The Global Mental Health Council Grants Program is an initiative of the Council for the Advancement of Global Mental Health Research to fund new investigators and new ideas in global mental health.
Below are summaries written by scholars and awardees of our first class of Council Grant Recipients, during the 2019-2020 school year.
Catherine Carlson, PhD, MSW; Laura Cordisco Tsai, PhD, MSSW; and Milton Wainberg, MD: Cultural adaptation of Safety Planning Intervention for survivors of human trafficking in the Philippines
Survivors of human trafficking experience elevated suicide risk in comparison to the general population. Anti-trafficking service providers in the Philippines have identified capacity building in suicide prevention as a critical priority for the sector given the insufficient number of trained mental health professionals and lack of culturally adapted evidence-based interventions in the Philippines. In this project, we will develop a culturally informed adaptation of Safety Planning Intervention (SPI) and training service providers within a trafficking-specific economic empowerment program in the Philippines on implementation of the culturally-adapted intervention. Lessons learned in the cultural adaptation, capacity building, and piloting process will be shared with other anti-trafficking organizations in the Philippines to strengthen the capacity of local systems. The project will inform the development of a subsequent R21 proposal to NIMH to pilot the effectiveness and implementation SPI with trafficking survivors in the Philippines.
We aim to: 1) develop a culturally-informed adaptation of Safety Planning Intervention (SPI) within an economic empowerment program for Filipino survivors of human trafficking; 2) build human resource capacity for suicide prevention within an economic empowerment program; and 3) pilot for acceptability and feasibility SPI for suicide prevention for Filipino trafficking survivors within an economic empowerment program.
Spring 2020/COVID-19 Update: Since the February meeting, we were able to complete our qualitative focus group discussions (FGDs) with staff and partners. The FGDs were transcribed and we are currently analyzing the qualitative data. We convened our first Working Group meeting to begin the process of the cultural adaptation of the Safety Planning Intervention, which will continue to occur over the next few months. We were fortunate to be in a phase of the project that does not require any face-to-face or participant engagement. Staff from our partner organization, 10 Thousand Windows, are facing significant challenges in trying to respond to the COVID 19 crises affecting their clients in the Philippines. However, they also continue to be dedicated to this study and work remains on track for now.
End of Year Summary: We completed the culturally-informed adaptation of SPI for survivors of human trafficking in the Philippines. Following this adaptation, we trained 100% of staff at the implementing partner organization in the new suicide prevention and intervention protocol, shifting our training model to a 5-month virtual training program due to the covid-19 pandemic. Our partner organization in the Philippines has begun piloting the new suicide protocol with human trafficking survivors. During the pilot, we have seen declines in suicidal risk levels for 95% of survivors. We are currently preparing a series of research publications and disseminating findings with other service providers in the anti-human trafficking movement to draw greater attention to suicidality among survivors of human trafficking and the urgent need for training in evidence-based interventions in the anti-trafficking sector.
Roberto Lewis Fernandez, MD and Manuela Orjuela-Grimm, MD, ScM: Coping with distress in a new context: self-coping and community resource utilization among migrant teens in the United States
Exposure to violence and hunger during the critical late-adolescent period of development (ages 15-19) can have a lasting impact on mental and physical health. Teens migrating without a parent are frequently exposed to violence and hunger, and European studies show that such youth have elevated risk of PTSD, depression, generalized anxiety, and substance use disorders. However, post-migration protective factors such as use of community resources (sports clubs, church youth groups) that facilitate self-coping strategies (e.g., playing soccer together, praying) appear to be key contributors to their mental health trajectory. Our novel pilot study, CAMINANDO, has recruited 42 such teens in partnership with community organizations in NYC and found that increased exposure to violence is associated with higher symptoms of PTSD, generalized anxiety, and depression and increased exposure to hunger is associated with higher symptoms of generalized anxiety. In preparation for our proposed longitudinal R01 (CAMINANDO-Mental Health [MH]) to further examine the impact of exposure to hunger and violence on the mental health of teen migrants, we will adapt an instrument developed for internally displaced Colombian youth for use in our study population in NYC. We propose a two-stage, mixed-methods approach that will result in a tool to assess utilization of community resources and self-coping strategies pre and post-US arrival in a group of 50 teens who migrated from Latin America without a parent.
Our goals are to: a) inform a larger longitudinal study examining potential post-migration protective factors and b) provide a tool that can be used to measure resource utilization and self-coping in the large number of Latin American migrant teens currently resettled in the US.
Spring 2020/COVID-19 Update: We have been able to launch our study with virtual assessments. We have been able to work efficiently thanks to Zoom. So far we have interviewed 3 youth for our instrument piloting after an initial adaptation and translation of the instruments. Our international advisors (Germany, Denmark, Colombia) are also grounded and so communication was actually faster than at other moments….in a bit of silver lining. We don’t know how long our good luck streak will continue, but we have actually been able to focus the study team’s energies on getting this pilot off the ground over the last almost month.
End of Year Summary: Our project launched just as the pandemic closed down in-person research. Our study had been designed to adapt and pilot two survey instruments (one from Colombia on internally displaced youth, and one from Germany with Syrian/Afghan migrant teens) using a two-phase (in-person) design. Fortunately, we were able to modify our project to occur by phone with occasional video calls, and we were able to interview 22 youth with the more challenging Colombian instrument, and 30 youth with the shorter and simpler instrument German instrument. Unfortunately, the costs of carrying out our work have been much higher because of the drawn out time period due to COVID. Despite this, the GMH Council Grant has been critical for permitting us to adapt these instruments. We were able to use pilot data to support an NIH grant submission and to justify creating a working group which was awarded a (very) small seed grant from Columbia’s Institute of Latin American Studies. We added a component of capturing the impact of the pandemic on our youth participants, and we were able to present qualitative findings in an international virtual meeting on migration. The Council Grant has allowed us to consider including mental health in a more integrative vision of migrant health and has enabled the formation of an MPI partnership with an established mental health researcher.
