Monday, Nov. 3, 2014
For low-income women in Central Virginia, debilitating cultural, economic and biological factors can accumulate rapidly after they become mothers.
In addition to barriers in health care and daily experiences with poverty, stress, sadness and loss, these mothers fear and face a perpetual stigma of being labeled “bad mothers” based on the situations they experience, all of which lead to a sense of normalcy in daily depression.
These are descriptions, words and themes gathered directly from low-income mothers during 2008 focus groups and in-depth face-to-face interviews, which were part of team-based research that has resulted in improved care for the mothers.
Their thoughts, compiled by Virginia Commonwealth University researchers, confirmed the pervasive presence of depression among low-income Central Virginia mothers that Amy Strite and her colleagues already suspected.
Strite is executive director of Family Lifeline, a nonprofit 501(c)(3) organization in Richmond that works alongside parents in homes to make sure children and families are healthy. The women interviewed by VCU researchers were participants in one of Family Lifeline’s programs, which at the time was sending a community health nurse and an outreach worker to participants’ homes at least two times per month.
“We knew in Richmond that there wasn’t the mental health support for these women, particularly if they were experiencing mild to moderate depression, postpartum depression or what we now refer to as toxic stress,” Strite said.
Based on this knowledge, a partnership materialized between Strite and Sarah Kye Price, Ph.D., an associate professor at the VCU School of Social Work.
“Sarah worked with us to set up a protocol that really changed how we assess and treat women, primarily those with the disorders I mentioned,” Strite said.
A main aspect of the new protocol was the addition of a social worker to each Family Lifeline team. Another was the creation of four treatment modules from which participants could choose, thus empowering them to take charge of their own care.
“The protocol is the concrete takeaway and is very important, but equally important is that Sarah was with us during an evolutionary period in the organization,” Strite said. “Culturally we were having to really take a hard look at how staff viewed mental health support period.”
In response to this shift, Price and her team interviewed individual Family Lifeline staff in addition to the mothers being served by the organization.
If we are healthy in all areas of our lives, we can take care of ourselves, take care of our children and plan for the future.
Themes that emerged from these interviews showed that service providers understood the economic situation of the women they served and the barriers they faced in accessing mental health services, but that the service providers also felt uncomfortable or unqualified to speak directly about depression with those they served.
“And so she walked with us through a phase where we worked with staff to change thinking and care, which then meant that women were receiving better care overall,” Strite said. “If we are healthy in all areas of our lives, we can take care of ourselves, take care of our children and plan for the future.”
Service providers were empowered with increased awareness, comfort and confidence in addressing issues and with a better understanding of mental health.
“Ultimately, individuals were assessed and treated in a more timely fashion,” Strite said.
By taking a team-based approach that included university researchers, practitioners and patients, Price and Strite were able to achieve academic success (publications, funding support and development of a research infrastructure) as well as community success (increased understanding of service needs, improved maternal and child health services, and training and skill development for staff).
A leader in CEnR
The partnership described between VCU and Family Lifeline is an example of community-engaged research (CEnR), a type of research that holds the goal of contributing to both academic disciplines and the community by incorporating input from all stakeholders.
The Family Lifeline story is one of nine case studies included in the “Excellence in Community-Engaged Research at Virginia Commonwealth University: A Compendium of Case Studies Developed Through a Faculty Learning Community” report, a collection of exemplary CEnR projects created to inform VCU and the higher education community about excellence in CEnR.
To create the collection, VCU’s Division of Community Engagement and the Center for Clinical and Translational Research enlisted the help of nine faculty members who have engaged in research projects that intentionally connect the campus and community. The members represented a wide range of disciplines, including education, social work, arts, public health, cancer prevention and control, psychology, family medicine, nutritional science and human and molecular genetics.
Their interdisciplinary work is appropriate to serve as an example for researchers across the country because of the emphasis VCU places on CEnR. VCU has earned Research University, Very High Research Activity status and the Community Engagement classification from the Carnegie Foundation and is one of only 28 national public research universities with an academic medical center to hold both distinctions.
Valerie Holton, Ph.D., is director of community-engaged research in the Division of Community Engagement. She facilitated the faculty group in order to gain a universitywide perspective on CEnR at VCU.
