seeking help from a variety of resources, including school counselors, outside therapists, nurses, youth workers, and religious leaders.
Data Source: MA Youth Risk Behavior Survey (YRBS), MA Department of Elementary and Secondary Education, MDPH, 2011
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ICH Staff Updates
ICH would also like to thank former staff members Susan Choi, PhD; Jocelyn Chu, ScD, MPH; Rodela Khan, MPH; Brianna Mills, MA; and Ffyona Patel, BA, who have departed ICH in the last few months to pursue further graduate schooling, move to another area, or persue other employment opportunities. You are all wished the best!
ICH Conference Presentations
ICH staff have been busy presenting on topics such as how to develop a participatory evaluation and how to use data at partner organization conferences and workshops over the last few months, including the YEAH! Network Conference in September 2012 and the 2012 Massachusetts Alliance On Teen Pregnancy Institute.
Seven ICH staffers - Karen Hacker, MD, MPH; Shalini Tendulkar, ScD, ScM; Lisa Arsenault, PhD; Nazmim Bhuiya, MPH; Jae Goines, BS; Justeen Hyde, PhD; and Julie Carpineto, MFA - also attended the 2012 APHA Annual Meeting in San Francisco to present on ICH's work in:
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Institute for Community Health
163 Gore Street
Cambridge MA
(617) 499-6677
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Special thanks to the ICH Dissemination and Visibility Committee - particularly Tufts University graduate intern Brianna Lieberman and Research Associate Adriana Bearse, MS - for writing, editing and producing this newsletter.
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