The goal of Community Psychiatry PRIDE is to increase the access to and quality of mental health care in community-based agencies across Massachusetts, by conducting research that explores the disproportionate mental health burden in underserved communities. Community Psychiatry PRIDE is located in Chelsea, MA. Chelsea is one of the most densely populated cities in Massachusetts, with nearly a quarter of its 39,000 residents living in poverty. According to the Boston Globe article “As Chelsea begins to blossom, struggles remain”, as of 2015, there were 138 drug-related arrests and 45 overdoses in Bellingham Square district alone. As Chelsea struggles with crime, violence, and poverty, mental health is subsequently a concerning problem. Due to the limited financial and human resources, adequate and effective health care is often not provided to these communities in need.
Cognitive Behavioral Therapies (CBT) have been proven to be effective for a wide variety of psychiatric diagnoses, and have been used as a first-line treatment for a variety of mood and anxiety disorders. It is important to monitor treatment quality and make sure the treatment is delivered as intended. Some studies suggest that many providers do not implement CBT with fidelity. In fact, assessing fidelity on large scale has been a major challenge in implementation science. Through one project specifically–imAPP leveraging routine clinical materials and mobile technology to assess CBT quality–Community Psychiatry PRIDE aims to relieve the mental health burden in resource-constrained communities by developing a novel instrument to evaluate and improve the quality of CBT for anxiety, depression, and Post-Traumatic Stress Disorder (PTSD).
As a research assistant, I have been working on processing, storing, and tracking data for this project. Following data from weekly therapy session over three months, I have noticed how providers are getting familiar with this evidence-based treatment. Providers are continuously getting better at sticking to the manual protocol and incorporating CBT worksheets into therapy. It is also noticeable how patients benefit in terms of symptom improvements from the process. This study uses the Post-traumatic Stress Disorder Checklist-Specific (PCL-5) to assess PTSD symptoms. With the total scores ranging from 0-80, the DSM-V defined cutoff score for PTSD is 33. As I processed data from early therapy sessions (i.e., protocol sessions 1 and 2), many of the patients scored over 60. The noticeable high scores of the PCL-5 within this sample demonstrates the mental health burden caused by the high rates of trauma in community settings. Patients reported seeing loved die in tragic accidents, sexual abuse, seeing a loved one overdose, being bullied, and being victims of physical assault. Through the therapy sessions, these patients’ PCL-5 scores decreased. Some patients even reported to score less than 10 at the end of the treatment!
Besides working with hard copy data, I also processed, stored, and tracked data from Qualtrics, a secure App for data collection. Other than the exciting progress mentioned above, there were problems that drew our attention. Some providers randomized to App group were not using Qualtrics to input data at all, and when they were using Qualtrics, they sometimes did not use the App in the right way. This led to having some problematic data that needed additional steps to be fixed. This data included data that had incorrect patient ID and incomplete worksheets. This problem showed that there were multiple barriers to incorporate technology into treatment in community settings.
Another problem that we came across was the length of treatment. The treatment protocol was intended to be delivered in 12 therapy sessions, but many patients went beyond 12 sessions. The repetition of session could mean that patients did not always show up in their session, or patients were not understanding the materials. This study is bringing attention to these situations that are specific to community settings.
As for my tasks for the imAPP study, properly organizing data avoided measurement errors and ensured future analyses to be accurate, thus correctly representing the community. Maintaining datasets helped continue the relationship between research based groups and community partners. When I tracked data, I monitored where each patient was at, thus helping the research team to keep their promise of payment for participants, prepare and deliver the next materials that providers needed, and schedule post-treatment interviews.
Another task I did earlier in this internship was printing and organizing Cognitive Processing Therapy (CPT) binders. In terms of organizing binders, useful information was extracted from the manual and I helped organize and print materials with different colors. This task facilitated providers to use CPT as we made it easier for providers to use CPT materials with their patients, and know what materials needed to be returned to the research staff. By providing materials to providers and strengthening the relationship between the research team and providers, I helped take steps towards decreasing the practice and research gap in the field of clinical psychology.
There are countless small steps building up to the high-end purpose of a study. Following along the process of one project has helped me to see how I had contributed to the whole process through small but meaningful efforts.
-Bingyu Xu ’19