“This is a really broad approach to research, so how do we know what it means to be great at it?” she said. “That’s why we brought together this group of faculty members to explore what excellence at VCU looks like.”
One of the case studies in the collection illustrates a partnership that promotes a Petersburg community’s overall health and well-being by increasing understanding of service needs. It involved input from VCU faculty, staff and students; Pathways of Petersburg; Wellness Ambassadors and other local community residents; Community Health Leadership Council comprised of local stakeholders and partners including government, faith-based, nonprofit, community organizations and health care providers.
Another case study focused on a project that provided an understanding of how jazz musicians are motivated to create music as a message for positive change. Partners included VCU Jazz Studies and the University of KwaZulu-Natal’s Centre for Jazz and Popular Music. Findings included “an increased understanding among partners regarding the depth of cultural influence on the creation and performance of music” and an understanding of “the critical importance of having a voice in one’s community and in knowing the risks associated with expressing that voice.”
Yet another focused on a partnership between the VCU Departments of Psychology and Psychiatry, the Clark-Hill Institute for Positive Youth Development, the City of Richmond Office of Multicultural Affairs, Richmond Behavioral Health Authority and Richmond’s Latino community to identify health concerns and service needs related to Latino youth living in Richmond.
Much of the highlighted research uses community-based participatory research as a model, including Price’s.
“[Community-based participatory research] emphasizes public health problems of local relevance and promotes taking an ecological perspective to attend to the multiple determinates of health,” Price writes in her case study. It’s an appropriate model to use if “the project goals require community and academic partners to exchange local and scientific expertise to address community needs and issues.”
“When we involve stakeholders in the development of our research, particularly the research question, we absolutely end up with information that is relevant to the stakeholders,” Holton said. “And that enhances the likelihood that information can be used to change or improve the way things are being done and/or the well-being of people.”
A full copy of “Excellence in Community-Engaged Research at Virginia Commonwealth University: A Compendium of Case Studies Developed Through a Faculty Learning Community” can be found at http://www.community.vcu.edu/about/reports/
Since 2013, when Price’s research with Family Lifeline ended, she has taken her findings and community-engaged technique to the state level.
“One of the things we learned from our partnership with Family Lifeline was that we didn’t have a good way in Virginia of assessing women for depression and behavioral health during their pregnancy,” she said. “So now we’ve sought funding and doing a state-level intervention to move toward a consistent means of screening to see what the levels are of depression, substance abuse and interpersonal violence.”
When that process is complete, Price and her team will work with community partners across Virginia to replicate the models they’ve created in earlier research.
The CEnR process is more time consuming than traditional research, but Price said that’s OK with her.
“It takes longer, but it’s more worthwhile because the transformation is happening at the same time as the research endeavor,” she said. “We’re co-creating change and practice in the policy landscape at the same time as we garner research.”
Community-engaged research faculty learning community members
· Rosalie Corona, Ph.D., associate professor, Department of Psychology, College of Humanities and Sciences
· Rebecca Etz, Ph.D., assistant professor, Department of Family Medicine and Population Health, School of Medicine
· Antonio Garcia, director of jazz studies, associate professor, Department of Music, School of the Arts
· Valerie Holton, Ph.D., FLC facilitator and director of community-engaged research, Division of Community Engagement
· Maghboeba Mosavel, Ph.D., associate professor, Department of Social and Behavioral Health, School of Medicine
· Sarah Kye Price, Ph.D., Ph.D. program director and associate professor, School of Social Work
· Elizabeth Prom-Wormley, Ph.D., assistant professor, Division of Epidemiology, Department of Family Medicine and Population Health, School of Medicine
· Carlin Rafie, Ph.D., clinical research affiliation coordinator, VCU Massey Cancer Center
· Deborah Speece, Ph.D., professor and associate dean of research, School of Education
Subscribe for free to the weekly VCU News email newsletter at http://newsletter.news.vcu.edu/ and receive a selection of stories, videos, photos, news clips and event listings in your inbox every Thursday. VCU students, faculty and staff automatically receive the newsletter. To learn more about research taking place at VCU, subscribe to its research blog, Across the Spectrum at http://www.spectrum.vcu.edu/