Tsion Firew, MD; Claire Greene, PhD, MPH; and Milton Wainberg, MD: Developing a screening and referral system for mental health problems among internally displaced persons in Ethiopia
Ethiopia is experiencing unprecedented levels of internal displacement countrywide. The Ethiopian Ministry of Health has identified mental health as a priority concern among internally displaced persons (IDPs). During the IDP crisis, the Ethiopian government and humanitarian agencies have invested in training non-specialists to deliver mental health services, but the implementation and availability of mental health care in these communities has not been systematically monitored. The proposed research aims to identify existing resources for mental health in IDP communities and develop a referral system to link IDPs with mental health problems to services. This research is timely given the planned national mental health assessment of IDPs in Ethiopia, which will require a protocol for these referrals.
The overall objective of this study is to assess existing resources for mental health services in order to develop and monitor a feasible screening and referral system for mental health problems among IDPs and returnees in Ethiopia. Specifically, we aim to: 1) Assess the formal mental health resources available to IDPs and returnees in Ethiopia; 2) Develop and evaluate the feasibility of implementing a screening and referral system for IDPs and returnees with mental health problems; and 3)Monitor the implementation and completion of referrals to mental health services among IDPs and returnees who participate in the national mental health assessment.
Spring 2020/COVID-19 Update: Currently all field activities in Ethiopia are on hold. Our partners are employed by the Public Health Emergency Management Directorate, which is the directorate responsible for emergency response within the Ethiopian Public Health Institute and Ministry of Health. They are currently focused on responding to COVID-19 and do not have the capacity to hire staff to dedicate to our project at this time. They are still committed to achieving the objectives of our small grants project but expect some delays in moving that forward. We are working with two MPH students to finalize any remote activities we have outstanding and to brainstorm ways to conduct interviews with practitioners remotely through our relationships with NGOs providing support to internally displaced persons (IDPs) in our project areas. We have also been considering integrating some questions into our key informant interviews about how COVID-19 has impacted psychosocial health and service delivery in IDP sites. We are mindful of the current demands on our partners and will see what is possible in the short-term to further our progress toward meeting the project objectives. Any activities that cannot be accomplished remotely will resume once we are cleared to conduct field-based research in Ethiopia.
End of Year Summary: We have completed 16 in-depth interviews with mental health providers and humanitarian practitioners supporting displaced persons in Ethiopia. This research has revealed critical challenges to mental health service delivery and promising strategies for increasing access to mental health care for emergency-affected populations in Ethiopia. We are so appreciative of this pilot award, which has strengthened our partnership with local researchers, practitioners, and policymakers, and has provided key insights and preliminary data that we may use to apply for funding to evaluate some of the strategies we have identified for improving access to mental health care in Ethiopia.
Franco Mascayano, PhD Student; Ezra Susser, MD, DrPH; and Lisa Dixon, MD, MPH: Early Psychosis Identification Program in Chile
In the absence of early intervention, psychotic disorders tend to become long-term disabling conditions. The shorter the duration of untreated psychosis (DUP), the greater the improvements of short and long-term clinical and functional outcomes. Given that approximately half of DUP may occur after health services are initiated, we suggest that a focus on enhancing health services once help-seekers come into contact with providers may be required. This approach is of particular relevance for Chile, where over 70% of the population receive health and mental health care via the health public system. Accordingly, we propose to develop an Early Psychosis Identification (EPI) package comprising outreach and engagement strategies to improve early psychosis identification based on the analysis of the gaps and bottlenecks in existing referral pathways within health services in Chile. We will use a Group Model Building approach, which is a system dynamics-based method that has been used to guide the adaption and implementation of evidence-based practices in varying health settings. Our approach will entail engaging key stakeholders in identifying causal loop diagrams (including variables, relationships, and feedback) that represent the main factors affecting the identification of early psychosis in health services, in order to inform the development and implementation of the EPI package.
Our specific aims are to: 1) Improve our understanding of the gaps and bottlenecks for identification and referral of early psychosis within health services in Chile. 2) Use this understanding to inform the design of the EPI package to improve early identification and engagement. 3) Create a preliminary version of the EPI package to be disseminated and discussed among stakeholders in Chile and other Latin American countries. 4) Develop a grant application aimed at studying the implementation and effectiveness of the EPI package.
Spring 2020/COVID-19 Update: We have conducted 3 out of 4 of the planned workshops for this study. The research team is now analyzing the qualitative data obtained in those workshops and polishing the initial model regarding pathways to care for individuals with early psychosis within the health system in Chile. We have already identified some potential areas for intervention (e.g., bottlenecks) and started to draft a preliminary version of the Early Psychosis identification (EPI) program. In terms of next steps, we will arrange a round of Zoom calls with the participating stakeholders in order to discuss our findings, refine our model further, and consolidate a draft of the EPI program to be disseminated later. A first report describing these procedures and findings is in development.
End of Year Summary: We have completed the second wave of workshops with stakeholders (via Zoom) and the data analysis is almost complete. We have two in-progress papers: 1) a qualitative analysis of the barriers and facilitators for the identification of individuals with FEP in Chile and targets for intervention; and 2) an historical, anthropology-based analysis of the Chilean approach for FEP identification in the context of 30 years of mental health reforms in Latin America.